tooth triage: disparities in dental health
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Eric
a H
idu,
MD
Inte
rnal
Med
icin
e-Pe
diat
rics
, PGY
-4M
aine
AAP
Spr
ing
Educ
atio
n Se
ries
May
18,
202
1
Tooth
Triage
: Dis
pariti
es in
Dent
al Hea
lth
Object
ives
1.Ex
plor
e gr
oups
that
exp
erie
nces
dis
pari
ties
in d
enta
l hea
lth.
2.
Rais
e aw
aren
ess o
f the
impo
rtan
ce p
edia
tric
den
tal c
are
give
n in
adeq
uate
co
vera
ge o
f adu
lts
3.Re
view
evi
denc
e-ba
sed
anti
cipa
tory
gui
danc
e 4.
Dev
elop
cata
log
ofre
sour
ces
in M
aine
5.In
trod
uce
futu
re d
irec
tion
sin
ped
iatr
ic d
enta
l car
e
I hav
e no
dis
clos
ures
.
Cases
5 yo F
emale
in Pe
diatri
c Clin
ic with
Tooth
Pain
26 yo
Female
in Me
d-Ped
s Clin
ic for
Hospit
al Fol
low Up
Cases
How
commo
n is
this?
Let th
is sit.
..D
enta
l car
ies a
re th
e m
ost c
omm
on c
hron
ic d
isea
se o
f chi
ldho
od.
In <
1 ye
ar o
lds
88%
ha
d re
gula
r doc
tor
appo
intm
ents
3.6%
had
regu
lar d
enti
stap
poin
tmen
ts
AAP
unpu
blis
hed
data
from
200
7-20
16 E
xpen
ditu
re d
ata
16%
Did
not
rece
ive
any
prev
enta
tive
dent
al ca
re
of C
hild
ren
42%
Had
a d
enta
l vis
it (c
ompa
red
to 6
7% o
f co
mm
erci
al in
sura
nce)
of C
hild
ren
on
Mai
neCa
re
4 in
10
Had
cari
es
Mai
ners
by
3rd
Grad
e
In Ma
ine D
uring
2015-
2017
Poor D
ental
Care
Associ
ated W
ith Ca
rdiom
etabol
ic Dise
ase●
n= 1
1,55
6●
Cros
s-se
ctio
nal s
tudy
●N
atio
nal L
ongi
tudi
nal S
tudy
of A
dole
scen
t to
Adul
t Hea
lth●
Pred
omin
antly
whi
te w
ith a
t lea
st h
igh
scho
ol e
duca
tion
●D
efer
red
dent
al c
are
●BM
I, ch
oles
tero
l, bl
ood
pres
sure
Ore
skov
ic e
t al.
2017
Jour
nal o
f the
Am
eric
an D
enta
l Ass
ocia
tion
Poor d
ental
care
associ
ated w
ith ca
rdiom
etabol
ic dise
aseOre
skov
ic e
t al.
2017
12-1
9 yo
26-3
2 yo
Jour
nal o
f the
Am
eric
an D
enta
l Ass
ocia
tion
Poor d
ental
care
associ
ated w
ith m
issed
schoo
l and
poor
schoo
l perf
orman
ce●
n= 2
,183
●Cr
oss-
sect
iona
l Stu
dy
●20
08 N
orth
Car
olin
a Ch
ild H
ealth
Ass
essm
ent a
nd M
onito
ring
Pro
gram
●Pr
edom
inan
tly w
hite
, non
- his
pani
c an
d pa
rent
s had
at l
east
som
e co
llege
with
pr
ivat
e he
alth
insu
ranc
e
Jack
son
et a
l. 20
11Am
eric
an Jo
urna
l of P
ublic
Hea
lth
Poor d
ental
care
associ
ated w
ith m
issed
schoo
l and
poor
schoo
l perf
orman
ce
●Ab
senc
es re
latin
g to
den
tal p
ain
wer
e m
ore
likel
y to
resu
lt in
poo
r per
form
ance
○1.94
(1.0
4 , 3
.63)
Very
Goo
d/Ex
celle
ntGo
od/F
air/
Poor
Mis
s sch
ool f
or d
enta
l pai
n1.
39(0
.67,
2.8
8)3.
