UCSF

Purpose: The purpose is to measure childhood caries experience and explore possibly associated geographic, demographic, socioeconomic, and sociocultural factors at community health centers (CHCs) in Hawai'i. Methods: The study comprises children ages 0-12 attending a CHC on Hawai'i and O'ahu between August 2007 and August 2012. Data extracted from existing paper charts include demographic, clinical, and utilization variables. Results: In 329 patients, 1666 encounters were recorded. Caries was found to be present in 63% of the children. 19.3% of dental appointments were broken, and treatment plans were not completed 35.1% of the time. On Hawai'i and O'ahu, overall visit type was significantly related to broken appointments (p=0.0002 and p=0.0038 respectively). Children were 3.0 times and 2.5 times more likely to miss their treatment appointments than examination appointments on Hawai'i and O'ahu (p<0.0001 and p=0.0009 respectively). Residence within the clinic/van ZIP code (p<0.0001) was significantly related to broken appointments and treatment plan incompletion on Hawai'i. Those residing outside the clinic/van ZIP code were 3.1 times more likely to not complete the treatment plan (p=0.004). The overall race effect (3 df, p=0.0369) was significant for broken appointments on Hawai'i. Pacific Islanders were more likely to break appointments compared to Asians (p=0.0142), Hawaiians (p=0.0385), and all other races (p=0.0082). All races other than Asian, Hawaiian, and Pacific Islander were also 3.2 times more likely to complete treatment plans (p=0.033) on Hawai'i. Discussion: The study provides an updated oral health profile of the low-income and minority pediatric population in Hawai'i and can serve as a database for CHCs to re-evaluate how to improve their clinical operations and for policymakers to make decisions on future strategies to effectively and culturally-appropriately promote dental health and enhance health status and access to care in Hawai'i. Despite CHCs accepting Medicaid and having schedule availability, large percentages of broken appointments and untreated caries still remain. This holds great relevance for the Affordable Care Act (ACA) and provide important insights of what to expect. Data from Hawai'i indicate that ACA-mandated enrollment may remain insufficient to meet pediatric dental treatment needs, especially where geographic barriers may reduce access to care.