Changes in Dental Visits and Oral Health for Children by Race/Ethnicity During the COVID-19 Pandemic

Abstract

Background:

The COVID-19 pandemic created new barriers to dental care, which may worsen oral health and exacerbate disparities. We quantified changes in children’s dental care receipt and oral health outcomes during the pandemic and examined differences among racial/ethnic groups.

Methods:

Using the National Survey of Children’s Health (163,948 child-observations during 2017–2021), weighted modified Poisson models were used to examine caregiver-reported dental care receipt (any dental care; preventive care) and adverse oral health outcomes (teeth in fair or poor condition; difficulty with toothaches, cavities, or bleeding gums) in 2017–2019 (pre-pandemic) compared to 2020 and 2021. Outcomes were examined within and across racial/ethnic groups.

Results:

Children from all racial/ethnic groups experienced declines in receipt of dental care, but there were limited changes in adverse oral health outcomes during 2020 and 2021. Pre-pandemic disparities in dental care persisted for Black children and Asian children when compared to White children. Hispanic children experienced larger increases in risk of both adverse oral health outcomes than White children in 2020 and in teeth in fair or poor condition in 2021.

Conclusions:

The pandemic did not create new disparities in receipt of dental care or oral health outcomes, but disparities in care persisted and the oral health of Hispanic children was differentially impacted.

Practical Implications:

Continued monitoring of dental visits and adverse oral health outcomes by race/ethnicity is critical to ensure all children have access to dental care. This information can help develop targeted interventions to improve children’s oral health, including for minoritized racial and ethnic groups.

INTRODUCTION

Despite increasing attention to the topic in the U.S., racial and ethnic disparities in children’s oral health and use of dental care persist. Rates of untreated dental caries in primary teeth and permanent teeth are generally higher among Black and Mexican-American children than White children. National Health and Nutrition Examination Survey (NHANES) data (2011–2016) shows that rates of untreated caries in primary teeth were about 20% for Mexican-American and Black children and about 10% for White children aged 2–11 years, with similar trends for adolescents’ permanent teeth.¹ Disparate access to dental care likely contributes to oral health disparities.² Although racial/ethnic disparities in dental care use among children declined from 2001 to 2016, disparities endured.³ In the 2016 Medical Expenditure Panel Survey (MEPS), Black and Hispanic children were 15.7 and 9.1 percentage points less likely, respectively, to receive dental care than White children.³ Importantly, differences in these measures across racial/ethnic groups varies by age, poverty status, and dentition-type,^1,3 complicating the measurement of disparities and development of tailored strategies to prevent adverse oral health outcomes.

Studies have reported declines in dental visits due to the COVID-19 pandemic,^4–7 yet our understanding of the pandemic’s impact on racial/ethnic disparities in children’s oral health and dental visits remains limited. The pandemic directly disrupted the dental care system through office closures, school closures (which paused school-based oral health care programs), and patients deferring care. As the pandemic emerged in the U.S. in March 2020, the American Dental Association (ADA) and Centers for Medicare & Medicaid Services (CMS) recommended delaying all non-essential healthcare procedures, including dental care.^8,9 Some children’s access to dental care was likely further disrupted because of loss of household income and insurance changes due to pandemic-related unemployment.¹⁰ These economic disruptions were disproportionally experienced by Black and Hispanic families,^11,12 highlighting a potential pathway for widening preexisting racial/ethnic gaps in receipt of dental care and oral health outcomes—as numerous studies have found an association between lower income and worse oral health outcomes.¹³ Additionally, children’s oral health outcomes may be impacted by receiving less preventive care, lack of timely acute care, and by changing dietary and hygiene behaviors during lockdowns.¹⁴ With continued disruptions over the course of the pandemic, the impact of these collective changes on children’s dental care and outcomes are unknown.

To our knowledge, only three repeated cross-sectional analyses using nationally representative data have examined the pandemic’s early impacts on children’s oral health and receipt of dental care.^15–17 Two studies found that children were less likely to receive dental care and more likely to have poor oral health in 2020 compared to 2019,^16,17 with the third finding continuing declines in dental care and oral health outcomes in 2021.¹⁵ Only the papers by Lyu and Wehby examined changes by race/ethnicity, finding that non-White children had greater risk of caregiver-reported teeth in poor condition in 2020 and 20201 compared to 2019.^16,15 Because these analyses grouped together all non-White children, it is unclear if effects vary among this heterogenous group.

