Dental Utilization Research Articles

RELATIONSHIP BETWEEN DENTAL VISIT TOWARDS QUALITY OF LIFE IN PRIMARY HEALTH CITEREUP CIMAHI

The aim of this study was to determine the relationship between Oral Health Quality of Life (OHRQoL) and the number of visits to the dentist. This is a cross-sectional study. This study using OHIP questionnaire and additional question about healthcare insurance ownership. Data were analysis using SPSS version 25. The findings of a study including 62 respondents. The prevalence respondent on 44-60 years old were 38,7%. Most of them as BPJS ownership and as unemployment. The highest prevalence OHRQOL based on dental utilization were low categorize and more than 6 months dental visit. The result bivariate analytic and statistically of Pearson chi square test, there are differences between OHRQol categorize towards dental visit p=0,000. Correlation between OHRQoL with dental visit statistically significant p=0,000 r=0,606. Maintaining dental and oral health by providing promotive and preventive programs can reduce the prevalence of visits to the dentist and can improve quality of life status. There are several determinant factors affected towards dental utilization. Universal health coverage is one of determinant factors to prevent out of pocket expenditures.

Dental Care Use Among Children and Adolescents in Medicaid: Associations With State-Level Medicaid Policy Factors and Provider Availability.

The aim of this study was to assess the relative strength of association of four state-level factors-Medicaid reimbursement, Medicaid adult dental benefit (MADB) generosity, dentist Medicaid participation, and dentist supply-on individual-level dental care use among children and adolescents in Medicaid. This national cross-sectional study used 2018-2019 National Survey of Children's Health data to estimate dental care utilizationamong children aged 1-17 enrolled in Medicaid. Subgroup analyses were conducted by child age group. A hierarchical regression approach was used; a series of logistic regression models assessed relative effect sizes among the four state-level variables. Among children aged 1-17, and the age 1-3 subgroup, dentist Medicaid participation was positively associated with dental care use. Among children aged 4-11, children in states with Emergency/No dental coverage for adults had greater odds of having a dental visit compared to children in states with Extensive dental coverage. Among adolescents aged 12-17, no state-level factors were associated with dental utilization. There was considerable variation by age group in the associations of state-level factors on dental care use among children and adolescents in Medicaid. Dentist participation in Medicaid was associated with dental care use among very young children. State-level policy levers have the potential to improve access to dental care for children enrolled in Medicaid, and are critical to achieve improvement toward oral health equity for children.

Factors associated with dental care utilization among Iranian adult populations based on Anderson model

BackgroundThe utilization of dental care is affected by different factors. Despite the importance of dental care, there are significant disparities in its utilization among various population groups. The aim of this study was to identify the main factors of dental care utilization and the influences of the Health Transformation Plan (HTP) in Iran based on the Anderson model.Methods and materialsThis cross-sectional house-by-house study was conducted during Aug-Nov 2022 among 704 adult people in two cities under the coverage of the HTP and two cities out-side the plan using a multi-stage sampling method. Dental visit in the last year was considered as the utilization of the dental services. Independent Factors included the contextual, individual enabling, individual predisposing and individual need factors based on the Andersen model. Personal health behaviors were also assessed. Statistical analysis was conducted using Chi-square tests, simple and multivariable logistic regression models (α < 0.05).ResultsThe 63.1% of the participants covered by the HTP and 57.7% of the population outside the plan sought dental care in the past year. In the final model individuals in the 35–44 age group (OR = 1.5, 95% CI = 1.02–2.2), males (OR = 1.7, 95% CI = 1.2–2.5), single individuals (OR = 1.4, 95% CI = 1.01-2) and those with the perception of need for dental treatment (OR = 2.1, 95% CI = 1.3–3.4) had higher chance of dental visit. Better perceived oral health status was associated with lower chance of visiting the dentist (OR = 0.9, 95% CI = 0.8–0.9). Being covered by the HTP was not significantly in association with the chance of dental visit in the last year (p value = 0.19, OR = 0.78, 95%CI = 0.55–1.12).ConclusionThe predisposing factors including age, gender, marital status, and perceived oral health status and perceptions of dental need were the main factors in association with the dental utilization behavior among adults and the coverage by the HTP did not have significant effect on it.

Examination of dental utilization of newly resettled adult refugees in Washington state enrolled in dental medicaid program.

