Inequalities in the dental health needs and access to dental services amongst looked after children in Scotland: a population data-linkage study

Background: There is limited information on the health needs and service access among children and young people who are looked after by the State. The aim of this study was to compare dental treatment need and access to dental services (as an exemplar of wider health and wellbeing concerns) among children and young people who are looked after with the general child population. Methods: Population data linkage study utilising: national datasets of social work referrals for “looked after” placements, the Scottish census of children in local authority schools, and NHS dental health and service datasets. Results: 633204 children in publicly funded schools in Scotland during academic year 2011/12, of whom 10927 (1.7%) were known to be looked after during that or a previous (from 2007/08) year. The children in the LAC group were more likely to have urgent dental treatment need at 5-years of age: 23% vs 10% (n=209/16533), adjusted (for age, sex, and area socioeconomic deprivation) odds-ratio 2.65 (95%CI 2.30, 3.05); were less likely to attend a dentist regularly: 51% vs 63% (n=5519/388934), 0.55 (0.53, 0.58); and more likely to have teeth extracted under general anaesthetic: 9% vs 5% (n=967/30253), 1.91 (1.78, 2.04). Conclusions: Looked after children are more likely to have dental treatment needs and less likely to access dental services even when accounting for sociodemographic factors. Greater efforts are required to integrate child social and health care for looked after children and to develop preventive care pathways upon entering and throughout their time in the care system.