摘要：Objectives. This study describes the relationship between dental needs and dental care utilization among children. Methods. Data from the third National Health and Nutrition Examination Survey (1988-1994) were used to analyze dental care needs and dental care utilization. Results. Younger children with perceived needs (needs perceived by the child or responsible adult) were more likely to be episodic users of dental care than children without perceived needs. Younger children with normative needs (defined by the presence of untreated caries diagnosed by a dentist) were less likely to be regular users. Older children with perceived or normative needs were more likely to be episodic users and less likely to have had a previous-year visit than children with no needs. Conclusions. Despite their presence, dental needs do not drive dental care use among children, and children’s dental care utilization is inadequate. The main theme of the public health objectives described in Healthy People 2010 is the reduction of health disparities. 1 This goal responds to research that demonstrates persistent disparities in various health outcomes and health care access in terms of both race/ethnicity and socioeconomic status (SES). Disparities in oral health status and dental care access among children have particular health services and epidemiological significance: there is underutilization of oral health care services among children of all ages, and caries is the most prevalent non–self-limiting disease of childhood. 2 It has already been demonstrated that a social gradient exists in children’s oral health status and dental care utilization. For example, children who are in a racial/ethnic minority or living in poverty are less likely to visit the dentist than their more advantaged counterparts. 1, 3, 4 It has also been shown that poor children have a higher prevalence of untreated dental caries than nonpoor children. 5 Indeed, poor children and racial/ethnic minority children use preventive measures such as dental sealants comparatively less frequently. 1 Infrequent use of dental services and poverty status appear to independently affect children’s oral health status. A study of children registered with general dental practitioners in Britain’s National Health Service found that irregular dental visits and lower SES were independently associated with higher rates of decayed and missing teeth. 6 Another study of British preschoolers found an inverse relationship between the presence of dental caries (treated and untreated) and contact with primary dental services, adjusted for low neighborhood SES. 7 While we know that SES in part determines frequency of use of preventive services and oral health status in the United States (in terms of the presence of caries), 2 the relationship between oral health needs and use of dental services has yet to be quantified. This question addresses the equity of dental care services in meeting the oral health care needs of children. Quantifying this relationship will inform policies regarding the availability of and barriers to oral health services. Oral health problems are not self-limiting; rather, they progress if left untreated. The relationship between needs and utilization in oral health is complicated by this progression. One conceptualization of this relationship is a spiral in which delayed care or the lack of care creates more severe health care needs, which, in turn, result in increased barriers to care. Delay in dental treatment creates barriers because the dental problems become more complicated and more expensive to treat. With the understanding that untreated oral health needs create their own barriers to care, we hypothesize that there is a positive association between the presence of needs and inadequate utilization of oral health care, when adjustments are made for sociodemographic characteristics. While health care services cannot remove the effects of an adverse environment and are not the only solution to health inequalities, 8 health services are important factors in protecting, promoting, and restoring health 9 and thus can be an important step in reducing inequalities in health outcomes.