To assess dental utilization of resettled adult refugees in Washington (WA) state and the demographic factors associated with dental utilization. Data were collected between January 1, 2015, and December 31, 2015 for newly arrived adult refugees (>21 years) enrolled in Washington State dental Medicaid program. Three state agencies provided enrollment and claims data that included demographic information as well as number and types of dental claims, and time to first dental claim for the newly resettled adult refugee population. A total of 1294 adult refugees resettled in WA State in 2015. Approximately, 67% were aged 21-39 years and 32.4% White race and 93.9% without any disability. Over half (57%) of adult refugees had at least one dental claim within 12 months, and the median time to first dental utilization was 4.1 months [IQR:2.4-6.8]. Black refugees had a 74% greater chance of a first dental claim within 12 months of resettlement compared to White refugees (p < .001), and people from countries with high volume of refugees also had a 31% greater chance than those from countries with low volume of refugees (p = .005). Over half of all the adult refugees resettled in WA utilized dental services within 12 months of arrival. Understanding the mosaic of demographic backgrounds of newly resettled refugees in any given state will improve early utilization of dental care needs and therefore improve their oral health.

State-Level Racial Inequity in Children's Dental Care Use in the U.S. and Association with State-Level Structural Racism.

The aims of this study were to estimate state-level racial inequities in dental care use among children in the U.S., overall and by insurance type, and to examine relationships between inequities and state-level structural racism. Pooled 2017-2019 data from the National Survey of Children's Health were used to estimate racial inequities in dental care use. Independent variables included state-level structural racism indicators and other factors. There was substantial variation in the degree and direction of inequities across states and by insurance type. Inequities were not associated with overall structural racism indices. However, one dimension of structural racism-the Black-White incarceration index-was significantly associated with the Black-White disparity (p=.040). Racial inequities in dental utilization among children varied across states and by insurance status. More research is needed to explore more granular geographic levels of structural racism and relationships with additional dental care access indicators.

A Comparison of Nationwide Dental Utilization and Medicaid Dental Coverage

Background: In 2020, Medicaid provided health and long-term care coverage to 72,995,197 adults aged 18-64 in the United States. While Medicaid broadly covered medical services, dental benefits were limited in many states. This study aims to examine the relationship between state-level differences in adult Medicaid dental coverage and access to oral health care, using oral health metrics from the Centers for Disease Control and Prevention (CDC). Methods: We conducted a retrospective analysis of data from the official Medicaid website, which outlined dental procedures covered in each state. Dental attendance for individuals aged 18 and older, based on income, was obtained from the Behavioural Risk Factor Surveillance System (BRFSS) for the period of January to December 2019. Authors analysed dental visits across three income groups: Group A (&lt;$15,000), Group B ($15,000-$24,000), and Group C (&gt;$50,000). Each dental procedure covered by Medicaid was assigned a value of '1,' resulting in a 'Total Score' for each state (ranging from 0-13). States were then grouped into categories based on their Total Scores: 1-4, 5-8, and 9-12. Scores of '0' and '13' were analysed separately. Authors found that Groups A and B visited the dentist less frequently than Group C, suggesting a correlation between income, dental coverage, and access to care. Result: This study examined the relationship between state-level Medicaid benefits and access to Oral Health care, demonstrating a direct relationship between Medicaid coverage in each state and overall access to dental services in the same state. Conclusion: Expanding Medicaid dental coverage for various procedures will enhance accessibility to dental care and ultimately protect oral health.

A Comparative Analysis of Oral Health and Self-Rated Health: 'All of Us Research Program' vs. 'Health and Retirement Study'.

Poor oral health can impact overall health. This study assessed the association between dental factors (dentate status and dental utilization) and self-rated health (S-RH) among older adults in two cross-sectional datasets: (1) NIH "All of Us (AoU) Research Program" (May 2018-July 2022 release) and (2) U.S. nationally representative "Health and Retirement Study" (HRS) 2018 wave. Participants aged ≥ 51 years were included in these analyses if (1) from AoU, they had clinical dental and medical data from electronic health records (EHRs) and surveys (n = 5480), and (2) from HRS, they had dental and socio-demographic survey data (n = 14,358). S-RH was dichotomized (fair/poor vs. better) and analyzed with logistic regression. Sample survey weights for HRS and stratification and averaging AoU results used the weighted HRS race-ethnicity and age distribution standardized respective analyses to the U.S. population. Fair/poor S-RH was reported by 32.6% in AoU and 28.6% in HRS. Dentate status information was available from 7.7% of AoU EHRs. In population-standardized analyses, lack of dental service use increased odds of fair/poor S-RH in AoU, OR (95% CI) = 1.28 (1.11-1.48), and in HRS = 1.45 (1.09-1.94), as did having diabetes, less education, and ever being a smoker. Having no natural teeth was not statistically associated with fair/poor S-RH. Lack of dental service was positively associated with fair/poor S-RH in both datasets. More and better oral health information in AoU and HRS are needed.

