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Inequalities in the dental health needs and access to dental services among looked after children in Scotland: a population data linkage study
  1. Alex D McMahon1,
  2. Lawrie Elliott2,
  3. Lorna MD Macpherson1,
  4. Katharine H Sharpe1,
  5. Graham Connelly3,
  6. Ian Milligan3,
  7. Philip Wilson4,
  8. David Clark5,
  9. Albert King6,
  10. Rachael Wood5,
  11. David I Conway1
  1. 1 Community Oral Health, University of Glasgow Dental School, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
  2. 2 Department of Nursing and Community Health, Glasgow Caledonian University, Glasgow, UK
  3. 3 Community Oral Health, CELCIS (Centre for Excellence for Looked After Children in Scotland), School of Social Work and Social Policy, University of Strathclyde, Glasgow, UK
  4. 4 Community Oral Health, University of Aberdeen, Centre for Rural Health, Inverness, UK
  5. 5 Community Oral Health, Division of Information Services, NHS National Services Scotland, Edinburgh, UK
  6. 6 Education Analytical Services, Scottish Government, Edinburgh, UK
  1. Correspondence to Dr Alex D McMahon, Community Oral Health, University of Glasgow Dental School, Level 8, Dental Hospital, Glasgow G2 3JZ, UK; alex.mcmahon{at}


Background There is limited evidence 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 needs and access to dental services (as an exemplar of wider health and well-being 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 national health service’s dental health and service datasets.

Results 633 204 children in publicly funded schools in Scotland during the academic year 2011/2012, of whom 10 927 (1.7%) were known to be looked after during that or a previous year (from 2007–2008). The children in the looked after children (LAC) group were more likely to have urgent dental treatment need at 5 years of age: 23%vs10% (n=209/16533), adjusted (for age, sex and area socioeconomic deprivation) OR 2.65 (95% CI 2.30 to 3.05); were less likely to attend a dentist regularly: 51%vs63% (n=5519/388934), 0.55 (0.53 to 0.58) and more likely to have teeth extracted under general anaesthesia: 9%vs5% (n=967/30253), 1.91 (1.78 to 2.04).

Conclusions LAC 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 healthcare for LAC and to develop preventive care pathways on entering and throughout their time in the care system.

  • lac-dental
  • looked after children
  • data-linkage
  • dental caries
  • tooth extraction

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  • Contributors LE, GC, IM, PW, LMDM and DIC conceived the study. KHS led on navigating the approvals required. DC, AK, KHS, ADM, RW and DIC were involved in the data linkage. All authors were involved in the study design and analysis plan. ADM, KHS supported by DC undertook the analysis which was further shaped by LMDM and DIC. AM and DIC can take responsibility for the integrity of the data and the accuracy of the data analysis. ADM with LE, LMDM and DIC undertook the first drafts of the manuscript and all authors reviewed and contributed to producing the final version.

  • Funding National Records Scotland cross-sectoral data linkage pathfinder grant. The funder had no role in the study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication. The researchers were independent of the funding organisation.

  • Competing interests None declared.

  • Ethics approval The NHS West of Scotland ethics service confirmed that NHS ethics approval was not required for this study due to non-disclosive nature of data analysed, use of safe-haven for analysis and robust national information governance procedures.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The datasets used in this project are national datasets that are held by the Scottish Government and NHS. Researchers wishing to use the national datasets for research purposes should contact the NHS National Services Scotland research support team – electronic data research and innovation service (eDRIS) in the first instance, see:

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