Health services, especially with the lack of

Health has been
acknowledged as fundamental human right and oral health is a vital part of
overall health and can be called the first line of contact to the human body.

Americans are enjoying increasing levels of oral health. However, oral health
improvements and dental care services are not being experienced evenly across
the population. The poor, some minorities, institutionalized elderly
people and children in foster care do not have
adequate access to dental care (Drainoni et al., 2006; Leck & Randall, 2017;
Northridge et al., 2017).

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unaffordable cost of dental treatment has been the main interference which
dispossesses people from using the services, especially with the lack of dental
care coverage in medical insurance or when there is a low reimbursement rates
for dental professionals from insurance companies (Garla, Satish, & Divya, 2014).

Generally, the high cost of health care service is due to the increasing demand
for health facilities, developing technology of health care, lacking
incentives, seeking higher quality treatment and general inflation (Garla et al., 2014; Glavind et al., 1992).

American Academy of Pediatrics (AAP) considers all children in foster care as
Children with Special Health Care Needs (CSHCN), and defines them as “children
who have or are at increased risk for a chronic physical, developmental,
behavioral, or emotional condition and who also require health and related
services of a type or amount beyond that required by children generally” (McPherson
et al., 1998). CSHCN
require specialized knowledge for treatment and additional measures beyond what
would be considered routine for children (American
Academy of Pediatric Dentistry, 2015).

A policy
statement by the AAP stated that, 80% of children and adolescents in foster
care have a significant mental health need and 40% have significant oral health
issues (Szilagyi,
Rosen, Rubin, & Zlotnik, 2015). When compared to children not in foster care,
those children have a higher prevalence of developmental disorders, disorders
of the teeth and jaw, attention scarcity, conduct and disruptive disorders, and
adjustment disorders (Baumrucker,
Fernandes-Alcantara, Stoltzfus, & Fernandez, 2012).

are over 415,000 children in the U.S. foster care system and recent data
suggest that this number is growing (Health
& Services, 2015). Over
260,000 children entered the foster care system in 2014, with over 238,000 children
exiting the same year (Health
& Services, 2015). The
mean age of children in foster care was 8.7 years and 75% of children in foster
care lived within a foster family setting; other settings including group
homes, institution, or pre-adoptive homes (Health
& Services, 2015).

dental cavity is the most common chronic childhood disease and a majority (67%)
of children in foster care did not utilize dental care due to lack of access to
dental care (M.

Melbye, Huebner, Chi, Hinderberger, & Milgrom, 2013; Negro, 2016). Though, there is limited literature on
children in foster care and their oral health, but the available data indicates
that children in foster care have untreated dental cavities and face multiple
barriers to receiving dental care (Colthirst,
2008). Even
though children in foster care having insurance coverage, they are unlikely to
access dental care,  Inadequate access to
dental care is proved to lead to harm to the child, especially pain and
decreased general health (Negro,

to dental care included insufficiency of dentists accepting Medicaid, children
moving from foster home to foster home, insufficient oral health knowledge and
lack of resources to the social workers (M. L.

Melbye, Chi, Milgrom, Huebner, & Grembowski, 2014). A study conducted in Iowa found that children
in foster care have 1.29 higher odds of utilizing dental services; this may
indicate that children in foster care require more dental care than the general
population care (Chi,
Momany, Kuthy, Chalmers, & Damiano, 2010).

To date,
there is no published study investigated the social workers’ knowledge and
perception as a potential intervention point to improve the oral health of
children in foster care through preventive education and measures in the state
of Florida. Since social workers have the most contact with foster families
through home visits, social workers could improve the oral health of children
in foster care by early diagnosis, providing resources and delivering oral
health education to foster parents during home visits and during foster parent