Relationship Between Dental Anxiety, Dental Utilization, and Oral Health-Related Quality of Life: A Systematic Review

Abstract Aim: No comprehensive synthesis of dental anxiety (DA), dental utilization (DU), oral health-related quality of life (OHRQoL), and their relationships have been examined despite various systematic investigations being done on their prevalence and interventions individually. Therefore, this review aims to systematically review the status and relationship between DA, DU, and OHRQoL among adult groups. Materials and Methods: Data collection spanned 6 months, from 1 July to 31 December 2023, involving eight databases. Only cross-sectional (CS) studies with adult participants aged 15–64 years, conducted globally, published in English, and available as full-text articles by December 31, 2023, were included. Two reviewers screened the titles and abstracts and assessed the full-text articles. All studies were CS. The risk of bias was evaluated using the Joanna Briggs Institute’s Critical Appraisal Checklist for Analytical CS studies. The quality of evidence for each measured factor was assessed using the Grading of Recommendations Assessment, Development, and Evaluation methodology. Results: The initial search yielded 3333 studies. The 22 final studies included 13 high-quality studies with over 80% and nine fair studies with 50% and 79% scored. None of the studies scored below 50%. A negative link between DA and DU was identified in 15 of 16 studies with 35,846 participants aged 22.19–50.21 years. Six studies on DA, DU, and OHRQoL included 22,845 participants aged 15–55 years, mostly in their late and mid-fifties. Four of six verified Berggren and Meynert’s (1984) vicious cycle theory’s high association between DA, DU, and OHRQoL. Conclusions: A 22-study review reveals a strong association between DA, DU, and OHRQoL. Most moderate to high-quality studies emphasized a negative correlation between DA and DU, which affected OHRQoL. PROSPERO registration number CRD42023455219.

A SYSTEMATIC REVIEW OF PARENTS' PATTERNS AND BARRIERS TO BRINGING CHILDREN TO THE DENTIST

Caries at an early age is a global problem that affects almost half of preschool children, the prevalence of early childhood caries (ECC) globally varies widely. One of the causes of caries in children less than 5 years old is the delay in the first visit to the dentist. The purpose of this study is to identify patterns of service utilization and obstacles that cause low visits to dentists so that programs can be planned that are able to increase the number of dental visits. A literature review was conducted using PubMed, ProQuest, SpringerLink, and ScienceDirect databases with keywords such as Dental care, Dental attendance, dental utilization, and Oral health promotion. The data were then thematically analyzed to uncover trends, common challenges, and effective interventions across the literature. The results of this systematic review show a pattern in visiting the dentist, including visiting for routine dental checkups, preventive treatments, acute pain conditions that have been experienced and trauma. The patterns of use of dental and oral health services in children are influenced by the level of parental education, the type of dental health care that is covered by limited health insurance, low socio-economic factors, socio-demographic factors, and lack of adequate insurance. This study aims to offer valuable insights into the patterns of dental care utilization and the obstacles preventing higher visitation rates to dental services. The findings are synthesized to highlight consistencies and gaps, ultimately providing insights to inform the development of programs aimed at improving dental visit rates.

Development of a Questionnaire for Dental Utilization Based on the Andersen Model.

Background and aim Oral health is an integral part of overall general health. Understanding the variables that affect the use of dental services can help overcome the challenges and lessen disparities in oral health. There are no significant reliable questionnaires available for determining factors that influence dental care utilization.This study aimed to develop and validate a questionnaire based on the Andersen model of healthcare utilization to assess these factors. Materials and methods A preliminary questionnaire consisting of 34 items was developed based on the Andersen model of healthcare utilization.The questionnaire's final version consisted of24 items after five subject area experts analyzed its face validity and content validity. Content validity ratio (CVR) was used to evaluate the validity of the questionnaire. The Cronbach's alpha coefficient was then used to establish the internal consistency and test-retest for the reliability of the questionnaire. Results The final version of the questionnaire included 24 items based on CVR, and the data of the final version suited the model well. The internal consistency measured with Cronbach's alpha coefficient was above the threshold for each item. The Cronbach's alpha value for test-retest reliability was found to be 0.72, which was acceptable. Conclusions The current results show that the proposed questionnaire for dental utilization based on the Andersen model has satisfactory validity and reliability. This questionnaire can be used as an instrument to determine the various factors that affect the utilization of dental services.