89 (1
.96,
7.7
5)
Jack
son
et a
l. 20
11Am
eric
an Jo
urna
l of P
ublic
Hea
lth
Early
inter
ventio
n is e
ssent
ial
14 sta
tes ha
ve no
preve
ntati
ve cov
erage
Main
ecare
covera
ge for
adult
s (21+
)●
Only
cov
ers
extr
acti
on
○Traum
atic
inju
ry○“Se
vere
ly d
ecay
ed” t
eeth
that
“pos
e a
seri
ous t
hrea
t” d
urin
g an
othe
r sur
gery
or
radi
atio
n th
erap
y●
“Med
ical
ly n
eces
sary
” den
ture
s○On
e se
t eve
ry 5
yea
rs
Who i
s at
risk?
Risk a
ssessm
ents
●AA
P●
AAPD
●Ca
lifor
nia
Den
tal A
ssoc
iatio
n●
ADA
Ris
k Fa
ctor
s
●M
ater
nal D
enta
l Dis
ease
●Bo
ttle
/Sip
py C
up
●Fr
eque
nt S
nack
ing
●Sp
ecia
l Hea
lth C
are
Nee
ds●
Med
icai
d El
igib
le
Prot
ecti
ve F
acto
rs
●H
as a
den
tal h
ome
●Fl
uori
de e
xpos
ure
○In wat
er○Sup
plem
ents
○Varni
sh in
last
6 m
o ●
Brus
hes t
eeth
twic
e da
ily
Racial
/ethn
ic mi
norit
iesHig
her pr
evalen
ce of
untre
ated c
aries
Lower
preval
ence
of den
tal se
alant
s
Black
childr
en at
incre
ased r
isk of
carie
s●
n= 1
,023
●
Cros
s-se
ctio
nal s
tudy
by
paid
surv
ey w
ith h
ygie
nist
per
form
ed e
xam
●En
glis
h sp
eaki
ng, n
on-h
ispa
nic i
n N
orth
east
ern
Ohio
ped
iatr
ic p
rim
ary
care
of
fices
●Bl
ack
child
ren
wer
e m
ore
likel
y to
hav
e○Be
en to
the
hosp
ital/
ED fo
r a d
enta
l-rel
ated
issu
e in
the
last
12
mo
○Low
er o
ral h
ealth
qua
lity
of li
fe sc
ore
○Poor
acc
ess t
o fo
od
Selv
araj
et a
l 202
0Jo
urna
l of P
ublic
Hea
lth
Den
tist
ry
Black
childr
en at
incre
ased r
isk of
carie
sSe
lvar
aj e
t al 2
020
Jour
nal o
f Pub
lic H
ealt
h D
enti
stry
Immi
grant
s
Compar
ing A
frican
& Asi
an Pe
diatri
c Refu
gees
●n=
228
●Cr
oss-
sect
iona
l stu
dy b
y re
tros
pect
ive
char
t rev
iew
●Re
fuge
e H
ealth
Pro
gram
at H
asbr
o Ch
ildre
n’s H
ospi
tal a
nd
St. J
osep
h Pe
diat
ric
Den
tal C
ente
r in
Prov
iden
ce, R
I
Oga
wa
et a
l. 20
19Pe
diat
ric
Den
tist
ry
●As
ian
patie
nts
○had
high
er c
arie
s ris
k
Oga
wa
et a
l. 20
19
Compar
ing A
frican
& Asi
an Pe
diatri
c Refu
gees
Pedi
atri
c D
enti
stry
●As
ian
patie
nts
○had
high
er c
arie
s ris
k○req
uire
d m
ore
emer
gent
inte
rven
tion
Oga
wa
et a
l. 20
19
Compar
ing A
frican
& Asi
an Pe
diatri
c Refu
gees
Pedi
atri
c D
enti
stry
Compar
ing R
efugee
vs. U
S Pedi
atric P
atien
ts●
n= 2
24●
Cros
s-se
ctio
nal s
tudy
with
ora
l hea
lth a
sses
smen
ts●
Refu
gee
Hea
lth A
sses
smen
t Pro
gram
with
Mas
sach
uset
ts D
epar
tmen
t of P
ublic
Hea
lth○Afr
ica-
Som
alia
, Lib
eria
, and
Sud
an○Eas
tern
Eur
ope-
Bosn
ia●
Thir
d N
atio
nal H
ealth
and
Nut
ritio
n Ex
amin
atio
n Su
rvey
of U
S ch
ildre
n●
Rate
s of u
ntre
ated
cari
es a
nd h
isto
ry o
f car
ies
Cote
et a
l. 20
04Pe
diat
rics
Easter
n Euro
pean v
s. Afr
ican R
efugee
sCo
te e
t al.
