Health as Children with Special Health Care Needs

Health has been
acknowledged as essential human right and oral health is a vital part of general
health and can be called the first line of contact to the human body. Americans
are enjoying the growing levels of oral health. However, oral health increases
and dental care services are not being practiced evenly across all population. Some
minorities, low income elderly people, poor children and children in foster
care do not have adequate access to dental care (Drainoni et al., 2006; Leck & Randall, 2017;
Northridge et al., 2017).

unaffordable cost of dental treatment is the main barrier which hinders people
from using the services, especially with the absence of dental care coverage in
medical insurance or when there is a low reimbursement rates for dental
professionals from insurance companies (Garla, Satish, & Divya, 2014).

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Generally, the high cost of health care service is due to the rising need for
health facilities, evolving technology of health care, lacking incentives, looking
for higher quality treatment and general inflation (Garla et al., 2014; Glavind et al., 1992).

to the American Academy of Pediatrics (AAP) all children in foster care consider
as Children with Special Health Care Needs (CSHCN), and define them as
“children who have or are at increased risk for a chronic physical,
developmental, behavioral, or emotional condition and who also require health
and related services of a type or amount beyond that required by children
generally” (McPherson
et al., 1998). CSHCN requires
specific procedures, comprehensive oral health knowledge for treatment and
additional measures compared to what considered routine treatment for other children
Academy of Pediatric Dentistry, 2015).

the average age of children in foster care was 8.7 years, and the numbers of children
in the U.S. foster care system is increasing with an over 415,000 children registered
in the foster care system, and over 260,000 children entered the foster care
system in 2014, with over 238,000 children exiting the same year (Health
& Services, 2015). In
fact, children and adolescents in foster care have significant mental and oral health
issues (Szilagyi,
Rosen, Rubin, & Zlotnik, 2015). Moreover, those children have greater incidence
of developmental syndromes, disorders of the teeth and jaw, attention scarcity,
conduct and disruptive disorders, and adjustment disorders (Baumrucker,
Fernandes-Alcantara, Stoltzfus, & Fernandez, 2012).

dental cavity is the most common chronic childhood disease and affecting a
majority of children in foster care who did not utilize any sort of dental care
due to lack of access (M.

Melbye, Huebner, Chi, Hinderberger, & Milgrom, 2013; Negro, 2016). Inadequate access to oral health care and
untreated dental issues may lead to harm to the child, especially pain, complicated
dental problem and decreased overall health (Negro,
2016). Furthermore,
the literature on children in foster care and their oral health condition is
limited, but the available data shows that children in foster care have untreated
dental cavities and face several barriers to receive preventive dental care (Colthirst,

though children in foster care have insurance coverage, they are unlikely to
access dental care. Barriers to dental care included limited number of dentists
participated in Medicaid program, children moving from foster home to foster
home, insufficient oral health knowledge and lack of resources to the social
workers (M. L.

Melbye, Chi, Milgrom, Huebner, & Grembowski, 2014). Also, children in foster care need more comprehensive
dental care than the general population, according to study conducted in Iowa,
they found that children in foster care have 1.29 higher odds of utilizing
dental services compared to children not in foster care, which indicate the
high demand for dental care for children in foster care (Chi,
Momany, Kuthy, Chalmers, & Damiano, 2010).

Up to
the present time, there is no published study evaluated the dental knowledge
and oral health training obtained by social workers at different foster care agencies
in state of Florida, as a potential involvement to enhance the oral health care
for children and their parent in foster care. Moreover, social workers have the
most contact with foster families through home visits, therefore they can participate
in oral health improvement for children in foster care by early diagnosis,
providing resources and delivering oral health education and prevention to
foster parents during home visits and during foster parent training.


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