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. 2021 Dec 18;8(1):48–55. doi: 10.1177/23800844211059072

Opposition to Early Dental Visit by Dentists: A Qualitative Study on Mothers’ Social Networks

JM Burgette 1,2,3,4,✉, ZT Dahl 4,5, RJ Weyant 4,6, DW McNeil 4,7,8, B Foxman 9, ML Marazita 4,5,10,11
PMCID: PMC9772961  PMID: 34927473

Abstract

Objectives:

To examine whether information that mothers received from dentists in their social network was consistent with professional recommendations for the first dental visit at age 1 y.

Methods:

We performed a cross-sectional qualitative study on mothers in Pennsylvania and West Virginia from 2018 to 2020 to explore how their social networks influence their children’s dental service utilization. In-person, semistructured interviews were conducted with 126 mothers of children ages 3 to 5 y. Qualitative data were transcribed, coded, and analyzed using NVivo 12. Two investigators analyzed data using grounded theory and the constant comparative method.

Results:

Over half of mothers reported a professional relationship with a dentist as part of their social network on children’s oral health. Mothers described the following themes: 1) mothers contacted dentists in their social network for child dental information and to schedule their child’s first dental visit, 2) mothers described dentists’ justifications for the timing of the first dental visit older than age 1 y, 3) mothers described the impact of the dentist declining to see her child, and 4) after the dentist declined to see her child, some mothers did not comply with the dentist’s recommendation of delayed child dental visits because they were given alternative information that encouraged early dental visits.

Conclusions:

Our findings indicate a need for dentists to reinforce mothers’ dental-seeking behavior for young children and adhere to recommendations on the age 1 dental visit.

Knowledge Transfer Statement:

Qualitative data on mothers’ social networks show that dentists play a key role in access to early dental visits, particularly when dentists decline to see the mother’s child for visits.

Keywords: help-seeking behavior, refusal to treat, mothers, dental care for children, social networking, dentist-patient relations

Introduction

Early dental care can promote a healthy lifestyle to prevent dental caries and acclimate both the child and the caregiver to the experience of dental care (National Institutes of Health [NIH] 2001; Institute of Medicine and National Research Council of the National Academies 2011; Institute of Medicine of the National Academies 2011; Marinho et al. 2013; Weyant et al. 2013; Frieden et al. 2014; Hagan et al. 2017; American Academy of Pediatric Dentistry [AAPD] 2018a, 2018b, 2019; American Dental Association [ADA] 2019). The use of preventive dental services in particular, such as topical fluoride, is effective at preventing dental caries in young children (NIH 2001; Institute of Medicine of the National Academies 2011; Weyant et al. 2013; Marinho et al. 2013). In addition to being effective at reducing the prevalence of dental caries, early preventive dental care is cost-effective (Savage et al. 2004; Lee et al. 2006; Weintraub et al. 2001; Beil et al. 2012; Nowak et al. 2014).

For the past 25 y, the AAPD has recommended that children see a dentist at age 1 or at the emergence of the first tooth (AAPD 2018a, 2018b, 2019). The ADA and American Academy of Pediatrics also recommend an age 1 visit (Hagan et al. 2017; ADA 2019). However, pediatric and general dentists are often unwilling to see very young children in their dental practice (Mofidi et al. 2002; Malcheff et al. 2009; Garg et al. 2013). Garg and colleagues conducted a cross-sectional survey of 2,311 general dentists affiliated with Medicaid managed care in New York City and found that less than 50% of general dentists saw children younger than 2 y (Garg et al. 2013). They found that “discomfort with small children” was the most common reason for not seeing young children (Garg et al. 2013). Even among pediatric dentists, Malcheff and colleagues found that only 53% of 2,157 American pediatric dentists surveyed performed infant oral health examinations for 1-y-old patients (Malcheff et al. 2009). According to a qualitative study using focus groups, mothers with children under 3 y old in North Carolina had difficulty finding a dental provider who would see their child (Mofidi et al. 2002). It is unclear whether dentists’ discomfort with providing care to very young children translates into communication with families and thereby mothers’ difficulty obtaining a dental visit for her child.

Social network analyses have been used to enhance our understanding of adult dental health (Maupome and McCranie 2015; Maupome et al. 2016) but not children’s oral health. Pullen and colleagues found an association between social network characteristics (e.g., talked with their connections about dental issues, perceived greater dental knowledge among their connections, had more connections who saw a dentist in the past year) and increased dental utilization by Mexican American adults (Pullen et al. 2018). Currently, there is no published research on the connection between a mother’s social network and dental utilization for her child.

