Graduation Date

Fall 12-16-2022

Document Type


Degree Name

Doctor of Philosophy (PhD)


Health Services Research, Administration, and Policy

First Advisor

Dr. Hyo Jung Tak, PhD

Second Advisor

Dr. Fernando A. Wilson, PhD

Third Advisor

Dr. Nizar K. Wehbi, MD, MPH, MBA

Fourth Advisor

Dr. Li-Wu Chen, MHSA, PhD


Oral diseases are one of the most prevalent non-communicable, chronic diseases of the 21st century. Yet, dental diseases are generally neglected and are a top concern for policymakers globally. The burden of oral diseases disrupts routine activities that affect the overall quality of life, especially for those with special healthcare needs. Dental diseases have also been marked as the “silent epidemic” and are the leading secondary health condition that affects individuals with disabilities. Disabled people are less likely to receive timely and adequate dental care, which could be tied to poor oral health outcomes among them. This group of studies explores the disparities in dental care and its factors for the disabled population. In addition, we attempt to find a potential solution for better oral health outcomes in family-centered care for children with special care needs.

The first study of this dissertation aimed to examine the association of disability status with unmet dental needs and barriers to dental needs among people with disabilities compared to those without disabilities. We use nationally representative personal level data from the 2013-18 National Health and Nutrition Examination Survey. To examine the disparities in the dental procedures received and relative dental care expenditures among the disabled, we use the nationally representative personal level data from the 2019 Medical expenditure panel survey in the second study. To investigate the impact of family-centered care on oral health outcomes and visualize its state-wide distribution for children with special care needs, we utilize nationally representative data from the 2017-19 National Survey of Children’s Health. For spatial analysis, we use the 2018 US Census Bureau shapefiles.

We found differences in unmet dental needs and utilization between adults with and without disabilities, especially for people with vision, mobility, and multiple disabilities. Both financial and non-financial barriers pose roadblocks to accessing dental care for people with disabilities. A multidimensional approach is required to alleviate the dental care disparities among people with disabilities. In addition, we found that family-centered care is associated with better oral health outcomes among children with special health care needs. Hawaii and Iowa are the states with the highest receipt of family-centered care and preventive dental visits among CSHCNs, respectively. Family-centered care could play a pivotal role in reducing oral health disparities among CSHCNs. More research should be directed towards outcomes and implementation of this approach to articulate family-centered dental care models.


2022 Copyright, the authors

Available for download on Saturday, August 03, 2024