Children in care are twice as likely to have a tooth removed under general anaesthetic, a study has found.
Youngsters in care - such as foster care or residential care - are also half as likely to attend dental services compared to the general child population, according to experts from the University of Glasgow.
The research, published in the Archives of Disease in Childhood, compared data from 622,280 children from Scotland - 10,924 of whom were currently or recently looked after - and found 49% of children in care do not attend the dentist regularly, in comparison with 38% of the general child population.
And 9% of children in care have had a tooth extraction under general anaesthetic compared with 5% of other youngsters.
But the authors caution they have not been able to "disentangle" whether the contrast in dental health is as a result of factors that lead to care in the first place, or whether the State is failing to fully look after children once they are in the care system.
Dr Graham Connelly (pictured) of the Centre for Excellence for Looked After Children in Scotland, and a member of the research team, said: "The research confirmed what we had suspected: looked after children have poorer dental health and lower uptake of dental health services than the general child population.
"Dental health varies with placement type. It is best among children in foster care and poorest among those who remain in the family home with children's panel and social work support.
"We are pleased that discussions about addressing this have already begun."
David Conway, professor of dental public health at the University of Glasgow Dental School, added: "The national Childsmile programme is making strides in improving the oral health of children in Scotland.
"These findings are a stark reminder of the need to ensure we need to focus our efforts to ensure it reaches the most vulnerable children."
Dr Alex McMahon, lead author of the study from the University of Glasgow Dental School, added: "We found that the dental needs and care of children in care were significantly worse than with those children not in care.
"We were also able to show for the first time that these differences were not explained by standard measurable socioeconomic factors."
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