This study extends prior research by examining the immediate (2020) and longer-term (2021) impacts of the COVID-19 pandemic on children’s receipt of dental care and oral health among children from different racial/ethnic groups. Using the nationally representative National Survey of Children’s Health (NSCH), we compared receipt of dental care and adverse oral health outcomes during 2017–2019 (pre-COVID) to 2020 and 2021. We compared outcomes over time within racial/ethnic groups, examined differences between racial/ethnic groups in each time period, and examined if groups were differentially impacted by the pandemic. We hypothesized that any pre-pandemic differences persisted through the pandemic and may have increased.

METHODS

This repeated cross-sectional observational study was approved by RAND Corporation’s institutional review board, and a waiver of informed consent was granted. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guidelines.

We used data from the 2017–2021 NSCH, which is a survey administered annually by the US Census Bureau on behalf of the Health Resources and Services Administration’s Maternal and Child Health Bureau, with the objective of collecting information on the health outcomes, health care access, and wellbeing of children.¹⁸ Surveys are available in both English and Spanish and can be completed online or on paper. We used 2017–2019 data to characterize the pre-COVID-19 period and 2020 and 2021 data to characterize the COVID-19 period. On March 13, 2020, the White House declared that COVID-19 was a national emergency.¹⁹ The three years of survey data in the 2017–2019 period were collected from June/July of the survey year to January of the following year. The 2020 NSCH data were collected from July 2020-January 2021 and 2021 NSCH data were collected from June 2021-January 2022.^20,21 We examined children aged 1–17 years because teeth typically erupt around 6 months of age. After exclusion of children with missing information on the variables of interest (see eFigure 1), we examined 165,982 children from 2017–2021, corresponding to a weighted population of approximately 67.7 million children. Summary statistics are presented by time period (pre-COVID [N=77,352], 2020 [N=40,614], and 2021 [N=48,016]) and shown in eTable 1.

Our dependent variables included two measures of receipt of dental care and two measures of adverse oral health outcomes. Two dichotomous measures of receipt of dental care indicated if a child, in the past 12 months, (1) saw a dentist for any kind of dental or oral health care and (2) saw a dentist for preventive dental care. We combined three survey items asking if a child had frequent or chronic difficulty in the past 12 months with bleeding gums, cavities or decayed teeth, or toothaches into a single dichotomous measure to identify if (3) a child had frequent or chronic difficulty in the past 12 months with any of these oral health problems (hereafter referred to as “any oral health problem”). Finally, the survey asked caregivers about the condition of each child’s teeth (response options: excellent, very good, good, fair, or poor). Based on the distribution of responses, we constructed a dichotomous measure indicating (4) the condition of the child’s teeth was described as fair or poor (“teeth in fair or poor condition”). Collectively, we refer to any oral health problem and teeth in fair or poor condition as “adverse oral health outcomes.” Although there are limitations to using caregiver-reported survey data, research suggests that a caregiver’s assessment of their child’s oral health is associated with actual need.^22,23

Our key variables of interest were time period (before and during COVID) and race/ethnicity. We constructed a three-level categorical indicator of time period to identify the time period before COVID (2017–2019; “pre COVID”) and compare this pre-pandemic period separately to each of the first two years of the pandemic (2020 and 2021). To examine outcomes across caregiver-reported racial/ethnic groups of each child, we used two survey items to construct our measure of race/ethnicity. We view racial categories as socially produced categories shaped by systems of power and privilege (as opposed to an innate, biological trait).^24,25 We operationalize this widely accepted view via our interpretation of the combined variable of race and ethnicity as a proxy for exposures to racism. We categorized children as Hispanic, non-Hispanic White (“White”), non-Hispanic Black or African American (“Black”), non-Hispanic Asian (“Asian”), and non-Hispanic other race groups. We grouped American Indian or Alaskan Native children, Native Hawaiian and Other Pacific Islander children, and children with two or more races into the “non-Hispanic other” category due to small cell sizes.

We report proportions for each binary outcome by race/ethnicity and by time period and changes in each outcome from pre-COVID to 2020 and pre-COVID to 2021 and compare these using Wald tests. We then estimated regression models:

• Stratified by race/ethnicity to examine changes in outcomes over time for each group, comparing outcomes in 2020 and 2021 to pre-COVID.

