Articles

A Scoping Review to Improve Universal Health Coverage for Pediatric Dental Services Policies

Abstract

Background: Poor oral and dental health significantly affects public health, impacting over half the world’s population. Dental caries can undermine children’s academic success and career prospects. Social inequities result in unequal access to oral healthcare, particularly among populations with lower socioeconomic status (SES). National policies that improve access to oral health can reduce these disparities.
Objectives: This study aims to compile policies implemented by various countries to achieve universal health coverage (UHC) for pediatric dental services.
Methods: This scoping review was conducted according to Arksey and O’Malley’s framework and is reported using the preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews (PRISMA-ScR) guidelines. A systematic search was conducted on databases including Scopus, PubMed, Magiran, SID, Irandoc, Google Scholar, the WHO website, and the databases of Iran’s Ministry of Health. The search aimed to identify literature discussing governmental steps taken to achieve UHC for pediatric dental health, published between January 1, 2011, and December 31, 2022. The results were charted and presented in a table.
Results: This review included 22 studies. Six themes were identified based on the roles played by key players in this field, including schools, government policy and support, community-oriented preventive plans, insurance support, parents’ awareness, and inequality in accessing dental services.
Conclusions: A comprehensive policy that reduces barriers to access, increases utilization, and engages all stakeholders—including parents, schools, and community centers—can effectively achieve UHC for pediatric dental health.

1. Rowan-Legg A, Canadian Paediatric Society CPC. Oral health care for children - a call for action. Paediatr Child Health. 2013;18(1):37-50. [PubMed ID:24381493]. [PubMed Central ID:PMC3680273]. https://doi.org/10.1093/pch/18.1.37.
2. Watt RG, Daly B, Allison P, Macpherson LMD, Venturelli R, Listl S, et al. Ending the neglect of global oral health: time for radical action. Lancet. 2019;394(10194):261-72. [PubMed ID:31327370]. https://doi.org/10.1016/S0140 6736(19)31133-X.
3. Peres MA, Macpherson LMD, Weyant RJ, Daly B, Venturelli R, Mathur MR, et al. Oral diseases: a global public health challenge. Lancet. 2019;394(10194):249-60. [PubMed ID:31327369]. https://doi.org/10.1016/S0140-6736(19)31146-8.
4. Seirawan H, Faust S, Mulligan R. The impact of oral health on the academic performance of disadvantaged children. Am J Public Health. 2012;102(9):1729-34. [PubMed ID:22813093]. [PubMed Central ID:PMC3482021]. https://doi.org/10.2105/AJPH.2011.300478.
5. Shariff JA, Edelstein BL. Medicaid Meets Its Equal Access Requirement For Dental Care, But Oral Health Disparities Remain. Health Aff (Millwood). 2016;35(12):2259-67. [PubMed ID:27920314]. https://doi.org/10.1377/hlthaff.2016.0583.
6. Federation FDIWD. FDI policy statement on perinatal and infant oral health: adopted by the FDI General Assembly: 13 September 2014, New Delhi, India. Int Dent J. 2014;64(6):287-8. [PubMed ID:25417780]. [PubMed Central ID:PMC9376408]. https://doi.org/10.1111/idj.12147.
7. Jamieson L, Haag D, Schuch H, Kapellas K, Arantes R, Thomson WM. Indigenous Oral Health Inequalities at an International Level: A Commentary. Int J Environ Res Public Health. 2020;17(11). [PubMed ID:32503229]. [PubMed Central ID:PMC7312047]. https://doi.org/10.3390/ijerph17113958.
8. Beall CJ, Campbell AG, Griffen AL, Podar M, Leys EJ. Genomics of the Uncultivated, Periodontitis-Associated Bacterium Tannerella sp. BU045 (Oral Taxon 808). mSystems. 2018;3(3). [PubMed ID:29896567]. [PubMed Central ID:PMC5989130]. https://doi.org/10.1128/mSystems.00018-18.
9. James SL, Abate D, Abate KH, Abay SM, Abbafati C, Abbasi N, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. The Lancet. 2018;392(10159):1789-858.
10. Homaie Rad E, Kavosi Z, Arefnezhad M. Economic inequalities in dental care utilizations in Iran: Evidence from an urban region. Med J Islam Repub Iran. 2016;30:383. [PubMed ID:27493927]. [PubMed Central ID:PMC4972081].