2004
Pedi
atri
cs
Cote
et a
l. 20
04
Compar
ing r
efugee
s to US
patie
nts
Cote
et a
l. 20
04
●Ea
ster
n Eu
rope
an R
efug
ees -
Whi
te U
S Ch
ildre
n○2.8
X m
ore
likel
y to
hav
e ha
d ca
ries
○9X m
ore
likel
y to
hav
e ac
tive
untr
eate
d ca
ries
●Af
rica
n Re
fuge
es -
Blac
k US
Chi
ldre
n○½ a
s lik
ely
to h
ave
had
cari
es○Jus
t as l
ikel
y to
hav
e ac
tive
untr
eate
d ca
ries
Pedi
atri
cs
Low in
come
Higher
preva
lence
of un
treate
d cari
es Low
er pre
valen
ce of
dental
seala
nts
Lower
preval
ence
of too
th ret
entio
nChi
ldren
with
specia
l hea
lth ca
re ne
eds
Develo
pmen
tal de
lay an
d cari
es rat
e●
n= 1
15●
Cros
s-se
ctio
nal s
tudy
●H
ead
Star
t in
Was
hing
ton
Stat
e●
Inde
pend
ent v
aria
ble:
Dev
elop
men
tal d
elay
●D
epen
dent
var
iabl
e: P
reva
lenc
e of
den
tal d
isea
se
Chi e
t al.
2013
BMC
Ora
l Hea
lth
Factor
s asso
ciated
with
incre
ased c
aries
Chi e
t al.
2013
Prev
alen
ce R
atio
P va
lue
Dev
elop
men
tal D
elay
1.26
0.04
Olde
r Age
(5 v
s. 3)
4.21
<0.0
01
Com
mun
icat
ion
Diff
icul
ty2.
47<0
.001
Low
er P
aren
tal E
duca
tion
2.58
<0.0
01
Hav
ing
a D
enta
l Hom
e0.
610.
01
Fluo
rida
ted
Wat
er0.
37<0
.001
BMC
Ora
l Hea
lth
Autis
m Spe
ctrum
disor
der●
n= 2
00●
Case
-con
trol
stud
y w
ith q
uest
ionn
aire
and
clin
ical
exa
min
atio
n●
Alex
andr
ia, E
gypt
●Ca
rrie
d di
agno
sis o
f ASD
by
DSM
IV, m
atch
ed to
con
trol
s mat
ched
to a
ge, s
ex,
and
soci
oeco
nom
ic st
atus
Kha
tib
et a
l. 20
13Jo
urna
l of I
nter
nati
onal
Ped
iatr
ic D
enti
stry
Patien
ts with
ASD h
ave m
ore di
fficul
ty wit
h den
tal he
alth
Kha
tib
et a
l. 20
13Jo
urna
l of I
nter
nati
onal
Ped
iatr
ic D
enti
stry
Not a
ll CSH
CN ar
e crea
ted eq
ual
●n=
150
●Re
tros
pect
ive
Long
itudi
nal C
ohor
t stu
dy●
Patie
nts f
rom
a p
riva
te d
enta
l pra
ctic
e in
Cha
rlot
te, N
C●
Com
pari
ng m
ultip
le d
iffer
ent s
peci
al h
ealth
care
nee
ds○Au
tism
Spe
ctru
m D
isor
der (
ASD
)○Co
ngen
ital H
eart
Dis
ease
(CH
D)
○Cere
bral
Pal
sy (C
P)○Do
wn
Synd
rom
e (D
S)○Co
ntro
l
Fran
k et
al.
2019
Pedi
atri
c D
enti
stry
CSHCN
have
associ
ated
risk f
actors
Fran
k et
al.
2019
●Pu
blic
insu
ranc
e●
Suga
r dri
nks/
snac
ks●
Dry
mou
th-in
duci
ng m
edic
atio
n●
Oral
hyg
iene
diff
icul
ty●
Liqu
id/p
uree
d di
et●
G-tu
be d
epen
dent
Pedi
atri
c D
enti
stry
Not a
ll CSH
CN ar
e crea
ted eq
ual
Fran
k et
al.