• Stratified by time period (pre-COVID, 2020, and 2021) to examine differences in outcomes in each time period for each racial/ethnic group compared to White children in order to determine if differences existed pre-COVID and if they persisted. We used White children as the reference group because they are the largest group and had the highest rates of dental visits and lowest rates of adverse oral health outcomes pre-COVID.

• Including an interaction of race/ethnicity and time period to compare the size of the changes in outcomes over time experienced by each racial/ethnic group to White children (e.g., comparing the change in dental visits for Black children from pre-COVID to 2020 to the change for White children from pre-COVID to 2020).

We estimated relative risk (RR) using modified Poisson models with standard errors corrected for the sampling strategy.²⁶ We used these models because they allow us to compare changes in RR across outcomes with different baseline rates. All models controlled for child age, gender, health insurance type, special health care needs, household income, and total children in the household and included state fixed effects to account for time-invariant state characteristics.

The pandemic had differential impacts on household income and insurance status by race/ethnicity,^11,12,24 and so controlling for them understates change across racial/ethnic groups. Therefore, we conducted a sensitivity analysis in which we excluded household income and insurance status from regression models to recapture the portion of the overall change in utilization and outcomes by race/ethnicity mediated through socioeconomic pathways.^11,12,24 All other controls mentioned above were included.

Survey weights were used to generalize estimates to the national population of children. We used Stata/MP statistical software, version 17.0 (StataCorp LLC) for analyses. We used a conservative 2-sided significance threshold of P<0.01 due to multiple hypothesis testing.

RESULTS

Pre-COVID, White children had the highest rates of caregiver-reported dental visits and preventive care and the lowest rates of teeth in fair or poor condition and any oral health problem (Table 1). Rates of dental visits ranged from 81.8% for White children to 76.5% for Asian children pre-COVID. Unlike caregiver-reported rates of dental visits, which began to rebound in 2021, rates of preventive care declined further in 2021. Racial/ethnic groups experienced declines of between 11.4% and 19.2% in preventive care when comparing 2021 to pre-COVID years.

Table 1.

Unadjusted Means for Caregiver-Reported Outcomes Over Time and by Race/Ethnicity

	Mean			Percent change from 2017–2019
	2017–2019	2020	2021	2020	2021
Child saw a dentist for any reason in past 12 months
White	0.818	0.790***	0.805	−3.5%	−1.6%
Hispanic	0.800	0.744***	0.760	−7.5%	−5.3%
Black	0.778	0.718**	0.730	−8.4%	−6.6%
Asian	0.765	0.689**	0.688	−11.0%	−11.2%
Other	0.808	0.737***	0.767	−9.6%	−5.3%
Child saw a dentist for preventive care in past 12 months
White	0.800	0.767***	0.717***	−4.3%	−11.6%
Hispanic	0.773	0.707***	0.694***	−9.3%	−11.4%
Black	0.748	0.672***	0.661***	−11.3%	−13.2%
Asian	0.739	0.669	0.620***	−10.5%	−19.2%
Other	0.787	0.717***	0.682***	−9.8%	−15.4%
Condition of child’s teeth was “fair” or “poor”
White	0.041	0.043	0.042	4.7%	2.4%
Hispanic	0.071	0.092	0.082	22.8%	13.4%
Black	0.072	0.076	0.069	5.3%	−4.3%
Asian	0.070	0.053	0.066	−32.1%	−6.1%
Other	0.048	0.055	0.040	12.7%	−20.0%
Child had frequent or chronic difficulty with an oral health problem in past 12 months
White	0.119	0.122	0.128	2.5%	7.0%
Hispanic	0.164	0.188	0.163	12.8%	−0.6%
Black	0.169	0.160	0.157	−5.6%	−7.6%
Asian	0.171	0.151	0.15	−13.2%	−14.0%
Other	0.132	0.150	0.133	12.0%	0.8%

Note: All outcomes were reported by caregivers. Means were generated using NSCH sampling weights to obtain nationally representative estimates. P-values were obtained from Wald tests comparing outcomes pre-pandemic to 2020 and pre-pandemic to 2021 for each racial/ethnic group.

^***P<0.001,

^**P<0.01.

In adjusted models, all racial/ethnic groups experienced significant reductions in dental visits and preventive care during the pandemic compared to pre-COVID rates (Table 2). Larger changes were observed for receipt of preventive care than for dental visits for all groups. The largest change for preventive care was observed in 2021 compared to pre-COVID for Asian children (RR= 0.85, 95% CI=0.79,0.91) and children categorized as non-Hispanic other (RR=0.85, 95% CI=0.81,0.90). No racial/ethnic groups had statistically significant changes in adverse oral health outcomes relative to pre-COVID.