This study fills this gap by examining how mothers’ relationships affect their dental care-seeking behavior for their child, specifically whether dentists were influential members in mothers’ social network related to child dental utilization. The purpose of this qualitative study was to examine whether information that mothers received from the dentists in their social network was consistent with professional recommendations that children see a dentist at age 1.

Methods

Study Design and Setting

We performed a cross-sectional qualitative study on mothers’ social networks and children’s oral health–related behaviors. A qualitative approach was used because there is little research on the influence of mothers’ connections on their child’s oral health, and this research design is appropriate to provide an in-depth understanding of both the types of relationships and information shared among relationships related to children’s oral health. Over a 2-y period (2018–2020), 3 trained interviewers in Pennsylvania and West Virginia recruited a community-based sample of mothers of children aged 3 to 5 y who were currently enrolled in a Center for Oral Health Research in Appalachia cohort (COHRA2). This study was approved by the SMART institutional review board mechanism with the University of Pittsburgh as the primary site and West Virginia University as the referring site. This study was conducted and reported in accordance with guidelines from the Standards for Reporting Qualitative Research. Informed consent was obtained from all mothers.

The COHRA2 parent study is described in detail elsewhere (Neiswanger et al. 2015). Briefly, COHRA2 recruited 1,000 healthy, adult (>18 y old), English-speaking pregnant White women living in 2 geographically distinct, low socioeconomic regions of northern Appalachia: the state of West Virginia and Pittsburgh, Pennsylvania. Mothers and infants are followed via telephone interviews and in-person visits for 6 y or more.

Qualitative Study Sample

The sample for this study was a subsample of COHRA2, which we will refer to going forward as the “qualitative study sample.” All COHRA2 mothers of children aged 3 to 5 y were eligible. Participants who met the eligibility criteria in both Pittsburgh and West Virginia COHRA2 cohorts were contacted at random. By age 3, most children have a full set of primary teeth, and the mother is often the primary caregiver with respect to diet, hygiene, and dental utilization. Participants were recruited via email, phone, COHRA2 newsletters, and at their scheduled COHRA2 study visits. Our final sample of 126 mothers was finalized after we reached theoretical saturation on the major themes (Patton 2002).

Collection of Qualitative Social Network Data

Three trained interviewers administered a 1-h, in-person, audio-recorded semistructured qualitative interviews to participants. The semistructured qualitative interview included open-ended questions about the mother’s relationships that affect her child’s dental utilization, diet, and hygiene. To elicit the members of the mother’s social network on child oral health, the mothers were asked, “Please provide the names of people that you have talked to in the last 6 months about your child’s mouth and teeth. These may be people with whom you discussed issues about your child’s dental health, people in your life that you feel you can count on for help when your child has dental health problems, people who help keep your child’s mouth and teeth healthy, and people who can make it more difficult for you to keep your child’s mouth and teeth healthy.” Then mothers were asked about how each named person affected their child’s oral health. Child play space was provided during the interview, and participants were given a $50 gift card and child picture book and toys. Additional sociodemographic and child dental measures were obtained from the larger COHRA2 study.

Data Analysis

Qualitative data were transcribed by a commercial company specializing in transcription (TranscribeMe). Research staff verified all transcripts for accuracy with the audio-recordings. Transcriptions were imported into NVivo 12, a software package that allows qualitative analysis of textual data (QSR International). The principal investigator (JMB) and a research assistant (ZTD) conducted a systematic examination of the text by analyzing codes and associated quotes to identify patterns until themes were identified using a grounded theory approach. Grounded theory is an inductive approach in which ideas or theories emerge from the participants themselves (Patton 2002). It provides a systematic procedure for shaping and handling rich qualitative data, and therefore, it is well suited for studying individual processes, interpersonal relations, and the reciprocal effects between individuals and larger social processes (Patton 2002). Analysis at all stages was guided by the constant comparative method (Boeije 2002), which uses iterative comparisons within and between analytic cases in order to understand the phenomena under study. Memos were written while coding and used to aid in the final data analysis. Field notes and feedback from the trained interviewers were used to aid in data interpretation, resulting in cross-location comparisons between the 3 interviewers performing data collection and therefore triangulation. Themes will be cited with quotes from the participants.

The principal investigator is a clinician-scientist specializing in pediatric dentistry and health services research. The research assistant has over 8 y of experience conducting primary data collection on mothers with young children related to children’s oral health.