Awareness and attitude towards dental coverage right affecting the dental service utilization among selected thais in Bangkok

Oral health problems are one of the most prevalent public health issues in Thailand. However, the rate of dental service utilization is relatively low despite having three major healthcare coverages provided for Thai citizens. Objectives: This study aims to investigate whether awareness about dental coverage affects the rate of dental care utilization and the attitude towards dental coverage compared across coverage types. Methods: A cross-sectional analytical study based on Bangkok, Thailand using a newly developed questionnaire to assess socio-demographic information, dental healthcare utilization, dental coverage, and attitude towards dental coverage. Convenience sampling was used. Population studied was Thai citizens of working age (above 15 years old). Paper-based questionnaire forms were handed out in public venues. Data was analyzed with chi-square analysis to assess whether the sociodemographic characteristics and awareness of dental coverage correlates with dental care service utilization. Logistic regression was used for multivariate analysis to determine which variables had more influence upon dental care utilization. ResultsA total of 315 participants were included for data analysis. Chi-square analysis showed that gender, age, occupation, education, income, and awareness of dental coverage and reported type of dental coverage were all significantly correlated to dental healthcare service utilization (p-value <0.05). Multivariate analysis revealed that gender, age, career, and income still affect utilization when put into a logistic regression model, while awareness was no longer significant in predicting utilization rate. ConclusionIn conclusion, sociodemographic factors that significantly affect dental care service utilization included age, gender, occupation, education and income. When weighted with other socioeconomic determinants of dental care utilization, awareness of dental coverage schemes did not have a significant prediction value.

Professional dental care and survival rates in long-term care recipients: A cohort study of 1 459 163 individuals in South Korea.

To determine the dental care pattern and survival rates of participants who received long-term care (LTC) and a matched control cohort in South Korea. Global ageing trends and the development of superaged societies pose healthcare challenges. South Korea's LTC system aids those with chronic illnesses and disabilities. Despite the link between oral health and systemic diseases, providing dental care in LTC facilities often reflects social neglect. We identified 1 459 163 individuals eligible for LTC insurance in the Korean National Health Insurance Service database from July 2008 to 2015 (LTC cohort) and 1 459 544 individuals matched through propensity-score matching (matched cohort). The LTC recipients were further categorised into subgroups based on their care type (institutional, home or mixed care). Population of utilising dental services and the average number of dental visits were counted in each cohort, and the survival rate of the LTC cohort was determined according to dental utilisation. Population of utilising dental services increased steadily in all cohorts except for institutional care, with the highest utilisation (around 30%) observed in the matched cohort. Lower independence in LTC cohorts was associated with lower dental utilisation: 18-27% for home care, 12-18% for mixed care, and 10% for institutional care. The survival rates in the LTC cohort were significantly lower than in the matched cohort (P < .0001), with 28.1% survival in LTC vs 59.3% in the matched cohort. Long-term care recipients experience social neglect for oral care, while higher survival rates were observed in those utilised dental services.

Dental anxiety and oral health in American Indian and Alaska natives.

American Indian and Alaska native (AI/AN) individuals report distrust of the healthcare system. This study explored associations between having either high levels of dental distrust or high levels of dental care-related fear and anxiety ("dental anxiety") and oral health outcomes in AI/AN adults. The 2022 State of Oral Health Equity in America survey included the Modified Dental Anxiety Scale and asked to what extent respondents agreed with the statement, "At my last oral health visit, I trusted the oral health provider I saw", and asked about self-rated oral health and presence of a dental home. AI/AN individuals (N = 564) who reported low dental trust (n = 110) or with high dental anxiety (MDAS≥19; n = 113) reported significantly worse overall and oral health and were significantly less likely to have a dental home (p < 0.05 used for each analysis). Dental distrust and dental anxiety can significantly impact oral health and dental utilization in AI/AN communities and are important intervention targets to improve AI/AN oral health.

