Underutilization of dental care when it is freely available: a prospective study of the New England Children's Amalgam Trial

J Public Health Dent. Summer 2008;68(3):139-48. doi: 10.1111/j.1752-7325.2007.00074.x.


Objective: This study aims to prospectively examine the trends and reasons for the underutilization of free semiannual preventive dental care provided to children with unmet dental needs who participated in the 5-year New England Children's Amalgam Trial.

Methods: Children aged 6 to 10 at baseline (1997-99) with > or = 2 posterior carious teeth were recruited from rural Maine (n = 232) and urban Boston (n = 266). Interviewer-administered questionnaires assessed demographic and personal characteristics. Reasons for missed appointments were recorded during follow-up and are descriptively presented. We used an ordinal logistic regression to analyze the utilization of semiannual dental visits.

Results: On average, urban children utilized 69 percent of the visits and rural children utilized 82 percent of the visits. For both sites, utilization steadily decreased until the end of the 5-year trial. Significant predictors of underutilization in the multivariate model for urban children were non-White race, household welfare use, deep debt, and distance to dental clinic. Among the relatively less-diverse rural children, caregiver education level and a greater number of decayed tooth surfaces at baseline (i.e., need for care) were significantly associated with underutilization. Among all children, the common reasons for missed visits included guardian scheduling and transportation difficulties; reasons among urban participants also indicated a low priority for dental care.

Conclusions: Among these children with unmet dental needs, the provision of free preventive dental care was insufficient to remove the disparities in utilization and did not consistently result in high utilization through follow-up. Differences between educational levels, ethnicities, and rural/urban location suggest that public health programs need to target the social settings in which financial burdens exist.

Trial registration: ClinicalTrials.gov NCT00065988.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • African Americans / statistics & numerical data
  • Appointments and Schedules
  • Attitude to Health
  • Boston
  • Caregivers / education
  • Child
  • Cohort Studies
  • DMF Index
  • Dental Care for Children / statistics & numerical data*
  • Dental Caries / therapy
  • Dental Clinics / statistics & numerical data
  • Educational Status
  • European Continental Ancestry Group / statistics & numerical data
  • Follow-Up Studies
  • Health Services Needs and Demand / statistics & numerical data
  • Healthcare Disparities / statistics & numerical data
  • Hispanic Americans / statistics & numerical data
  • Humans
  • Income / statistics & numerical data
  • Maine
  • Preventive Dentistry / statistics & numerical data*
  • Prospective Studies
  • Public Assistance / statistics & numerical data
  • Rural Health / statistics & numerical data
  • Transportation / statistics & numerical data
  • Urban Health / statistics & numerical data

Associated data

  • ClinicalTrials.gov/NCT00065988