2019
Pedi
atri
c D
enti
stry
Congen
ital H
eart D
isease
Assoc
iated
with D
ental
Disea
seCarr
illo
et a
l. 20
18
●n=
156
●Re
tros
pect
ive
revi
ew●
Hyp
othe
size
d re
ason
s●
Poor
den
tal h
ygie
ne●
Cari
ogen
ic d
iets
●Su
gar-
base
d m
edic
atio
ns●
Pare
ntal
anx
ietie
s ab
out
stre
ssfu
l situ
atio
ns
Jour
nal o
f the
Can
adia
n D
enta
l Ass
ocia
tion
Conclu
sions
What
can we
do
?
Antic
ipator
y Guid
ance
Eviden
ced-ba
sed an
ticipa
tory g
uidan
ce
0-11 m
o●
Pare
ntal
hyg
iene
●Av
oid
bott
le p
ropp
ing
●W
ashc
loth
on
gum
s●
Don
’t sh
are
uten
sils
●D
on’t
put p
acifi
er in
you
r mou
th
Caregi
ver be
havior
to pr
event
Verti
cal tr
ansm
ission
●n=
3,0
35●
Cros
s-se
ctio
nal s
urve
y●
Japa
nese
3 y
ear o
lds a
nd th
eir c
areg
iver
s●
Oral
exa
ms a
nd q
uest
ionn
aire
s●
Div
ided
by
if th
ey a
void
ed sh
arin
g ut
ensi
ls/p
acifi
ers
●Ou
tcom
e va
riab
le-c
arie
s on
exam
Wak
agur
i et a
l. 20
11Ca
ries
Res
earc
h
Caregi
ver be
havior
to pr
event
Verti
cal tr
ansm
ission
Wak
agur
i et a
l. 20
11Ca
ries
Res
earc
h
1-4 yo
●D
isco
urag
e th
umb
suck
ing
●Av
oid
juic
e an
d su
gary
bev
erag
es
Dietar
y Advi
ce Im
pact
●n=
782
●Co
chra
ne R
evie
w M
eta-
Anal
ysis
●Th
ree
stud
ies,
2 in
Bra
zil,
1 in
the
UK●
Advi
ce g
iven
to p
regn
ant w
omen
and
wom
en w
ith c
hild
ren
<1 y
o○Br
east
feed
ing,
avo
idin
g su
gar
○Advi
se a
roun
d us
ing
bott
les a
roun
d sl
eep
●Ou
tcom
es fo
llow
ed u
p to
6 y
ears
old
●M
oder
ate
grad
e of
cer
tain
ty
Rig
gs e
t al.
2019
Co
chra
ne R
evie
w
Dietar
y Advi
ce Im
pact
Rig
gs e
t al.
2019
Co
chra
ne R
evie
w
5-10
yo●
Avoi
d su
gary
dri
nks
●M
outh
gua
rds w
ith sp
orts
11+ yo
●Ad
oles
cent
tran
sitio
n to
olki
t●
Subs
tanc
e us
e●
Eatin
g di
sord
ers
●Pi
erci
ngs
Toothb
rushin
g●
How
ofte
n?●
Twic
e pe
r day
●W
hat w
ith?
○Fluor
ide-
cont
aini
ng to
othp
aste
for a
ll●
How
muc
h?○< 3
yo-s
mea
r lea
ve o
n○3-6
yo-
pea-
size
d, sp
it OK
, don
’t ri
nse
●W
ho n
eeds
supe
rvis
ion?
○Can’t
brus
h te
eth
until
they
can
tie
shoe
s ~7-
8 yo
○Floss
ing
star
ts 5
-10
yo
Specia
l Heal
thcare
Needs
Guide
lines
●H
ave
a de
ntal
hom
e w
ith fl
exib
le a
ppoi
ntm
ents
●Re
fer a
s ear
ly a
s pos
sibl
e●
Be a
war
e of
pat
ient
’s se
nsor
y is
sues
/tri
gger
s●
Dev
elop
indi
vidu
aliz
ed p
reve
ntat
ive
plan
(bru
shin
g, m
outh
gua
rds,
etc.)