Results

The 126 study participants in this qualitative sample were mothers of children aged 3 to 5 y who resided in West Virginia (n = 66) and Pittsburgh, Pennsylvania (n = 60). In data obtained from the parent COHRA2 study, the large majority of mothers identified as non-Hispanic White and one-third of the mothers had a bachelor’s degree (Table). Over two-fifths of mothers reported a family income under $50,000 and over three-fifths had private dental insurance for the child in the study (Table). The average age of the mothers’ children was 4 y (Table). The mothers reported that two-thirds of their children had received preventive dental care from a dentist (Table). Over one-fifth of children had dental caries experience as determined by clinical exam in the parent COHRA2 study (Table).

Table.

Characteristics for Mothers Who Participated in the Semistructured Interviews on Mothers’ Social Networks and Child Oral Health (N = 126).

Family Sociodemographic Characteristics Value
Child age, mean (SD), y 4.77 (1.02)
Child dental insurance
 Private 77 (61)
 Public 18 (14)
 None 31 (25)
Mother’s education
 ≤ High school or equivalent 18 (14)
 Some college or associate’s degree 35 (28)
 Bachelor’s degree 38 (30)
 Master’s, doctorate, or professional degree 35 (28)
Mother’s race and ethnicity
 Non-Hispanic White 120 (95)
 Hispanic White 5 (4)
 Other 1 (1)
Family income
 Under $50,000 52 (41)
 $50,000–99,999 47 (37)
 $100,000 or more 20 (16)
 Missing 7 (6)
Child dental information
 Child preventive dental utilization 87 (69)
 Dental caries experience (d2ft >0)a 29 (23)
Dentist named as part of the mother’s social network 67 (53)
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Values are presented as number (%) unless otherwise indicated.

a

d2ft is the number of decayed (cavitated) or restored primary teeth. d2 refers to the depth of the decay as limited to the enamel layer of the tooth.

Although unsolicited, mothers volunteered to discuss their relationship with a dentist as a member of their social network for their child’s oral health in over half of the interviews (n = 67) (Table). In all but 2 cases, the dentists were not social acquaintances but dental professionals who mothers knew in the context of a professional dental health care relationship. With the exception of 3 participants (n = 64), all mothers named only 1 dentist in their social network.

Four main themes emerged from the mothers’ experience seeking dental care for their children from dentists: 1) mothers contacted dentists in their social network for child dental information and to schedule their child’s first dental visit, 2) mothers described dentists’ justifications for the timing of the first dental visit older than age 1, 3) mothers described the impact of the dentist declining to see her child, and 4) after the dentist declined to see her child, some mothers did not comply with the dentist’s recommendation of delayed child dental visits because they were given alternative information that encouraged early dental visits.

Seeking Child Dental Information and Visits from Dentists

Mothers often reported that their dentist told them that their child did not need a dental visit until age 3. One mother stated the following: “My dentist said they wouldn’t take him ’til he was three.”

The following quote is from a mother who sought a first dental visit for her child to receive preventive dental care. She received the same message from each dentist that her child was not appropriate for a dental visit until age 3: “I tried my previous dentist . . . I tried the dentist we all go to now, and I tried one other specific pediatric dentist by our house. There were three of them; and they all said, ‘Not ’til age three.’” After contacting multiple dentists beyond her existing dental provider, including both general and pediatric dentists, the mother was unable to find a dentist who would see her child before age 3. Her experience illustrates how a caregiver can be unsuccessful at obtaining dental care for a child when every dental provider that she contacts is not willing to see young children.

Some mothers who successfully scheduled a dental appointment were told upon arrival that their child was too young to be examined and the family should wait until the child was older. For example, one mother stated, “I took her to her first dental appointment when she was two, but they said she was too small and they couldn’t do anything. So, I had to wait.”

Dentists’ Justifications for the Timing of the First Dental Visit

Overall, mothers stated that the dentists gave 2 justifications for why their child should wait until the child is older for a dental exam. The first justification was that the child needed all primary teeth erupted. A mother stated, “What they were telling you at the time, ‘Wait until they had most of their teeth.’ I guess their two-year molars.” This benchmark aligns with the age 3 visit depicted in the first theme, since most children will have fully erupted second molars by their third birthday.

