Geographic disparities in children’s oral health in the United States

Objectives: This study examines variations in access to dental care and oral health outcomes by residence for children and adolescents in the United States (US). Methods: This cross-sectional study of 50,277 children and adolescents derived child residence, child and caregiver demographic characteristics, as well as access to dental care and oral health from the 2021–2022 National Survey of Children’s Health. Access measures include dental care receipt, preventive dental visit, forgone dental care, and fluoride treatment; oral health outcomes include teeth condition, oral health problems, and tooth decay status. All descriptive, bivariate and multivariate analyses consider sampling weights for population-based estimates. Results: Rural versus urban children had lower rates of reporting excellent/very good teeth condition (71.1% vs 74.4%, p = 0.0015), higher rates of one or more oral health problems (18.7% vs 15.6%, p = 0.0009) and tooth decay (16.6% vs 13.5%, p = 0.0008), and lower rates of receiving fluoride treatment (18.3% vs 15.5%, p = 0.0043). Regarding access to dental care, in the unadjusted analysis, rural children were less likely to receive preventive dental care (81.7% vs 84.5%, p = 0.0012) and more likely to forgo needed dental care than urban children (2.6% vs 1.6%, p = 0.0082). After adjusting for other child and caregiver characteristics, there was no significant difference between residence and preventive dental care. Conclusions: This study provides updated and timely information for policymakers and community partners and shows that rural US children were both more likely to experience oral health problems and less likely to receive needed dental care.