11. Jahromi NN, Jafari A, Kavosi Z, Shokrpour N, Sajjadnia Z, Ravangard R. Demand for Dental Services in Shiraz, Iran, 2013. Health Care Manag (Frederick). 2016;35(4):340-9. [PubMed ID:27749470]. https://doi.org/10.1097/HCM.0000000000000136.
12. McAuliffe U, Whelton H, Harding M, Burke S. ‘Toothless’-the absence of political priority for oral health: a case study of Ireland 1994-2021. BMC Oral Health. 2022;22(1):95. [PubMed ID:35346151]. [PubMed Central ID:PMC8958340]. https://doi.org/10.1186/s12903-022-02125-1.
13. Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Method. 2005;8(1):19-32. https://doi.org/10.1080/1364557032000119616.
14. Devlin D, Henshaw M. Improving access to preventive dental services through a school-based dental sealant program. J Dent Hyg. 2011;85(3):211-9. [PubMed ID:21888778].
15. Discepolo K, Kaplan AS. The patient protection and affordable care act: effects on dental care. N Y State Dent J. 2011;77(5):34-8. [PubMed ID:22029113].
16. Verlinden DA, Reijneveld SA, Lanting CI, van Wouwe JP, Schuller AA. Socio-economic inequality in oral health in childhood to young adulthood, despite full dental coverage. Eur J Oral Sci. 2019;127(3):248-53. [PubMed ID:30791128]. [PubMed Central ID:PMC6593773]. https://doi.org/10.1111/eos.12609.
17. Zlotnick C, Tam T, Ye Y. Statewide Policy Change in Pediatric Dental Care, and the Impact on Pediatric Dental and Physician Visits. Matern Child Health J. 2017;21(10):1939-48. [PubMed ID:28741086]. https://doi.org/10.1007/s10995-017-2310-3.
18. Gross-Panico ML, Freeman WK, 3rd. Identifying barriers to receiving preventive dental services: expanding access to preventive dental hygiene services through affiliated practice. J Dent Hyg. 2012;86(4):306-14. [PubMed ID:24024273].
19. Kenney GM, Marton J, Klein AE, Pelletier JE, Talbert J. The effects of Medicaid and CHIP policy changes on receipt of preventive care among children. Health Serv Res. 2011;46(1 Pt 2):298-318. [PubMed ID:21054374]. [PubMed Central ID:PMC3037784]. https://doi.org/10.1111/j.1475-6773.2010.01199.x.
20. Kranz AM, Lee J, Divaris K, Baker AD, Vann W, Jr. North Carolina physician-based preventive oral health services improve access and use among young Medicaid enrollees. Health Aff (Millwood). 2014;33(12):2144-52. [PubMed ID:25489032]. [PubMed Central ID:PMC4331078]. https://doi.org/10.1377/hlthaff.2014.0927.21. Edelstein BL, Maas WR. Policy entrepreneurship in the reform of pediatric dentistry. Isr J Health Policy Res. 2017;6(1):37. [PubMed
ID:28666472]. [PubMed Central ID:PMC5492897]. https://doi.org/10.1186/s13584-017-0160-5.
22. Orynich CA, Casamassimo PS, Seale NS, Litch CS, Reggiardo P. The Affordable Care Act and Health Insurance Exchanges: Advocacy Efforts for Children’s Oral Health. Pediatr Dent. 2015;37(1):17-22. [PubMed ID:25685968].
23. Chalmers NI, Compton RD. Children’s Access to Dental Care Affected by Reimbursement Rates, Dentist Density, and Dentist Participation in Medicaid. Am J Public Health. 2017;107(10):1612-4. [PubMed ID:28817336]. [PubMed Central ID:PMC5607675]. https://doi.org/10.2105/AJPH.2017.303962.
24. Nasseh K, Vujicic M. The Impact of Medicaid Reform on Children’s Dental Care Utilization in Connecticut, Maryland, and Texas. Health Serv Res. 2015;50(4):1236-49. [PubMed ID:25483733]. [PubMed Central ID:PMC4545356]. https://doi.org/10.1111/1475-6773.12265.