The second justification for delaying child dental care was that young children cannot cooperate with the dentist to perform a dental exam. One mother recalled that she “asked [the dentist], ‘When do you take a kid to the dentist?’ and he said, ‘Honestly, there’s no real point before about age three. Until they can lay there with their mouth open, there’s really not the point to do it.’ She was three before I took her to her first official dentist. He said ‘You’re smart. If there’s an issue, take her, but up until then, don’t worry about it.’” In this quote, the dentist is willing to schedule a first dental visit only when the child can lie still in the dental chair or “if there is an issue.” The recommendation for starting dental health-seeking behavior for children as episodic transfers the responsibility of detecting dental problems onto the mother. According to this advice, the first dental visit and establishment of a dental home would be delayed until the mother examined her child’s mouth and found a problem.

Impact of Dentist Declining to See the Child on the Mother

The mother’s relationship with the dentist was negatively affected if the dentist declined to see the child for a first dental visit. For example, one mother recalled, “He was my dentist when I was a little kid, and it shocked me that he wouldn’t, he did not, want to see her. Like, at all! He was like, ‘You have to bring her back when she’s four.’” When the dentist declined to see her child, the mother expressed shock and frustration.

For the mothers who were aware of the professional recommendation for the age 1 dental visit, they expressed confusion when the dentist declined to see their child at the age recommended by the policy. One mother explained, “It’s a little confusing, because if these are the recommendations, why are we not going by them? [My son] definitely had teeth long before we actually could get him an appointment at the dentist.”

When one mother’s dentist declined to see her child, she asked the dentist to engage in a known behavioral method (i.e., exposure) used for children in the dental setting: desensitization (AAPD 2020). Desensitization to the dental setting is recommended by the AAPD to diminish emotional responsiveness to a negative or aversive stimulus after progressive exposure (AAPD 2020). The mother stated, “I remember saying to [the dentist], ‘Could you humor me and just let her sit in the chair and like look in her mouth or something? Because the longer you put this off, the more you’re going to freak her out.’ But they made me wait, literally, until her third birthday. I was just concerned, because I wanted her not to be scared of [dentists]. I wanted her to be comfortable.” This mother was determined to seek an early dental visit for her child and argued that the early care would foster a less stressful dental experience. Her concern for her child’s oral health became a source of anxiety and frustration because her goal of building a positive relationship between her child and the dental staff was blocked by the dental provider.

When this mother was finally able to obtain a dental visit for her child, she advocated for the dentist to reinforce the same oral health education messages and practices that she was encouraging at home. She stated,

They were like “Everything looks good. She’s fine. She’s brushing okay.” I think I was more of a crazy parent, about like, “Are you sure she’s brushing enough? Because she doesn’t brush enough, sometimes she’s not brushing for two days. You know, I’m struggling.” She was still sucking her binky at the time. She was almost three and a half, we went one time to the dentist while she still had her binky and that was something that I grabbed the dentist and was like, “Dude, I need you to tell her that this is not good. Because we keep telling her this is not good.” And I brought up the crossbite. When the dentist talked to [her] about brushing. Oh my gosh! She’s brushing twice a day, every day, for like two weeks.

This mother had questions for the dentist and wanted to discuss changes that would improve her child’s dental health and development. She asked the dentist to be a partner in educating her child about optimal oral habits for both toothbrushing and nonnutritive sucking, recognizing that the dentist would have an influence on her child’s behavior and cooperation. These questions and concerns about preventing dental caries and tooth malalignment were built for over 2 y from when she first attempted to schedule her child’s dental visit with her dentist, making her feel like she was “a crazy mom” for wanting more from the first dental visit than “she’s fine.”

Noncompliance with the Recommendation for Delayed Dental Care

After dentists declined to see their children for a first dental visit, the mothers in this study had different reactions. Some mothers followed the dentist’s advice and waited until their child was older. Other mothers did not comply with dentists’ recommendations to postpone the child’s first dental visit because they were often given alternative information on the availability of child dental services.

One source of information on child dental services was from the child’s dental insurance. A mother stated,

[My son] went to the dentist the first time because the insurance company sent us a paper in the mail saying that they can now be seen whenever they just turn a year, or with their first tooth. So that’s why he started going early. . . . We seeked out a different dentist that he goes [to] somewhere else now. He’s been going since he was two. But, some parents may have just been like, “Ah I’m just going to wait till three, then.” I was like, “No, my insurance covers it. He’s going when he’s two!” And he loves going to the dentist. Yeah. So, it’s great it worked out. We did the right thing.

As the mother acknowledges, it is easy to comply with the dentists’ recommendation and wait until age 3 for the first dental visit because it requires less work by the caregiver. This mother expressed satisfaction that she had persevered in obtaining an early dental visit for her child motivated by her dental insurance coverage.

