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Children
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Oral Heath Disparities in Children and Adolescents: Determinants and Challenges
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Oral Heath Disparities in Children and Adolescents: Determinants and Challenges

A special issue of Children (ISSN 2227-9067). This special issue belongs to the section "Pediatric Dentistry & Oral Medicine".

Deadline for manuscript submissions: 5 July 2025 | Viewed by 5784

Special Issue Editor

Dr. Caroline M. Sawicki

E-Mail Website
Guest Editor
Division of Pediatric and Public Health Adams School of Dentistry, University of North Carolina, Chapel Hill, NC, USA
Interests: pain; anxiety; stress; pediatric dentistry

Special Issue Information

Dear Colleagues,

Access to dental care for prevention and treatment is crucial to ensure optimal oral health. Dental care has recently been identified as the most prevalent unmet health need among children in the United States. The disparity in oral health among children and adolescents is a pressing concern, highlighting inequities in access to dental care and meeting specific oral health needs. Financial barriers constitute a significant deterrent to obtaining dental care, especially for children who reside in low-income households. Children from low-income and minority families have poorer oral health outcomes, fewer dental visits, and fewer protective sealants. Water fluoridation is the most effective measure in preventing dental caries, though a lack of fluoridation may disproportionately affect poor and minority children. Oral health is also the most prevalent unmet health need of children with special health care needs.

The goal of this Special Issue is to raise awareness and highlight the current issues surrounding oral health determinants and disparities in children and adolescents. We invite manuscripts that comprehensively describe the prevailing understanding of oral health determinants and disparities in youth and focus their attention on addressing the oral health statuses of children and their access to care.

We welcome original research reports, reviews, and meta-analyses for submission to this Special Issue, and we encourage the submission of proposals for interdisciplinary work and collaborative research. We look forward to receiving your contributions and creating a Special Issue with the aim of providing readers with updated research findings and novel data in understanding the oral health determinants and disparities in children and adolescents.

Dr. Caroline M. Sawicki
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Children is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2400 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • access to care
  • oral health determinants
  • oral health disparities
  • children’s oral health
  • childhood caries
  • special health care needs
  • untreated dental disease

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Published Papers (8 papers)

