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Adolescent Health Services: Missing Opportunities
Dentistry has significantly different characteristics from medicine that directly influence the quantity, quality, accessibility, and affordability of dental services for adolescents. Service characteristics associated with oral health also result in environmental constraints that impede coordination of care with other basic medical and developmental health services; foster varying systems of professional education and training, financing, staffing, service delivery, accreditation, licensure, and professional governance; and contribute to differing involvement in government health programs and sometimes profound differences in professional culture, mores, and norms. As a result, observations and recommendations based on the medical professions typically cannot easily be extrapolated to dental services.
Dental services are used with approximately the same frequency as medical services among adolescents (see Table 3-4). Orthodontic and aesthetic concerns generate dental visits, and dental pathologies are both common and often symptomatic among adolescents. This frequent contact gives dentists both opportunities and responsibilities to engage their adolescent patients in promoting salutary health behaviors, to detect eating disorders and risky behaviors, and to identify health conditions that require referral. Despite the frequency with which adolescents visit dentists, however, the dental profession and its pediatric specialty have until recently focused relatively little on adolescence beyond orthodontic issues.
While 80 percent of adolescents’ parents report that they obtained a dental visit in a year on the National Health and Nutrition Examination Survey (NHANES) in Table 3-4, overreporting of dental services is a well-recognized problem that is evidenced by discrepancies between federal surveys (Macek et al., 2002). This may result from the social expectation that all children should receive two preventive dental visits each year, an expectation that is not shared with medical care. Because of its more intensive surveillance approach, the Medical Expenditure Panel Survey (MEPS) is regarded as the most reliable national data source on adolescents’ use of dental services. MEPS reports that 53 percent of adolescents ages 6 through 20 received at least one dental visit in the year 2004, virtually unchanged from 51 percent reported in 1996 (Manski and Brown, 2007). A variety of recognized barriers to dental care, including coverage inadequacies, workforce shortages, and adolescents’ failure to use dental services (as occurs with medical services), combine to reduce utilization of dental care among adolescents. The percentages of adolescents who report dental care needs reflect compromised oral health status among the adolescent population: half of those aged 10–19 (53.5 percent) are reportedly in need of dental care (National Institute of Dental and Craniofacial Research, 1994, NHANES III data 1988–1994).