●En
cour
age
low
car
b di
et w
hen
able
●Re
view
med
icat
ions
that
cau
se d
ry m
outh
We ca
n’t ju
st talk
abou
t gett
ing t
o a de
ntist
...Lu
o et
al 2
020
Gett
ing
Advi
ce
Hav
ing
a D
enta
l App
oint
men
t
Jour
nal o
f Pub
lic H
ealt
h D
enti
stry
Inter
ventio
ns
inter
ventio
ns Fluori
de●
Perf
orm
ed b
y pr
ovid
ers
●Ev
ery
3-6
mon
ths
●Ap
ply
to a
ll te
eth
●Af
ter f
irst
eru
ptio
n●
Dry
with
gau
ze●
Can
drin
k/ea
t sof
t foo
ds●
No
brus
hing
that
eve
ning
Sealan
ts●
Perf
orm
ed b
y de
ntis
ts/a
ssoc
iate
s●
Appl
y to
mol
ars
●Af
ter e
rupt
ion
of th
e fis
t mol
ars
(~
6 yo
)●
Last
2-4
yea
rs●
Reco
mm
ende
d fo
r all
child
ren
Fluori
dated
water
-St
arte
d in
the
1945
in G
rand
Rap
ids
-In
201
6, 7
3% o
f US
popu
latio
n-
Dec
reas
e to
oth
deca
y by
25%
-
Mai
ne ra
nks 2
3rd
in th
e US
-79
.3%
of t
he p
opul
atio
n se
rved
Schoo
l seala
nt pr
ogram
s●
Fund
ed a
t sta
te a
nd fe
dera
l lev
els
●Pr
ovid
e se
alan
ts in
the
scho
ol se
ttin
g●
Sieg
al e
t al.
2010
Main
e Reso
urces
Partn
ership
for C
hildre
n’s
oral h
ealth
●W
orks
to im
plem
ent s
trat
egie
s to
prom
ote
oral
hea
lth●
Map
with
serv
ices
acr
oss M
aine
http
s://
ww
w.m
aine
pcoh
.org
/cov
id19
/map
From
the fir
st too
th●
Prom
otin
g or
al h
ealt
h of
in
fant
s, to
ddle
rs, p
resc
hool
ers
in p
rim
ary
care
●M
E, N
H, V
T, M
A, R
I, CT
●H
ealth
y Sm
iles 2
020
Chal
leng
e●
Virt
ual t
rain
ing
AAP Pr
imer
●To
ols f
or p
edia
tric
ians
http
s://
ilike
myt
eeth
.org
/ohp
p/
Main
e Acce
ss Imm
igran
t Netw
ork●
Foun
ded
in 2
002
by S
omal
i Com
mun
ity●
Conn
ects
imm
igra
nts t
o he
alth
and
soci
al
serv
ices
in P
ortla
nd●
Expa
nded
serv
ices
to S
outh
Sud
anes
e, R
wan
dan,
Bu
rund
ian,
and
Con
gole
se p
eopl
e●
Wor
king
on
Mid
dle
East
ern
imm
igra
nts
●Co
mm
unity
Hea
lth W
orke
rs●
Wor
ksho
ps, e
vent
s
Main
ely Te
eth●
Serv
ing
Port
land
-are
a●
Den
tal h
ygie
nist
●
Orga
nize
s out
side
refe
rral
s●
Prev
enta
tive
and
emer
genc
y se
rvic
es ○X-Ray
○flu
orid
e ○nu
triti
onal
adv
ice
○seala
nts
●Pe
diat
ric
spec
ialty
, inc
ludi
ng
expe
rien
ce w
ith sp
ecia
l nee
ds●
207-
808-
9498
●ht
tps:
//m
aine
lyte
eth.
com
/
Future
direc
tions
H.P.10
14: “An
Act to
Impro
ve Ora
l Heal
th an
d Acce
ss to D
ental
Care
for Ma
ine C
hildre
n”Vir
tual d
ental
home
●Em
bedd
ed d
enta
l hyg
ieni
st e
valu
ates
●E-
cons
ults
with
den
tists
●Tr
ial w
ith H
eadS
tart
pro
gram
s
Learn
ing P
oints
1.D
ispa
riti
es e
xist
:a.
Raci
al/E
thni
c M
inor
ities
-Im
mig
rant
gro
ups d
iffer
b.Lo
w In
com
ec.
