A survey was administered to 55 homeless adolescents and young adults aged 14 to 28 years who presented for care at a community health center in Seattle, Washington in 2005. Forty-five valid surveys were analyzed. The aim of the study was to identify factors associated with self-reported oral health. The most common self-reported dental problem was sensitive teeth (52.6%), followed by discolored teeth (48.6%), toothache (38.5%), or a broken tooth (37.8%). Dental problems were associated with lower self-reported oral health, while non-high school graduates, mixed race youths, and methamphetamine users had significantly higher self-reported oral health. Among homeless youths, addressing dental problems with direct dental care may improve self-perceived oral health. The relationships between methamphetamine use and education level, on the one hand, and self-reported oral health, on the other, are complex and may be modified by age.

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Purpose This hypothesis-generating study sought to identify potential determinants of dental care use and oral health among children living in foster care. Method Using a grounded theory approach, fourteen key informant interviews were conducted among health and social services professionals experienced with children in foster care and families in western Washington State. Results The identified potential determinants of oral health and dental use among children living in foster care included: (1) linguistic and cultural barriers; (2) lack of dentists willing to accept children's Medicaid dental insurance; (3) lack of resources available to case workers (i.e. large caseload burden) (4) lack of federal funding for specialized dental care; (5) lack of systematic health record-keeping; (6) child transience, leading to the lack of a dental home; (8) foster parents' competing needs; (7) child behavior problems; and (9) lack of dental ‘buy in’ from adolescents. Conclusion Additional studies are needed to determine whether children living in foster care achieve oral health, and the extent of their unmet dental need.

The results of this study can be used by researchers to develop chairside strategies to help dentists identify and manage fluoride refusal behaviors in clinical settings. This could help preserve topical fluoride as an evidencebased preventive therapy and address a growing public health problem.

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