Table 2.

Results of Modified Poisson Regressions Estimating the Risk of Caregiver-Reported Outcomes Compared to Pre-Pandemic Within Each Racial/Ethnic Group

	Relative Risk (95% CI)
	2020 (vs. 2017–2019)	2021 (vs. 2017–2019)
Child saw a dentist for any reason in past 12 months
White	0.95*** [0.94,0.96]	0.97*** [0.95,0.98]
Hispanic	0.93*** [0.89,0.96]	0.95** [0.92,0.99]
Black	0.91*** [0.87,0.95]	0.93** [0.89,0.97]
Asian	0.90** [0.84,0.96]	0.91** [0.86,0.97]
Other	0.91*** [0.87,0.95]	0.94** [0.90,0.98]
Child saw a dentist for preventive care in past 12 months
White	0.94*** [0.93,0.96]	0.88*** [0.87,0.89]
Hispanic	0.91*** [0.87,0.95]	0.90*** [0.86,0.94]
Black	0.89*** [0.85,0.93]	0.87*** [0.83,0.92]
Asian	0.90** [0.84,0.97]	0.85*** [0.79,0.91]
Other	0.91*** [0.86,0.95]	0.85*** [0.81,0.90]
Condition of child’s teeth was “fair” or “poor”
White	0.91 [0.78,1.05]	0.88 [0.77,1.01]
Hispanic	1.19 [0.92,1.53]	1.09 [0.84,1.41]
Black	0.93 [0.71,1.21]	0.85 [0.64,1.11]
Asian	0.72 [0.49,1.06]	0.90 [0.62,1.31]
Other	0.96 [0.67,1.36]	0.74 [0.53,1.04]
Child had frequent or chronic difficulty with an oral health problem in past 12 months
White	0.94 [0.87,1.02]	0.98 [0.92,1.06]
Hispanic	1.11 [0.94,1.31]	0.97 [0.83,1.14]
Black	0.90 [0.76,1.06]	0.88 [0.74,1.04]
Asian	0.87 [0.68,1.10]	0.88 [0.68,1.14]
Other	1.08 [0.88,1.33]	0.97 [0.81,1.18]

Note: All outcomes were reported by caregivers. Models were stratified by race/ethnicity and controlled for time, age, sex, insurance type, special health care needs, household income, and total children in the household and included state fixed effects to account for time-invariant state characteristics. Models were estimated using NSCH sampling weights to obtain nationally representative estimates with standard errors correcting for complex sampling design.

^**P<0.01,

^***P<0.001.

Some differences in receipt of dental care were observed for non-White children compared to White children in all periods (Table 3). Differences in receipt of dental visits and preventive care observed pre-COVID for Black children and for Asian children persisted compared to White children. Compared to a White child, a Black child’s relative risk of receiving preventive care was 5% lower pre-COVID (95% CI=0.92,0.97), 8% lower in 2020 (95% CI=0.88,0.96), and 6% lower in 2021 (95% CI=0.90,0.99). Compared to a White child, an Asian child’s relative risk of receiving preventive care was 8% lower pre-COVID (95% CI=0.88,0.95), 12% lower in 2020 (95% CI=0.82,0.95), and 13% lower in 2021 (95% CI=0.82,0.93). No significant differences in adverse oral health outcomes were observed for non-White children compared to White children in 2020 or 2021 (Table 3). Differences in adverse oral health outcomes for Asian children compared to White children present pre-COVID were not significant in 2020 and 2021. Compared to a White child, an Asian child’s relative risk of teeth in fair or poor condition was 62% (RR=1.62, 95% CI=1.23,2.14) higher pre-COVID and not significantly different in 2020 and 2021.

Table 3.