Another reason why some mothers chose not to comply with the dentist’s recommendation about delayed child dental visits is that they received alternative information about the timing of the first dental visit from friends and family. To illustrate this dynamic, one mother heard two others discussing how their dentists told them to wait until age 3 before taking their children to the dentist. She had recently overcome the same barriers to scheduling a first dental visit for her own child and referred the other mothers to her child’s dentist by stating, “I think most people were told by their dentist that three was the age they would be accepting. And, I said, ‘Oh no, they can start going at two! Here’s a better option for you if you have one of these close to you, that children’s dentistry.’”

Discussion

Results of this qualitative study of 126 mothers of children aged 3 to 5 y provides new insights into why very young children may not see at dentist as recommended by professional organizations. Over half of the mothers in the study named at least one dentist as a member of their social network that influenced the search for their young child’s dental care. However, many dentists did not encourage early dental visits. Notably, they actively discouraged it. This is a missed an opportunity for anticipatory guidance to prevent dental caries and possibly diagnose and treat dental caries. Dentists should reinforce mothers’ efforts to seek care for their children at a young age and be the standard bearers for promoting adherence to the established recommendations.

The results of this study were consistent with the previous literature on the low rates of dental utilization by young children in the United States (Griffin et al. 2014). Only 7.6% (95% confidence interval [CI], 6.0–9.7) of children from birth to age 2 used dental care in 2009 (Griffin et al. 2014). For preventive services in particular, only 1.7% (95% CI, 1.1–2.5) of children from birth to age 2 had a preventive dental visit in 2009 (Griffin et al. 2014). The percentage of young children using dental care or receiving a preventive dental service annually was persistently low from 2003 to 2009 (Griffin et al. 2014). The mothers in this study faced barriers to accessing dental care for young children that contribute to these statistics.

Mothers described “attempt exhaustion” when trying to schedule a dental visit for their child due to pushback from dental offices. This result is consistent with previous literature that both general and pediatric dentists who are available to treat young children may choose not to do so (Edelstein 2000; Mofidi et al. 2002; Seale and Casamassimo 2003; Smith and Lewis 2005; Malcheff et al. 2009; Institute of Medicine and National Research Council of the National Academies 2011; Garg et al. 2013). In addition, there is a limited supply of dentists who are trained, available, and willing to treat young children (Institute of Medicine and National Research Council of the National Academies 2011; Kranz et al. 2014; ADA 2020). The international literature also supports this finding, with a study by Gussy and colleagues (2006) documenting a reluctance by dental professionals in the United Kingdom to assert a primary role in the oral health of preschool-aged children.

One rationale as to why dentists decline to provide dental care to young children, even when covered by dental insurance (Hom et al. 2013), is that early dental visits can be a difficult experience for both the families and the dentist. Providing dental care to young children can be particularly challenging if the dentist did not receive appropriate training on infant oral health during their predoctoral dental education. The results of this study are a call to action for mandatory infant oral health training in predoctoral dental curricula.

In addition to barriers to self-efficacy to perform early dental visits as a result of insufficient training, another rationale for why dentists may decline to provide dental care to young children is that they may be unaware of, be unfamiliar with, or lack agreement with the AAPD, ADA, and American Academy of Pediatrics professional guidelines on the recommend age 1 dental visit (Cabana et al. 1999; Hagan et al. 2017; AAPD 2018a, 2018b, 2019; ADA 2019). In our first theme, mothers described that they received information from their dentist on the lack of need for an early dental visits, which is distinct from the dentists’ lack of willingness to perform the visit. The lack of need for an early dental visit may be an indication that the dentist is not aware of the guidelines, has an incorrect subjective interpretation of the guidelines, or disagrees with the guidelines. Future research on dentists’ perspective—versus the mothers’ perspective—can clarify the reasons for not complying with early dental visits in order to develop appropriate interventions.

Notably, mothers described that dental insurance coverage for children under age 3 motivated early child dental visits even when the dentist declined to see the child. Consistent with the literature, dental insurance, such as Medicaid, generally has a positive impact on preventive dental utilization for children in the United States and is associated with increased dental utilization (Lewis et al. 2007; Institute of Medicine and National Research Council of the National Academies 2011; Institute of Medicine of the National Academies 2011). However, dental insurance was not a panacea for access to dental care for families with children under 3 y old in this study.

