90 - Geographic Information System Analysis of Demographics and Caries Burden

Introduction: Early childhood caries (ECC) remains the most prevalent chronic disease of childhood, disproportionately affecting low-income and minority populations despite expanded public insurance coverage and preventive care initiatives. Medicaid-insured children continue to experience lower utilization of routine dental services and higher reliance on emergency care compared to privately insured peers. Geographic information systems (GIS) have emerged as a valuable tool to evaluate spatial access to care and identify community-level determinants influencing oral health outcomes. Utilizing GIS to examine the demographic characteristics and geographic distribution of our patient population may provide deeper insight into care utilization patterns and support the development of targeted, equity-focused interventions.


Objectives: To use GIS to examine the spatial distribution of Medicaid-insured pediatric patients receiving care at an outpatient pediatric dentistry residency clinic in Northern Manhattan and identify associations between caries burden and sociodemographic patterns that may inform patient-centered, community-responsive dental care delivery.

Materials &

Methods: This retrospective chart review included active pediatric dental patients treated at the NewYork-Presbyterian Morgan Stanley Children’s Hospital outpatient pediatric dentistry residency clinic between October 1, 2022, and October 1, 2024. Demographic and clinical data were extracted from the EPIC electronic health record and included age, sex, race, ethnicity, zip code, preferred language, special health care needs (SHCN) status, dmf/dmfs/DMF/DMFS indices,CAMBRA caries risk assessment, number of emergency visits, and total number and type of visits. GIS mapping was used to evaluate the spatial distribution of routine patients and emergency walk-in only patients. Descriptive statistics were calculated, and multilevel models were constructed to assess factors associated with caries burden in the primary dentition (ages 1–5), mixed dentition (ages 6–13), and permanent dentition (ages 14–19).

Results &

Conclusions: Caries burden in primary dentition was high, affecting 58.9% of children aged 1–5 and 75.9% of children aged 6–13, indicating a substantial burden of disease beginning in early childhood and persisting through later childhood. Age was a strong predictor of both primary and permanent dentition caries. Among children aged 1–5, each additional year of age was associated with a 77% increase in the odds of having any primary caries (OR = 1.77, p < .001). Among children aged 6–13, each additional year of age was associated with a 91% increase in the odds of having any permanent caries (OR = 1.91, p < .001). Children with any primary caries had 79% higher odds of having caries in the permanent dentition (OR = 1.79, p < .001). GIS analysis demonstrated spatial clustering of emergency-only visits, with 80% of patients originating from neighborhoods closest to the clinic in Upper Manhattan and the Bronx, suggesting that the clinic is located in a high-need area where patient demand may exceed available capacity.


Discussion: A high burden of ECC was observed across all age groups, beginning in early childhood and persisting through adolescence, with risk increasing significantly with age. High utilization of emergency walk-in visits was observed among routine patients, with a mean of 2.81 visits per patient (SD = 2.08) among those using walk-in services. Emergency-only dental utilization was relatively high (9.7%, n = 642) and may reflect barriers to establishing a dental home and accessing preventive care. Interpretation of risk factors was limited by incomplete CAMBRA documentation and likely underrepresentation of SHCN. Approximately 21.8% of patients lacked a recorded CAMBRA assessment; among documented cases, 51% were high risk (n = 2,591), 36% moderate (n = 1,839), and 13% low (n = 653). Additionally, 12.8% of patients (n = 841) were identified as SHCN based on scheduling labels, likely underestimating the true prevalence, which may be closer to ~25% and would require chart review to confirm. Future studies should examine whether emergency-only dental utilization is associated with reliance on emergency departments as a primary source of dental care. Further research should also assess the geographic distribution of caries burden using GIS-based analyses to identify spatial patterns and communities with the greatest unmet preventive dental care needs.