Spec
ial H
ealth
Car
e N
eeds
-Aut
ism
, DD
, CH
D
2.An
tici
pato
ry G
uida
nce
help
s:
a.D
ecre
ased
sw
eets
, dec
reas
ed b
ottle
pro
ppin
gb.
Shar
ing
uten
sils
?c.
Yes,
you
shou
ld b
rush
twic
e pe
r day
3.Th
ere
are
mul
tipl
e re
sour
ces
a.Pa
rtne
rshi
p fo
r Chi
ldre
n’s
Oral
Hea
lthb.
AAP
4.Th
e ti
me
to a
ct is
bef
ore
age
21
Case
Follow
Up
Thank
You
Refere
nces
Acad
emy
of P
edia
tric
Den
tistry
; 202
0: 2
75; 8
0
Ahov
uo-S
alor
anta
A.,
Fors
s H
., W
alsh
T.,
Nor
dbla
d A.
, Mak
ela
M.,
Wor
thin
gton
HV.
"Pit
and
fissu
re s
eala
nts
for p
reve
ntin
g de
ntal
deca
y in
per
man
ent t
eeth
." C
ochr
ane
Dat
abas
e Sy
stem
ic R
evie
w. 2
017;
201
7(7)
Amer
ican
Aca
dem
y of
Ped
iatri
c D
entis
try. "
Man
agem
ent o
f den
tal p
atie
nts
with
spe
cial
hea
lth c
are
need
s." T
he re
fere
nce
Man
ualo
fPed
iatri
c D
entis
try. C
hica
go, I
LL: A
mer
ican
Brig
ht F
utur
es G
uide
lines
for H
ealth
Sup
ervi
sion
of I
nfan
ts, C
hild
ren,
and
Ado
lesc
ents
. "Pr
omot
ing
Ora
l Hea
lth"
Brow
n C
J., S
mith
G.,
Shaw
L.,,
Par
ry J
., Sm
ith A
J. “T
he e
rosi
ve p
oten
tial o
f fla
vour
edsp
arki
ng w
ater
drin
ks.”
Inte
rnat
iona
l Jou
rnal
of P
aedi
atric
Den
tistry
200
7; 1
7:86
-91
Car
rillo
C.,
Rus
sell
J., J
udd
P., C
asas
MJ.
“Ora
l Hea
lth o
f Chl
dren
with
Con
geni
tal H
eart
Dis
ease
at a
Ped
iatri
c H
ealth
Sci
ence
Cen
tre.”
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nal o
f the
Can
adia
n D
enta
l Ass
ocia
tion.
201
8; 8
4(7)
Col
vara
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ustin
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DD
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eyer
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ilger
t JB.
, Cel
este
RK.
"Mot
ivat
iona
l Int
ervi
ewin
g in
Pre
vent
ing
Early
Chi
ldho
od C
arie
s in
Prim
ary
Hea
lthca
re: A
Com
mun
ity-b
ased
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Chi
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, Ros
sitc
h KC
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eles
EM
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evel
opm
enta
l del
ays
and
dent
al c
arie
s in
low
-inco
me
pres
choo
lers
in th
e U
SA: a
pilo
t cro
ss-s
ectio
nal s
tudy
and
pre
limin
ary
expl
anat
ory
mod
el."
BMC
Ora
l Hea
lth. 2
013;
13(
53)
Cot
e S.
, Gel
tman
P.,
Nun
n M
., Li
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K., H
ensh
aw M
., G
arci
a R
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enta
l Car
ies
of R
efug
ee C
hild
ren
Com
pare
d w
ith U
S C
hild
ren.
" Ped
iatri
cs. 2
004;
114
(6)
Cen
ters
for D
isea
se C
ontro
l. "S
choo
l Sea
lant
Pro
gram
s". h
ttps:
//ww
w.c
dc.g
ov/o
ralh
ealth
/den
tal_
seal
ant_
prog
ram
/sch
ool-s
eala
nt-p
rogr
ams.
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BA,
Xia
nfen
L.,
Thor
nton
-Eva
ns G
. "O
ral H
ealth
Dis
parit
ies
as D
eter
min
ed b
y Se
lect
ed H
ealth
Pep
le 2
020
Ora
l Hea
lth O
bjec
tives
for t
he U
nite
d St
ates
, 200
9-20
10. "
CD
C, N
CH
S D
ata
Brie
f. 20
12
Fran
k M
., Ke
els
MA.