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Research

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12 pages, 845 KiB  
Article
An Assessment of Oral-Health-Related Quality of Life and Anxiety in Early Adolescents (11–14 Years) at Their First Dental Visit: A Cross-Sectional Study
by Trinidad Rincón, Cristina Gómez-Polo, Javier Montero, Daniel Curto and Adrián Curto
Children 2025, 12(4), 428; https://doi.org/10.3390/children12040428 - 28 Mar 2025
Viewed by 255
Abstract
Background: Knowing the oral-health-related quality of life (OHRQoL) status of pediatric patients would be helpful in analyzing their level of dental anxiety before their first visit to a pediatric dentist. However, few studies have analyzed OHRQoL and anxiety in early adolescent patients. The [...] Read more.
Background: Knowing the oral-health-related quality of life (OHRQoL) status of pediatric patients would be helpful in analyzing their level of dental anxiety before their first visit to a pediatric dentist. However, few studies have analyzed OHRQoL and anxiety in early adolescent patients. The aim of this study was to describe the OHRQoL and anxiety levels of early adolescents, according to age and sex, at their first dental examination. Methods: A cross-sectional study was conducted on early adolescents (11–14 years old) attending their first dental examination in 2023–2024. OHRQoL was assessed using the Spanish version of the Child Perceptions Questionnaire 11–14 (CPQ-Esp11-14) and anxiety using the State–Trait Anxiety Inventory in Children (STAIC). Results: A total of 130 early adolescents were assessed, with an average age of 12.6 years (±1.06) and an equal sex distribution (65 boys and 65 girls). Among the analyzed sample, the OHRQoL dimension with the highest score was social well-being (15.01 ± 10.7), whereas the oral symptoms dimension (8.6 ± 4.25) had the lowest impact. There were no statistically significant differences between female and male early adolescents in the anxiety state or anxiety-trait dimensions or in the dimension of OHRQoL, except for oral symptoms, which were higher in boys (9.48 ± 4.51 versus 7.72 ± 3.81). Similarly, no significant differences were found based on age regarding anxiety or OHRQoL. Conclusions: Considering the limitations of this study, it can be concluded that higher levels of anxiety negatively impacted the OHRQoL of the early adolescent population studied. Full article
(This article belongs to the Special Issue Oral Heath Disparities in Children and Adolescents: Determinants and Challenges)
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11 pages, 623 KiB  
Article
Impact of Interrupting Oral Prevention on Dental Health of 7- to 8-Year-Old Children Due to COVID-19
by Julia Winter, Thea Hartmann, Constanze Schul, Esther Hörschgen, Miriam Thöne-Mühling, Birgit Wollenberg, Stefanie Amend and Roland Frankenberger
Children 2025, 12(3), 315; https://doi.org/10.3390/children12030315 - 28 Feb 2025
Viewed by 400
Abstract
Background/Objectives: In Marburg (Hesse, Germany), the selective intensive preventive program (SIP) with fluoride varnish applications had to be interrupted due to the COVID-19 pandemic. The aim of this retrospective anonymized evaluation was to investigate possible effects of SIP interruption on oral health [...] Read more.
Background/Objectives: In Marburg (Hesse, Germany), the selective intensive preventive program (SIP) with fluoride varnish applications had to be interrupted due to the COVID-19 pandemic. The aim of this retrospective anonymized evaluation was to investigate possible effects of SIP interruption on oral health in socially vulnerable 7- and 8-year-olds. Methods: The caries increment in 7- and 8-year-olds for the test group (N = 180) between last dental check-up before the interruption of SIP (02/2019–02/2020) and the first check-up after restart (01/2022–07/2022) were calculated from dental public health service data. The test group was compared to a control group of children (N = 215; same age and schools, with SIP, data collected between the school year 2017/18 and 2019/20). One dentist conducted the dental examinations. The University of Marburg ethics committee approved the study. The Mann–Whitney U test and Pearson’s chi-square test were used for statistical analysis. Results: There was no significant difference in the caries increment in the first dentition between the test and the control group for both age groups. In the different groups, a maximum of 61% of the children with caries experience were completely treated. There was no significant difference between the test and control groups in either the percentage of sealed first permanent molars or the degree of restoration. Conclusions: The interruption of SIP had no negative impact on caries increment. It is possible that the children examined went through the pandemic without a significant increase in tooth decay because the children were well-trained in tooth brushing since kindergarten. Full article
(This article belongs to the Special Issue Oral Heath Disparities in Children and Adolescents: Determinants and Challenges)
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15 pages, 970 KiB  
Article
Changes in Toothbrushing Behaviors Following a Child Dental Care Reform in Israel