Retrospective Analysis of the Impact of the COVID-19 Pandemic on Dental Health and Utilization of Dental Services: A Tertiary Care Study between 2017 and 2022

ABSTRACT Background: Worldwide healthcare systems, especially those that provide dental treatment, have been devastated by the COVID-19 epidemic. Future healthcare initiatives must take into account the pandemic’s effects on oral health and service consumption. The purpose of this retrospective study was to examine how the COVID-19 pandemic affected dental health and the use of dental services, with a particular emphasis on a tertiary care facility from 2017 to 2022. Methods: Descriptive analysis was performed on data gathered from patient records, including demographics, diagnoses, treatments, and service consumption. Prepandemic, pandemic, and postpandemic variations in oral health trends and service use were evaluated. Findings: During the pandemic, there was a notable decrease in emergency dental visits, whereas teledentistry consultations increased. Age and socioeconomic level are two demographic variables that have an impact on variations in oral health trends. Conclusion: In summary, the COVID-19 pandemic has had a significant influence on dental health and service consumption, underscoring the necessity of flexible approaches to deal with new issues and inequities in dental care access. This study adds insightful information to the conversation on healthcare resilience and pandemic preparedness.

Disparities in dental healthcare utilization based on regional characteristics in Korea

Disparities in dental healthcare utilization based on regional characteristics in Korea

Medicaid Dental Benefits for Pregnant People and Dental Care Use Among Very Young Children.

The aim of this study was to examine the association between Medicaid dental benefits for pregnant people and dental care use among very young children in Medicaid. We hypothesized that children living in states with more generous dental benefits for Medicaid-enrolled pregnant people would be more likely to have a recent dental visit. This national cross-sectional study used pooled2017-2019 data from the National Survey of Children's Health, as well as state Medicaid policy data. The study sample included children aged 0-2 enrolled in Medicaid. Multivariable logistic regression models estimated the association between Medicaid dental benefit generosity for pregnant people and the child having a dental visit in the past year. Children in states with emergency-only dental coverage for pregnant people were 2.5 times as likely to have had a dental visit than children in states with extensive coverage (OR 2.48, 95% CI 1.35-4.53). In supplemental analyses excluding children living in Texas, there was no longer an association between dental coverage for pregnant people and dental utilization among young children (OR 1.52, 95% CI 0.82-2.83). Young children in states that provided emergency-only dental benefits for pregnant people in Medicaid had significantly higher odds of dental utilization than young children in states with more generous dental benefits for pregnant people. This relationship disappeared after excluding the state Texas, which had the highest rate of child dental utilization in the country and provided emergency-only dental benefits for pregnant people in Medicaid.

Preventive dental care reduces risk of cardiovascular disease and pneumonia in hemodialysis population: a nationwide claims database analysis

This study aims to investigate the impact of dental care utilization status on the occurrence of fatal complications such as cerebral/cardiovascular disease (CVD) and infectious diseases in patients with end-stage renal disease (ESRD) undergoing hemodialysis. This retrospective cohort study was performed using the Japanese claims database and included patients who first underwent hemodialysis between April 2014 and September 2020. The exposure variable of interest was the pattern of dental utilization, which was categorized into three groups, “dental treatment group”, “preventive dental care group”, and “no-dental visit group”. The primary outcomes were the time interval until a composite end point of first major cardiovascular event (acute myocardial infarction, heart failure, or cerebral infarction) of infectious disease (pneumonia and sepsis). The secondary outcomes were the time interval until the incidence of each component of primary outcomes. Survival analyses, including log-rank tests and Cox proportional hazards regression analyses, were performed. Among the 10,873 patients who underwent the first dialysis treatment, 6152 were assigned to the no-dental visit group, 2221 to the dental treatment group, and 2500 to the preventive dental care group. The preventive dental care group had significantly lower hazard ratios (HRs) of the incidence of CVD (adjusted hazard ratio [aHR]: 0.86, 95% confidence interval [CI]: 0.77–0.96) and infectious diseases (aHR: 0.86, 95% CI: 0.76–0.97). As for pneumonia, preventive dental care and dental treatment groups had significantly lower HRs (aHR: 0.74 and 0.80, 95% CI: 0.61–0.88, 0.66–0.96) than the no-dental visit group. This study demonstrated that dental visits for preventive dental care were associated with a significant risk reduction in CVD and infectious complications in patients with ESRD undergoing hemodialysis.