25. Beazoglou T, Douglass J, Myne-Joslin V, Baker P, Bailit H. Impact of fee increases on dental utilization rates for children living in Connecticut and enrolled in Medicaid. J Am Dent Assoc. 2015;146(1):52-60. [PubMed ID:25569499]. https://doi.org/10.1016/j.adaj.2014.11.001.
26. Romaire MA, Bell JF, Grossman DC. Health care use and expenditures associated with access to the medical home for children and youth. Med Care. 2012;50(3):262-9. [PubMed ID:22228246]. https://doi.org/10.1097/MLR.0b013e318244d345.
27. Duderstadt KG. Impact of Affordable Care Act on children’s oral health: states hold the key. J Pediatr Health Care. 2014;28(6):565-7. [PubMed ID:25441969]. https://doi.org/10.1016/j.pedhc.2014.08.014.
28. Yu ZJ, Elyasi M, Amin M. Associations among dental insurance, dental visits, and unmet needs of US children. J Am Dent Assoc. 2017;148(2):92-9. [PubMed ID:28129806]. https://doi.org/10.1016/j.adaj.2016.11.013.
29. Schwendicke F, Dorfer CE, Schlattmann P, Foster Page L, Thomson WM, Paris S. Socioeconomic inequality and caries: a systematic review and meta-analysis. J Dent Res. 2015;94(1):10-8. [PubMed ID:25394849]. https://doi.org/10.1177/0022034514557546.
30. Palencia L, Espelt A, Cornejo-Ovalle M, Borrell C. Socioeconomic inequalities in the use of dental care services in Europe: what is the role of public coverage? Community Dent Oral Epidemiol. 2014;42(2):97-105. [PubMed ID:23786417]. [PubMed Central ID:PMC3864569]. https://doi.org/10.1111/cdoe.12056.
31. Nash DA, Mathu-Muju KR, Friedman JW. Ensuring Access to Oral
Health Care for Children: School-Based Care by Dental Therapists - A Commentary. J Sch Health. 2015;85(10):659-62. [PubMed ID:26331747]. https://doi.org/10.1111/josh.12297.
32. Kranz AM, Dick AW. Low rates of pediatric dental coverage for families purchasing marketplace insurance plans. J Public Health Dent. 2019;79(4):275-8. [PubMed ID:31407343]. https://doi.org/10.1111/jphd.12332.
33. Shin BM, Jung SH, Kim MH, Ryu JI. Did the extended coverage policy contribute to alleviating socioeconomic inequality in untreated dental caries of both children and adolescents in South Korea? BMC Oral Health. 2020;20(1):124. [PubMed ID:32321493]. [PubMed Central ID:PMC7178997]. https://doi.org/10.1186/s12903-020-01112-8.
34. Qiao N, Carroll AE, Bell TM. Factors affecting the Affordable Care Act Marketplace stand-alone pediatric dental plan premiums. J Public Health Dent. 2018;78(4):360-4. [PubMed ID:30238457]. [PubMed Central ID:PMC6309299]. https://doi.org/10.1111/jphd.12287.
35. Natapov L, Sasson A, Zusman SP. Does dental health of 6-year-oldsreflect the reform of the Israeli dental care system? Isr J Health Policy Res. 2016;5:26. [PubMed ID:27708769]. [PubMed Central ID:PMC5050852]. https://doi.org/10.1186/s13584-016-0086-3.
36. Carpino R, Walker MP, Liu Y, Simmer-Beck M. Assessing the Effectiveness of a School-Based Dental Clinic on the Oral Health of Children Who Lack Access to Dental Care. J Sch Nurs. 2017;33(3):181-8. [PubMed ID:27698209]. https://doi.org/10.1177/1059840516671784.
37. Fine JI, Isman RE, Grant CB. A comprehensive school-based/linked dental program: an essential piece of the California access to care puzzle. J Calif Dent Assoc. 2012;40(3):229-37. [PubMed ID:22655421].
38. Decker SL. Medicaid Payment Levels to Dentists and Access to Dental Care Among Children and Adolescents. Jama. 2011;306(2). https://doi.org/10.1001/jama.2011.956.
39. Buchmueller TC, Orzol S, Shore-Sheppard LD. The Effect of Medicaid Payment Rates on Access to Dental Care among Children. Am J Health Econ. 2015;1(2):194-223. https://doi.org/10.1162/AJHE_a_00012.
