# Oral health disparities among children with special healthcare needs: a comparative cross-sectional study

## TL;DR

Children with special healthcare needs show worse oral health behaviors but have lower tooth decay compared to healthy children, highlighting complex factors affecting dental health.

## Contribution

Identifies unique oral health behaviors and predictors of caries in children with special healthcare needs versus controls.

## Key findings

- Children with SHCN showed higher resistance to toothbrushing and swallowing toothpaste compared to controls.
- Control group children had significantly higher caries experience despite better oral health behaviors.
- Group type and age were significant predictors of caries experience, explaining 12.2% of the variance.

## Abstract

Children with special healthcare needs (SHCN) often experience poorer oral health due to limitations in self-care, behavioral challenges, medical conditions, and reduced access to specialized dental services. This study aimed to assess and compare oral health behaviors, risk factors, and caries experience between children with SHCN and healthy controls, and to identify predictors of poor oral health outcomes.

In this cross-sectional study, 300 children (150 SHCN, 150 controls) underwent clinical examinations. Caries experience was assessed using the decayed, missing, and filled teeth (dmft/DMFT) indices, while oral hygiene status was evaluated with the Plaque Index and Gingival Index. Occlusal characteristics, dental trauma, and oral habits were also recorded. Behavioral assessment was performed using the Frankl Behavior Rating Scale (FBRS).

Children with SHCN demonstrated higher resistance to toothbrushing (42.7% vs. 6.7%, p = 0.001), more frequent swallowing of toothpaste (32.0% vs. 0%, p = 0.001), and a greater prevalence of habits such as mouth breathing (30.7% vs. 8.7%, p = 0.001). Interestingly, the control group showed significantly higher mean dmft scores (5.07 ± 3.56) compared to SHCN children (2.64 ± 4.22, p = 0.001). Regression analysis identified group (B = 2.44, p < 0.001) and age (B = − 0.125, p = 0.002) as significant predictors, explaining 12.2% of the variance. SHCN children exhibited distinct behavioral risk factors, while younger age was associated with higher caries experience.

Children with SHCN exhibited significantly poorer oral health behaviors, including resistance to brushing, swallowing toothpaste, and abnormal oral habits, compared to controls. Interestingly, despite these behavioral disadvantages, caries experience was higher in the control group, underscoring the multifactorial and complex nature of caries development. Group type and age emerged as significant predictors of dmft.