by Efrat Aflalo, Sharon Barak, Sharon Levi, Lilach Ben Meir, Ariela Giladi, Shlomo Paul Zusman, Yossi Harel Fisch, Miri Shachaf, Moti Zwilling and Riki Tesler
Children 2025, 12(3), 289; https://doi.org/10.3390/children12030289 - 26 Feb 2025
Viewed by 430
Abstract
(1) Background: Toothbrushing behavior in children and adolescents is shaped by national dental health policies and sociodemographic and psychological factors. In 2010, child dental care was incorporated into Israel’s National Health Insurance Law (NHIL). This study explored toothbrushing behavior and its predictors before [...] Read more.
(1) Background: Toothbrushing behavior in children and adolescents is shaped by national dental health policies and sociodemographic and psychological factors. In 2010, child dental care was incorporated into Israel’s National Health Insurance Law (NHIL). This study explored toothbrushing behavior and its predictors before and after this reform. (2) Methods: Data from 36,755 students in grades 6–10 were analyzed from the Health Behaviour in School-Aged Children study conducted pre-reform (1998, 2002, 2006) and post-reform (2010, 2013, 2016). The dependent variable was toothbrushing behavior, while the independent variables included sociodemographic and psychological characteristics. Chi-squared tests compared proportions of compliant toothbrushing behaviors, and logistic regression identified significant predictors. (3) Results: According to recommendations, 59–64% of children brushed their teeth before the reform. This proportion increased significantly post-reform, reaching 73% in 2018. Predictors of compliance included being female, younger, Jewish, and non-observant, having a higher socioeconomic status, and having a better psychological status. These predictors were consistent in pre- and post-reform regression models. (4) Conclusions: The dental care reform positively influenced toothbrushing habits among children and adolescents. However, disparities remain among specific communities. Interventions tailored to address sociodemographic and psychological factors are recommended to enhance regular toothbrushing habits across all populations. Full article
(This article belongs to the Special Issue Oral Heath Disparities in Children and Adolescents: Determinants and Challenges)
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12 pages, 446 KiB  
Article
Caries Level in 3-Year-Olds in Germany: National Caries Trends and Gaps in Primary Dental Care
by Ruth M. Santamaría, Christian H. Splieth, Roger Basner, Elisabeth Schankath and Julian Schmoeckel
Children 2024, 11(12), 1426; https://doi.org/10.3390/children11121426 - 26 Nov 2024
Cited by 1 | Viewed by 933
Abstract
Background: Nationally representative long-term data on caries in the primary dentition are rare but essential for determining the need for prevention and treatment. This research assessed the prevalence and trends of dental caries in 3-year-old children across Germany, with national data analyzed and [...] Read more.
Background: Nationally representative long-term data on caries in the primary dentition are rare but essential for determining the need for prevention and treatment. This research assessed the prevalence and trends of dental caries in 3-year-old children across Germany, with national data analyzed and compared with the corresponding data for 6–7-year-olds. Methods: Data were extracted from the most recent German National Oral Health Survey in 2016. Children aged 3 years were examined by calibrated dentists in 10 German regions using the WHO criteria for d3–4mft, including assessment of initial carious lesions d1–2mft. In addition, the Significant Caries Index (SiC), the Care Index (CI) and the Specific Affected Caries Index (SaC) were considered to identify provision of care and risk groups. Results: In a total of 95,127 3-year-old preschool children, caries prevalence was 13.7% with a mean d3–4mft of 0.48. Including initial carious lesions, prevalence increased to 18.7% (mean 0.67 d1–4mft). Dependent on the German region, d3–4mft values varied noticeably from 0.38 (Schleswig-Holstein) to 0.58 (Saxony-Anhalt and Berlin). Comparing data from 3-year-olds to 6–7-year-olds, the d3–4mft value for 6–7-year-olds (1.73) was more than three times higher than that for 3-year-olds (0.48). The SiC value was 1.47 for 3-year-olds and 4.88 for 6–7-year-olds, while the SaC values were 3.57 and 3.97, respectively. The Care Index was low for both groups (26.1% and 57.5%, respectively). Conclusions: Germany exhibited a high level of dental caries in the primary dentition for 3 (13.7%) to 6–7-year-olds (44%) children. This large cross-sectional study revealed considerable room for improvement in the early caries prevention and treatment within the well-equipped German dental health infrastructure. Full article
(This article belongs to the Special Issue Oral Heath Disparities in Children and Adolescents: Determinants and Challenges)
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7 pages, 592 KiB  
Article
Caries Incidence in School-Based Prevention Programs in the Presence of Interval Censoring
by Ryan Richard Ruff
Children 2024, 11(11), 1350; https://doi.org/10.3390/children11111350 - 5 Nov 2024