Results of Modified Poisson Regressions Estimating the Risk of Caregiver-Reported Outcomes Compared to White Children Within Each Time Period

	Relative Risk (95% CI)
	2017–2019	2020	2021
Child saw a dentist for any reason in past 12 months
White (reference group)
Hispanic	1.01 [0.99,1.03]	0.99 [0.96,1.03]	0.98 [0.94,1.01]
Black	0.96** [0.93,0.98]	0.94** [0.90,0.98]	0.93*** [0.89,0.97]
Asian	0.93*** [0.90,0.97]	0.88*** [0.82,0.94]	0.87*** [0.82,0.92]
Other	1.00 [0.97,1.02]	0.96 [0.92,1.00]	0.96 [0.92,0.99]
Child saw a dentist for preventive care in past 12 months
White (reference group)
Hispanic	1.00 [0.98,1.02]	0.99 [0.95,1.03]	0.99 [0.95,1.03]
Black	0.95*** [0.92,0.97]	0.92*** [0.88,0.96]	0.94 [0.90,0.99]
Asian	0.92*** [0.88,0.95]	0.88*** [0.82,0.95]	0.87*** [0.82,0.93]
Other	0.99 [0.97,1.02]	0.96 [0.92,1.01]	0.95 [0.90,0.99]
Condition of child’s teeth was “fair” or “poor”
White (reference group)
Hispanic	0.99 [0.83,1.17]	1.39 [1.08,1.80]	1.18 [0.93,1.50]
Black	0.85 [0.70,1.03]	0.9 [0.70,1.14]	0.82 [0.62,1.07]
Asian	1.62*** [1.23,2.14]	1.19 [0.80,1.77]	1.3 [0.87,1.96]
Other	0.85 [0.67,1.08]	0.94 [0.65,1.37]	0.72 [0.53,0.97]
Child had frequent or chronic difficulty with an oral health problem in past 12 months
White (reference group)
Hispanic	1.04 [0.93,1.15]	1.14 [0.98,1.32]	0.99 [0.86,1.15]
Black	0.94 [0.83,1.06]	0.87 [0.73,1.03]	0.87 [0.74,1.02]
Asian	1.42*** [1.21,1.66]	1.13 [0.90,1.43]	1.12 [0.88,1.42]
Other	0.93 [0.81,1.06]	1.03 [0.86,1.24]	0.91 [0.77,1.08]

Note: All outcomes were reported by caregivers. Models were stratified by time (pre-COVID, 2020, and 2021) and controlled for race/ethnicity, age, sex, insurance type, special health care needs, household income, and total children in the household and included state fixed effects to account for time-invariant state characteristics. Models were estimated using NSCH sampling weights to obtain nationally representative estimates with standard errors correcting for complex sampling design.

^**P<0.01,

^***P<0.001.

We also examined if racial/ethnic groups were differentially impacted by the pandemic, finding only significant differences for the trajectories of Hispanic children compared to White children. The estimated change since pre-COVID in the relative risk of teeth in fair or poor condition was 63% higher in 2020 (95% CI=1.20, 2.20) and 53% higher in 2021 (95% CI=1.13, 2.07) for a Hispanic child than for a White child (Figure 1, Panel C). The estimated change since pre-COVID in the relative risk of having any oral health problem was 30% higher (95% CI=1.08, 1.56) in 2020 for a Hispanic child compared to a White child (Figure 1, Panel D), but not significant in 2021.

Figure 1. Results of Poisson Regression Estimating the Comparative Risk of Dental Outcomes.

Note: Relative risks (RR) presented in the figures show the interaction between year and racial/ethnic group, allowing the comparison of the size of changes in outcomes over time experienced by each racial/ethnic group to White children (e.g., comparing the change in rate of dental visits for Black children from pre-pandemic to 2020 to the change for White children from pre-pandemic to 2020). All models controlled for time period, race/ethnicity, an interaction between time period and race/ethnicity, age, sex, insurance type, special health care needs, household income, and total children in the household and included state fixed effects to account for time-invariant state characteristics. Models were estimated using NSCH sampling weights to obtain nationally representative estimates and standard errors correcting for complex sampling design.

There were no changes in significance of our findings in race-stratified models excluding controls for income and insurance status. However, when we excluded these controls and examined models estimating differences across race/ethnic groups compared to White children, we found significant differences for Hispanic children compared to White children, both in receipt of care and adverse oral health outcomes (eTable 2). The size of noted disparities in receipt of care compared to White children widened in the absence of these economic controls, including among children categorized as non-Hispanic other in 2020 and 2021. We also observed additional differential changes compared to White children in the trajectory of adverse oral health outcomes for Black children in 2021 and Asian children in 2020 (eTable 3).