40. Kyoon-Achan G, Schroth RJ, DeMare D, Sturym M, Edwards JM, Sanguins J, et al. First Nations and Metis peoples’ access and equity challenges with early childhood oral health: a qualitative study. Int J Equity Health. 2021;20(1):134 [PubMed ID:34098968]. [PubMed Central ID:PMC8183050]. https://doi.org/10.1186/s12939-021-01476-5.
41. Meyerhoefer CD, Panovska I, Manski RJ. Projections Of Dental Care Use Through 2026: Preventive Care To Increase While Treatment Will Decline. Health Aff (Millwood). 2016;35(12):2183-9. [PubMed ID:27920305]. https://doi.org/10.1377/hlthaff.2016.0833.
42. Alsharif AT, Kruger E, Tennant M. Disparities in dental insurance coverage among hospitalised Western Australian children. Int Dent J. 2014;64(5):252-9. [PubMed ID:24835791]. [PubMed Central ID:PMC9376395]. https://doi.org/10.1111/idj.12116.
43. Edelstein BL, Rubin MS, Clouston SAP, Reusch C. Children’s dental service use reflects their parents’ dental service experience and insurance. J Am Dent Assoc. 2020;151(12):935-43. [PubMed ID:33228886]. https://doi.org/10.1016/j.adaj.2020.08.018.
44. Naavaal S, Barker LK, Griffin SO. The effect of health and dental insurance on US children’s dental care utilization for urgent and non-urgent dental problems - 2008. J Public Health Dent. 2017;77(1):54-62. [PubMed ID:27613222]. [PubMed Central ID:PMC10927192]. https://doi.org/10.1111/jphd.12171.
45. Markovic D, Soldatovic I, Vukovic R, Peric T, Campus GG, Vukovic A. How Much Country Economy Influences ECC Profile in Serbian Children-A Macro-Level Factor Analysis. Front Public Health. 2019;7:285. [PubMed ID:31681721]. [PubMed Central ID:PMC6798075]. https://doi.org/10.3389/fpubh.2019.00285.
46. Ismail AI, Sohn W. The impact of universal access to dental care on disparities in caries experience in children. J Am Dent Assoc. 2001;132(3):295-303. [PubMed ID:11258086]. https://doi.org/10.14219/jada.archive.2001.0172.
47. Khouja T, Burgette JM, Donohue JM, Roberts ET. Association between Medicaid expansion, dental coverage policies for adults, and children’s receipt of preventive dental services. Health Serv Res. 2020;55(5):642-50. [PubMed ID:32700423]. [PubMed Central ID:PMC7518821]. https://doi.org/10.1111/1475-6773.13324.
48. Pinilla J, Negrin-Hernandez MA, Abasolo I. Time trends in socioeconomic inequalities in the lack of access to dental services among children in Spain 1987-2011. Int J Equity Health. 2015;14:9. [PubMed ID:25636711]. [PubMed Central ID:PMC4316659]. https://doi.org/10.1186/s12939-015-0132-8.
49. Jean G, Kruger E, Tennant M. Universal access to oral health carefor Australian children: comparison of travel times to public dental services at consecutive census dates as an indicator of progressive realisation. Aust J Prim Health. 2020;26(2):109-16. [PubMed ID:32252888]. https://doi.org/10.1071/PY19148.
50. Bhagavatula P, Xiang Q, Eichmiller F, Szabo A, Okunseri C. Racial/ ethnic disparities in provision of dental procedures to children enrolled in Delta Dental insurance in Milwaukee, Wisconsin. J Public Health Dent. 2014;74(1):50-6. [PubMed ID:22970893]. [PubMed Central ID:PMC4121860]. https://doi.org/10.1111/j.1752-7325.2012.00366.x.
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IssueVol 8 No 2 (2024) QRcode
SectionArticles
DOI https://doi.org/10.18502/htaa.v8i2.15631
Keywords
Universal Health Coverage Utilization Access Pediatric Dentistry Dental Care for Children

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Pouraghasi L, Olyaeemanesh A, Jafari M. A Scoping Review to Improve Universal Health Coverage for Pediatric Dental Services Policies. Health Tech Ass Act. 2024;8(2).