Cited by 1 | Viewed by 900
Abstract
Background/Objectives: School-based caries prevention can increase access to critical dental services and reduce oral health inequities. However, little is known regarding the incidence of dental caries in children participating in school caries prevention, and caries diagnosis is often interval censored. Methods: In this [...] Read more.
Background/Objectives: School-based caries prevention can increase access to critical dental services and reduce oral health inequities. However, little is known regarding the incidence of dental caries in children participating in school caries prevention, and caries diagnosis is often interval censored. Methods: In this paper, we used data from a longitudinal, school-based, randomized clinical trial of minimally invasive treatments for dental caries to estimate the per-visit incidence rate and compare the hazard of dental caries in children receiving either silver diamine fluoride or glass ionomer dental sealants. To account for interval censoring, we used semiparametric transformation models for univariate failure time data and imputed caries incidence using G-imputation. Results: There were 3040 children that met inclusion criteria for analysis, 1516 (49.9%) of which were randomly assigned to receive silver diamine fluoride and 1524 (50.1%) were assigned to receive glass ionomer dental sealants and atraumatic restorations. There were no differences in the hazard of caries between treatments (HR = 0.99, 95% CI = 0.72, 1.24), while children with caries at baseline had a significant increase in the hazard of new caries (HR = 2.54, 95% CI = 2.26, 2.83) compared to those that were caries free. The per-visit caries incidence ranged from 4.8 to 11.1 at the individual level and increased with each successive study observation. Conclusions: School-based caries prevention can positively affect caries incidence, and the results can be used to inform future program design and implementation. Full article
(This article belongs to the Special Issue Oral Heath Disparities in Children and Adolescents: Determinants and Challenges)
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15 pages, 2422 KiB  
Article
Pediatric Dentists’ Practice Patterns in the Screening, Diagnosis, and Management of Temporomandibular Disorders
by Caroline M. Sawicki and Linda Sangalli
Children 2024, 11(10), 1168; https://doi.org/10.3390/children11101168 - 26 Sep 2024
Cited by 1 | Viewed by 1014
Abstract
Background/Objectives: Pain associated with temporomandibular disorders (TMDs) is the main non-odontogenic cause of orofacial pain among youth. Pediatric dentists are often the first healthcare practitioners to perform a comprehensive oral examination in children, which should include evaluation of the temporomandibular joint, masticatory muscles, [...] Read more.
Background/Objectives: Pain associated with temporomandibular disorders (TMDs) is the main non-odontogenic cause of orofacial pain among youth. Pediatric dentists are often the first healthcare practitioners to perform a comprehensive oral examination in children, which should include evaluation of the temporomandibular joint, masticatory muscles, and surrounding structures for signs and/or symptoms of TMD. This study assessed pediatric dentists’ practice patterns in the screening, diagnosis, and management of TMD. Methods: A 19-item online survey was used to assess pediatric dentists’ clinical practice patterns and perceived knowledge and comfort levels in the screening, diagnosis, and management of TMD. The survey was distributed in July 2024, with a one-month window open for the study. Confidence levels and perceived knowledge were compared according to years from graduation and frequency of TMD screening assessment with ANOVA or independent t-test, as appropriate. Open-ended items were analyzed thematically. Results: A total of 206 pediatric dentists and pediatric dentistry residents participated in this study. A share of 72.8% of respondents reported that up to 25% of their patients per week present with signs and symptoms of TMD. About one-fifth of pediatric dental providers never complete a screening history for TMD (22.1%) or a clinical assessment of TMD-related structures (21.6%). There was overall low self-perceived knowledge and confidence among pediatric dentists regarding the diagnosis, screening, and management of TMD in children and adolescents, regardless of the number of years from graduation. Respondents who reported seeing up to 50% of TMD patients reported significantly more knowledge and confidence in diagnosing pediatric TMD than those who encountered fewer TMD patients. An overwhelming majority (81.6%) indicated a need for continuing education courses and training focused on the management of TMD in pediatric patients. Conclusions: Providers reported low confidence and self-perceived knowledge about TMD in pediatric populations, a high rate of referral of patients with TMD, and a particular interest for professional development opportunities focused on management of TMD. Full article
(This article belongs to the Special Issue Oral Heath Disparities in Children and Adolescents: Determinants and Challenges)
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Review