Association of general anxiety and pediatric dental preventive examination utilization, National Survey of Children's Health, 2021.

Many factors influence preventive dental health service access for children. The objective of this research was to examine one factor, general anxiety, in accessing at least one preventive dental examination in the past 12 months in children with special healthcare needs (CSHCN) and children without special healthcare needs (CWSHCN). National Survey of Children's Health (NSCH) 2021 were obtained for this cross-sectional research. Chi-square and logistic regression analyses were used to determine association of anxiety and past 12-month preventive dental examinations. The sample included 10493 CSHCN, and 35675 CWSHCN. Overall, 72.7% had past 12-month preventive dental examinations, and 9.9% had a healthcare provider indicate they had general anxiety. CSHCN with anxiety, CWSHCN with anxiety, and CSHCN without anxiety were more likely to have a past 12-month preventive dental examination visit than CWSHCN without anxiety (Adjusted Odds Ratios: 1.86, 1.39, 1.32, respectively). Our results suggest children with general anxiety (both CSHCN and CWSHCN) are more likely to have had at least one regular preventive dental visit within the past 12 months than CWSHCN and without general anxiety. There is a need for further understanding the relationship of general anxiety and dental health to improve the health of all children. CWSHCN without anxiety need individualized, comprehensive care with enough time, attention, instruction, and rewards to demonstrate to parents/guardians the importance of making routine preventive dental examinations a priority for their child.

Pattern of dental services utilization among adolescents and adults in Kano, Northern Nigeria

Nigeria is often conveniently described along geographical lines as North and South, each with its peculiar culture, predominant religion, and distinctive determinants of health. Available oral health information for Nigeria is derived from studies that have mainly been conducted in southern Nigeria. This study describes oral care-seeking behavior in northern Nigeria by analyzing the attendance pattern at a tertiary hospital over a period. Clinic records of patients who visited the Oral Diagnostic Sciences (ODS) clinic in Aminu Kano Teaching Hospital, Kano, were retrieved and retrospectively reviewed. Data on age, sex, ethnicity, and chief dental complaints were extracted and analyzed using SPSS version 20 (IBM Corp.; Armonk, NY, USA). The clinic records of 1,620 patients were reviewed, and the results showed that more males than females visited the clinic (55.4%), and dental pain was the most common reason for visiting the clinic (57.1%). Young adults and youths comprised the majority of patients, while the elderly population was the least represented. The study reveals dental healthcare utilization patterns in Kano, Nigeria, with sex differences reflecting sociocultural factors influencing health behaviors. The high proportion of dental pain cases highlights the need for preventive oral health efforts. The association between young/middle-aged individuals and dental trauma highlights occupational hazards and lifestyle as key determinants of dental health outcomes.

Barriers to dental utilization among Medicaid-enrolled young children from primary care practices in Northeast Ohio.

To evaluate the individual and community factors that contribute to dental utilization among young children on Medicaid utilizing the Anderson Model and the Socio-Ecological Framework. This observational cross-sectional study was conducted using baseline data (socio-demographics, clinical dental need) from a cluster-randomized hybrid effectiveness-implementation trial among 1021 child-parent dyads recruited from primary care practices across northeast Ohio. The baseline data were then linked to dental Medicaid claims data (categorized as any dental visit, volume, and type in the past 12 months) and ICD-10 codes from the child's EHR data (individual-level) together with Dental Health Provider Shortage Area (HPSA) status and Area Deprivation Index (ADI) which were obtained at the neighbourhood-level using home address of each dyad (community-level). Multivariable analyses using generalized estimating equations (GEE) accounted for clustering by practice, and models included individual-level alone, and individual + community-level factors to evaluate their effects on dental utilization. Medicaid claims data indicated that among the 1021 children (mean age: 4.3 ± 1.1 years; 54.4% males; 43.8% Black, Non-Hispanic), a majority of children were seeing the dentist at least once a year by the age of 4 (56.1%). The mean ADI of their neighbourhoods was 109.22 (20.2) and 27.5% lived in a HPSA area. The GEE analyses revealed that individual factors such as older children, parents being married, and continuous Medicaid enrollment were associated with significantly higher dental utilization. Among community factors, being in a HPSA had an OR = 1.53 (CI: 1.03, 2.27) associated with higher dental utilization. Being in a HPSA was associated with higher dental utilization possibly due to dentists or safety net dental clinics in these areas accepting Medicaid-eligible children.