Foster care requires the guardian to focus on a child’s total health, which includes oral health. A majority of foster children come from environments affiliated with violence, abuse, neglect, or a combination of those factors. Traumatic dental experiences and poor access to dental care are the main contributors to children having unmet oral needs upon initial entry into the foster system. Research shows that dental neglect and periodontal disease are common disorders found among these children. Almost 40% of foster children display dental disease. Untreated dental diseases can cause long-term and potentially permanent damage to overall health. This validates the importance of oral care for neglected children and the role foster families play in restoring and maintaining the oral health of the children they are caring for. Based upon this background information, this paper will review current literature to determine if the oral health of children improves after entering the foster care system.
Dental decay and poor oral health are public health concerns among children who are neglected and in low-income familial circumstances. Dental diseases in a foster child are often undiagnosed and untreated until after the child enters the foster care system. Prior to entering the foster care system, the child may have been neglected. Dental neglect is the result of failure of a caregiver to prevent oral disease, failure of a caregiver to become educated on the need for dental care, and failure of the caregiver to schedule and attend preventive dental appointments for the child. Poor oral hygiene, bad breath, decay, infections, and gum disease may develop with dental neglect. Access to alcohol, illegal drugs, and unhealthy food options may also lead to poor oral health. It is important to note that dental neglect may also result from financial and transportation barriers. The longer children are in the care of neglecting guardians, oral diseases become more extensive and expensive to restore. After entering the foster care system, neglected children are removed from many of the circumstances that led to dental disease, which may be conducive to improving oral health.
Many barriers prevent foster children from receiving adequate dental care. Health care in the foster system is often crisis oriented, rather than focused on preventative measures, such as routine dental visits. Dental care is not given importance within the foster care system. Oral assessments are not common when a child is admitted into the system in comparison with physical or mental health assessments. A study conducted in 2014 focused on factors associated with dental utilization and expenditures for children within the Washington foster care system. The study concluded that only 43% of children had a dental visit. This is a problem that needs to be addressed within foster care systems and homes. Some foster families lack the finances to pay for dental services, have no means for transportation to dental appointments, and insufficient knowledge of the importance of oral care. Additionally, due to moving in and out of homes within the foster system, the children may not have an established dental provider. The dental records of these children may be incomplete or entirely unavailable. Without dental records, it may be hard to know when the last dental visit was or what problems were present in the mouth in order to follow up with dental care as a child is placed into a home. Foster children may exhibit fear of pain and authority, thus leading them to respond negatively to dental treatments and other attempted restorative work.
Dental providers may have concerns about treating children who are in the foster system. They may speculate how they will be compensated for the work provided and not know who is legally able to sign consent for treating the child. Dental providers may decline treating a child if legal consent for treatment cannot be obtained. Foster children may exhibit fear of pain and authority, thus leading them to respond negatively to dental treatments and other attempted restorative work. These barriers could allow dental diseases to progress.
Research supports that foster parents possess the capability to help shape the oral health of the children that they are caring for. A qualitative study explored the impact that foster families had on the oral health of children who had just been placed into their home. The study focused on the foster parents’ knowledge of oral health and attitudes towards dental care. The 12 foster parents in the study saw oral health as a crucial aspect of their foster child’s total wellbeing. The study concluded that foster parents are integral in the restoration and maintenance of the oral health and the total wellbeing of neglected children.
While this study found positive improvements in oral health when the child entered the foster system, these results do not appear to be universal. While it is true that neglected children are removed from the factors that initially contributed to dental disease, the significance and seriousness of dental care is often pushed aside within the foster system. Therefore, the improved oral health of children after entering the foster care system is essentially circumstantially based. Foster parents have the ability to influence children’s oral health and total wellbeing in a constructive and positive way, however there are factors on both ends that could limit the improvement of oral health.
There are ways to improve the odds of attaining improved oral health for foster children. Collaboration between dental professionals and the foster care community is vital in providing appropriate care for the children within the foster care system. Prevention of dental diseases is one key component. Education and daily oral care are inexpensive and effective methods to reduce dental disease prevalence. Dental professionals could serve as educators to foster families’ community and social workers by holding informative meetings and programs regarding dental visits and oral care. By improving access to oral hygiene products and informative dental programs, disease management and elimination is achievable. Studies have shown that early access to preventive dental services can prevent costly future dental conditions. Access to appropriate dental care can improve if dentists offer subsidized dental care. This has the potential to make dental care affordable to the foster community and prioritize oral health for children who are in need of dental care.
Acknowledgements
This research was supported by Emily R. Holt, RDH, MHA, CDA. The authors are immensely grateful for her advice and encouragement throughout the publication process.
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