Our fourth theme, which found that mothers received information from family and friends about early dental visits, was consistent with previous work that caregivers sought information on the first dental visit from members of their social network other than of dentists (Barbra Aved Associates 2016). “First 5 Sacramento” interviewed over 150 caregivers about barriers to child dental visits (Barbra Aved Associates 2016). Caregivers reported that they were advised by family members, physicians, and health plans to wait until their child was older for the first dental visit because older children behave better for dental care (Barbra Aved Associates 2016). In contrast, we found that mothers listened to advice from family and friends in their social networks to pursue early dental visits, even when their dentists recommended delayed dental care. In addition, our findings differed from “First 5 Sacramento” in that mothers sought advice from their dentist first and then went to other members of their social network when their dentist declined to see their child. The difference in our findings may be due to differences in the study samples in that the Sacramento study population included caregivers who were not mothers and the majority of families were insured by Medicaid.

Our findings describe a process in which mothers became less trusting of their dentists’ recommendations about seeking dental care for children. This is an important finding in the context of the public’s high level of trust in the dentists. Currently, dentists are one of the top 5 professionals rated as high or very high in honesty (Gallup 2020). In order to maintain a reputation of honesty and high ethical standards, dentists can reinforce policies and practices that benefit children, such as early dental visits.

This study has several limitations. First, findings may not be generalizable outside of northern Appalachia. Other regions may have dentists who are more willing to see young children and provide recommendations consistent with the age 1 dental visit. In addition, other communities may have a different culture of supporting early preventive dental visits by family and friends. Second, the aim of this qualitative study was specifically focused on the perspective of mothers with young children and not dentists’ perspective. Although this study does not reflect the 3-way dynamic in the patient–caregiver–dentist interaction, our results bring attention to the experience of mothers, which fills an important gap in the literature. Similarly, we did not obtain the perspective of primary care medical providers, who may be a prominent source of information on the timing of the first dental visit and referral.

This study has several strengths. The qualitative methods used in this study were based in grounded theory to determine when we reached theoretic saturation on main themes. The reliability of our findings was supported by the use of a grounded theory approach in which we found a high level of similarity and consistency in naming the dentist as an influential person who was a barrier to early dental visits. In addition, we conducted a community-based study that was not limited to mothers with previous dental utilization experiences for themselves or their child. Therefore, mothers who attempted but were not able to obtain a dental visit for their child were included in the study. Third, we had a large sample size of qualitative interviews to ensure that we captured the depth and breadth of mothers’ perspectives across 2 states in northern Appalachia. Finally, the findings from this study provide insight into the culture of dental service delivery from the perspective of the mother, highlighting the importance of addressing both family behavior and dental professional behavior when studying oral health disparities and the translation of professional guidelines into clinical practice.

Conclusion

This study is the first to provide an in-depth qualitative analysis of how mothers seek dental care for young children through the relationship with their dentist. We found a critical barrier to accessing dental care for children that is modifiable: some dentists’ unwillingness to treat young children and spread of misinformation on the timing of the first dental visit. Two action items that can result from this study are the following: 1) mandatory didactic and clinical infant oral health training in predoctoral dental curricula and 2) a national website that provides the contact information for dental providers willing and trained to treat children at 1 y of age (From the First Tooth 2021). Dental schools can strive to train all dental students to be competent providers of infant oral health so that they can be listed on the national website. The second action item will provide a needed resource not only for dentists but also for caregivers, school health advocates, non–dental health care providers, and other community members on how to obtain a dental visit for a young child. Addressing this barrier to dental care for young children can not only improve adherence to professional recommendations (Hagan et al. 2017; AAPD 2018a, 2018b, 2019; ADA 2019) but also address oral health disparities (Ramos-Gomez 2019). With improved access to dental care for young children, we can better address the silent epidemic of poor oral health in American children.

Author Contributions

J.M. Burgette, contributed to conception, design, data acquisition, analysis, and interpretation, drafted and critically revised the manuscript; Z.T. Dahl, contributed to data acquisition, analysis, and interpretation, critically revised the manuscript; R.J. Weyant, contributed to design, data analysis, and interpretation, critically revised the manuscript; D.W. McNeil, M.L. Marazita, contributed to design, data acquisition, analysis, and interpretation, critically revised the manuscript; B. Foxman, contributed to data interpretation, critically revised the manuscript. All authors gave final approval and agree to be accountable for all aspects of the work.

Footnotes

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding: The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was completed with the support of the Robert Wood Johnson Foundation, Harold Amos Medical Faculty Development Program, and the National Institute of Dental and Craniofacial Research (grant R01 DE014899).

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