, Qui
none
z R
., D
ivar
is R
M. "
Den
tal C
arie
s R
isk
Varie
s Am
ong
Subg
roup
s of
Chi
ldre
n w
ith S
peci
al H
ealth
Car
eN
eeds
." Pe
diat
ric D
entis
try. 2
019;
41(
5) 3
78-8
4
Hoy
vik
AC.,
Lie
B., G
rjibo
vski
AM
., W
illum
sen
T. "O
ral H
ealth
Cha
lleng
es in
Ref
ugee
s fro
m th
e M
iddl
e Ea
st a
nd A
frica
: A C
ompa
rativ
e St
udy.
" Jou
rnal
of I
mm
igra
nt a
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inor
ityH
ealth
. 201
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1:44
3-45
0
Jack
son
SL.,
Vann
WF.
, Kot
ch J
B., P
ahel
BT.
, Lee
JY.
"Im
pact
of P
oor O
ral H
ealth
on
Chi
ldre
n's
Scho
ol A
ttend
ance
and
Per
form
ance
." Am
eric
an J
ourn
al o
f Pub
lic H
ealth
. 201
1; 1
01 (1
0).
Khat
ib A
A., E
l Tek
eya
MM
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Tan
taw
i MA,
Om
ar T
. "O
ral h
ealth
sta
tus
and
beha
viou
rs o
f chi
ldre
n w
ith A
utis
m S
pect
rum
Dis
orde
r: a
case
-con
trol s
tudy
." In
tern
atio
nal J
ourn
al o
f Pae
diat
ric D
entis
try. 2
014;
24:
314
-323
Kum
ar S
., Ta
daka
mad
la J
., Jo
hnso
n N
W. "
Effe
ct o
f Too
thbr
ushi
ng F
requ
ency
on
Inci
denc
e an
d In
crem
ent o
f Den
tal C
arie
s: A
Sys
tem
atic
Rev
iew
and
Met
a-An
alys
is."
Jour
nal o
f
Den
tal R
esea
rch.
201
6; 9
5(11
) 123
0-12
36
Luo
H.,
Gar
cia
RI.,
Mos
s M
E., B
ell R
A., W
right
W.,
Wu
B. "T
rend
s of
chi
ldre
n be
ing
give
n ad
vice
for d
enta
l che
ckup
s an
d ha
ving
ade
ntal
vis
it in
the
Uni
ted
Stat
es: 2
001-
2016
."Jo
urna
l of P
ublic
Hea
lth D
entis
try. 2
020;
80(
2) 1
23-1
31
Oga
wa
JT.,
Kian
g J.
, Wat
ts D
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Lew
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ral H
ealth
and
Den
tal C
linic
Atte
ndan
ce in
Ped
iatri
c R
efug
ees.
" Ped
iatri
c D
entis
try. 2
019;
41
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Gal
lucc
i GO
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Milli
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hmon
d TK
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ral h
ealth
sta
tus
and
long
itudi
nal c
ardi
omet
abol
ic ri
sk in
a n
atio
nal s
ampl
e of
you
ng a
dults
." Jo
urna
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mer
ican
Den
tal A
ssoc
iatio
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148
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uthu
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regn
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omen
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hers
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oth
er p
rimar
y ca
regi
vers
for p
reve
ntin
g ea
rly c
hild
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" Coc
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atab
ase
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iew
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201
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)
Selv
araj
D.,
Cur
tan
S., C
opel
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T., M
cNam
ee E
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ebel
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la T
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omot
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ariti
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mon
g M
edic
aid-
enro
lled
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g ch
ildre
n fro
m p
edia
tric
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2020
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24
Partn
ersh
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r Chi
ldre
n's
Ora
l Hea
lth. w
ww
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nepc
oh.o
rg
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al M
D.,
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hard
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ty A
M. "
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ased
den
tal s
eala
nt p
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ams
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gher
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ourn
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orita
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Asso
ciat
ion
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egiv
er B
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iour
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Pre
vent
Ver
tical
Tra
nsm
issi
onan
d D
enta
l Car
ies
in T
heir
3-Ye
ar-O
ld C
hild
ren.
" Car
ies
Res
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