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19 pages, 3043 KiB  
Review
Salivary Markers as Potential Stress Descriptors for Pediatric Dental Patients: A Literature Review
by Shelby Main, Marcela R. Carrilho, Anna Alessandri-Bonetti, Caroline Sawicki, Jahnavi Rao, Sheila Hall and Linda Sangalli
Children 2025, 12(4), 500; https://doi.org/10.3390/children12040500 - 14 Apr 2025
Viewed by 213
Abstract
Dental fear and anxiety are frequently identified as major contributing factors to non-compliance, uncooperativeness, and difficulties during dental procedures in pediatric patients. These issues can lead to avoidance of dental treatment, resulting in long-term negative consequences for oral health and overall well-being. The [...] Read more.
Dental fear and anxiety are frequently identified as major contributing factors to non-compliance, uncooperativeness, and difficulties during dental procedures in pediatric patients. These issues can lead to avoidance of dental treatment, resulting in long-term negative consequences for oral health and overall well-being. The assessment and quantification of psychological functioning (i.e., dental fear, anxiety, and self-perceived stress) has traditionally relied on self-reported questionnaires validated for the pediatric population. While this approach is cost-effective and non-invasive, it relies on subjective self-reported data, oftentimes influenced by parental or guardian interaction, especially in young children. Salivary diagnostics has recently emerged as an objective method for the procurement of biological molecules that serve as biomarkers for a variety of oral and systemic conditions. This literature review aims to comprehensively summarize the available literature on the correlation between psychological and salivary physiological measurements assessing dental fear, dental anxiety, and self-perceived stress in pediatric dental patients, highlighting the advantages and disadvantages of each method of assessment. Four databases (PubMed®, PsycInfo, Dentistry & Oral Sciences Source, and Web of Science) were searched for published articles, in the English language, assessing the correlation between psychological and physiological distress in children undergoing dental procedures. Studies on pediatric patients reveal positive correlations between salivary cortisol and dental fear, stress, and anxiety, especially in returning patients. Conversely, findings on salivary alpha-amylase and secretory immunoglobulin A were inconsistent, with some studies suggesting correlations with dental fear and prior dental experiences. Full article
(This article belongs to the Special Issue Oral Heath Disparities in Children and Adolescents: Determinants and Challenges)
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17 pages, 303 KiB  
Review
A Narrative Review on Advancing Pediatric Oral Health: Comprehensive Strategies for the Prevention and Management of Dental Challenges in Children
by Sung-Ying Han, Chia-Lin Chang, Yung-Li Wang, Ching-Shuen Wang, Wei-Ju Lee, Thi Thuy Tien Vo, Yuh-Lien Chen, Chueh-Yi Cheng and I-Ta Lee
Children 2025, 12(3), 286; https://doi.org/10.3390/children12030286 - 26 Feb 2025
Viewed by 890
Abstract
Oral health is fundamental to overall well-being, especially in childhood, when dental structures and lifelong habits are established. This review provides a comprehensive analysis of children’s dental development, common oral health challenges, and evidence-based preventive strategies. Key topics include the mechanisms of tooth [...] Read more.
Oral health is fundamental to overall well-being, especially in childhood, when dental structures and lifelong habits are established. This review provides a comprehensive analysis of children’s dental development, common oral health challenges, and evidence-based preventive strategies. Key topics include the mechanisms of tooth development, the eruption processes of primary and permanent dentition, and the management of developmental abnormalities. The prevalence, risk factors, and health impacts of dental caries in children are examined, underscoring the need for early intervention and targeted prevention. This review evaluates the effectiveness of preventive measures such as dental sealants, fluoride varnishes, and fluoride mouth rinses while highlighting the influence of dietary habits, toothbrush selection, and parental involvement on oral health outcomes. Additionally, it explores the synergistic benefits of combining preventive approaches, such as the concurrent use of dental sealants and fluoride applications, which have demonstrated superior caries prevention compared to either method alone. The effectiveness of these strategies is analyzed across different age groups, from early childhood to adolescence, with tailored recommendations for each developmental stage. Furthermore, the role of education, policy interventions, and community-based programs in addressing oral health disparities is discussed. By integrating developmental insights with epidemiological data and clinical evidence, this review provides a comprehensive framework for advancing pediatric dentistry, informing best practices, and enhancing preventive strategies to reduce the burden of oral diseases in diverse pediatric populations. Full article
(This article belongs to the Special Issue Oral Heath Disparities in Children and Adolescents: Determinants and Challenges)
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