The Swedish out-of-home care children cohort (SweOHC) – evaluation of dental health and dental care

TL;DR

Children in out-of-home care in Sweden have worse dental health and receive fewer dental exams compared to other children, highlighting a need for improved healthcare access.

Contribution

This study provides the first comprehensive evaluation of dental health and care for children in out-of-home care in Sweden using national registry data.

Findings

Children in out-of-home care had significantly fewer regular dental examinations compared to controls.

They experienced more dental caries and emergency dental appointments than children not in care.

Despite increased dental exams after a 2017 law, children in care still lagged behind in dental care access.

Abstract

Children in out-of-home care (OHC) are at greater risk of ill health than other children in the community. The aim of this registry-based cohort study was to compare the oral health and dental care needs of children in OHC with those of other children in Sweden, by merging data from different Swedish registries. A further aim was to analyse whether children in OHC received more dental examinations after 2017, following implementation of a law requiring mandatory health evaluations prior to placement.

We identified an exposed cohort of Swedish children and young people, 0–19 years old, who had been placed in OHC 2010–2018 (N = 50,878), and an unexposed cohort, five times larger, matched for age, sex and county of residence (N = 254,380). During the study period, children in OHC received relatively fewer regular, scheduled dental examinations (4.21 vs. 4.88; p < 0.0001). More children entering OHC in 2018 received dental examinations (81.7%) compared with 2016 (76.6%) (p < 0.0001), but this was still lower than the proportion of controls. Moreover, during the study period, dental caries affected more teeth in children in OHC than in the controls (dft 6-year-olds 1.56 vs. 0.74; p < 0.0001, and DFT 12-year-olds 1.18 vs. 0.65; p < 0.0001), and they had more extractions and more emergency dental appointments than children who had never been in OHC.

Not only do children in OHC have poorer oral health than other children, they also receive less support from the dental health services. It seems that society has failed in its mission to ensure that children in OHC are not disadvantaged with respect to health and access to comprehensive healthcare. Thus, there is an urgent need for reappraisal of guidelines, legislation, and organizational models for providing dental care to children and adolescents in OHC.

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