The oral health status of America's rural children: An opportunity for policy change

J Public Health Dent. 2021 Dec;81(4):251-260. doi: 10.1111/jphd.12444. Epub 2021 Jan 27.


Objectives: The purpose of our study was to examine the association between rurality and select oral health care metrics: teeth condition, decay, and access measures such as preventive dental care among children in the United States.

Methods: We conducted a cross-sectional study with a sample of 20,842 respondents from the 2017 to 2018 National Survey of Children's Health (NSCH), a nationally representative sample of U.S. children. Socio-demographic information, residence, and oral health and healthcare utilization information were used to create study variables. Descriptive statistics, bivariate analyses, and a multivariable regression model were performed.

Results: Rural children were less likely to have a preventive dental visit than urban children (84.9 percent versus 87.5 percent, P = 0.03). Children residing in rural areas were more likely to have their teeth condition reported as fair or poor than children residing in urban areas (7.3 percent versus 6.6 percent, P = 0.02). Compared to their urban counterparts, rural children were also less likely to have received fluoride treatment (46.6 percent versus 52.5 percent, P = 0.0022) and less likely to have received a dental sealant (19.5 percent versus 22.5 percent, P = 0.0147). In adjusted analysis, there was no significant difference in receiving a preventive dental visit for rural children, compared to their urban counterparts.

Conclusions: As preparations are made for the 2020 Surgeon General's report on oral health, the current study provides important evidence to inform future advocacy and legislative priorities. To reduce urban-rural disparities among children, there must be enhanced dental care access, dental workforce expansion, and increased awareness about preventive oral health services.

Keywords: dental caries; health disparities; oral health; risk factors; rural health.

MeSH terms

  • Child
  • Cross-Sectional Studies
  • Dental Care
  • Dental Caries* / epidemiology
  • Dental Caries* / prevention & control
  • Humans
  • Oral Health*
  • Policy
  • Rural Population
  • United States