DISCUSSION

In this study, we found that children from all racial/ethnic groups experienced caregiver-reported declines in receipt of dental care during the COVID-19 pandemic. Unlike caregiver-reported rates of dental visits, which began to rebound in 2021, caregiver-reported rates of preventive care declined further in 2021. This finding may reflect families seeking dental treatment for oral health issues, rather than a return to routine dental visits, which are important for obtaining preventive care and addressing issues in a timely manner. We did not observe a significant change in 2020 and 2021 of caregiver-reports of adverse oral health outcomes, measured as reporting their child’s teeth in fair or poor condition or their child having frequent or chronic difficulty with toothaches, cavities, or bleeding gums. As oral health problems may take time to develop, and may be a lagging indicator of reduced dental care, children’s oral health outcomes by race/ethnicity should continue to be monitored as post-pandemic norms are established.

Importantly, the gaps in dental care reported by caregivers of Black and Asian children compared to White children observed before the pandemic persisted. The persistence of these gaps in care highlights the need for continued efforts to address disparities in access to oral health care. Attention to this is especially important since prior research documented that the disparity in dental visits compared to White children had narrowed, with declines in this gap by 10 percentage points for Black children and by 14 percentage points for Asian children from 2001 to 2016.³ Furthermore, Hispanic children experienced greater increases in adverse oral health outcomes during COVID than White children.

Some of the changes we observe during the pandemic likely reflect differential impacts of the pandemic on household income and insurance status by race/ethnicity.^11,12 After removing household income and insurance controls in the sensitivity analysis, we find that all minoritized racial/ethnic groups had significantly lower risk of receiving dental care and that Hispanic children had significantly higher risk of adverse oral health outcomes than White children in 2020 and 2021. In essence, our sensitivity analysis illustrates the added racial/ethnic gap in receipt of care and adverse oral health outcomes that are mediated through economic pathways.

Prior interventions over the last 40 years to improve children’s oral health and access to care have primarily focused on expanding insurance eligibility and dental benefits.^27,28 Our results show that despite policy interventions during the COVID-19 pandemic that temporarily raised enrollment in Medicaid (which includes dental coverage for children), this was not sufficient to prevent declines in dental care observed across all racial/ethnic groups in 2020 and 2021. Receipt of dental care may continue to decline as children lose Medicaid coverage with dental benefits due to the end of the COVID-19 Federal Public Health Emergency and accompanying mandated continuous Medicaid eligibility. As of September 2023, at least 6.5 million Medicaid enrollees have been disenrolled.²⁹ Predictive modeling from the HHS Assistant Secretary for Planning and Evaluation Office of Health Policy suggested that Black and Hispanic individuals were at highest risk of losing Medicaid coverage despite remaining eligible,³⁰ which highlights a potential pathway for disparities in dental care and ultimately outcomes to worsen or emerge.

There are several limitations to our analysis. Although we control for time-invariant state-level characteristics, there may be differences across states in pandemic severity over time and healthcare system responses. Additionally, we used caregiver-reported measures of oral health and not objective clinical measures. Prior research has shown that caregiver reports have high concordance with clinical measures of tooth condition,^22,23 but low-income and Hispanic caregivers may underestimate their child’s need for dental care.³¹ Also, we examined how our findings changed with and without adjustment for economic controls, but we did not assess interactions of variables with race/ethnicity. While racial/ethnic minoritized children generally have worse oral health and are less likely to receive dental care than White children, outcomes vary across by age, poverty status, and dentition-type.^1,3 Thus, further research is needed to examine pandemic changes by race/ethnicity across these characteristics. Our findings may not be generalizable to all children because we combined small population subgroups together, which highlight the need for additional study of children from minoritized groups that we were not able to analyze separately. Finally, we include data from 2020 and 2021, but highlight a need for future studies to examine whether the low rates of utilization that we observed continue and if outcomes may subsequently decline.

CONCLUSION

We found reductions in caregiver-reported receipt of dental visits and preventive care for children in all racial/ethnic groups, but limited changes in oral health outcomes during 2020 and 2021 compared to pre-pandemic. The COVID-19 pandemic did not appear to create new disparities in receipt of dental care or oral health outcomes, but disparities in receipt of dental care persisted for Black and Asian children. Further, Hispanic children experienced larger increases in risk of both adverse oral health outcomes than White children in 2020 and in teeth in fair or poor condition in 2021. Continued monitoring of trends in dental visits and oral health outcomes by race/ethnicity is important to ensure all children have access to dental care. This information can help to enact effective interventions to improve the oral health of children, particularly among those from minoritized racial and ethnic groups.