OBJECTIVES: The objective was to examine the factors that influence dental care, dental expenditures, and dental insurance among children (2-17) in the US. Dental caries are the most prevalent childhood chronic disease.  Lack of dental care in childhood can lead to poor health outcomes and decreased quality of life. METHODS: The Medical Expenditure Panel Survey data (2008), descriptive statistics, linear regression, and logistic regression were used to perform a cross sectional retrospective analysis. Covariates included race, residence, insurance status, and family income. RESULTS: Mean dental expenditures per child in 2008 was $1,246. Half (52%) of children had dental insurance, and half (54%) used preventative dental services. Children that utilized preventative services had annual mean dental expenditures ($559) that were significantly lower than children that did not utilize preventative services ($2,092).  Logistic regression analysis indicated that children without caries were more likely (OR: 2.43 [2.42-2.44]) to have preventative care than children with caries. Higher income and dental insurance were positive predictors of preventative dental care. Those with dental insurance had higher mean annual expenditures ($1,579) compared with those uninsured ($975), indicating that dental insurance increases dental resource use.   Predicting factors for dental insurance were lack of caries, preventative service utilization, higher income, residence in the Northeast or Midwest, Asian descent, and white race.  Linear regression showed that dental expenditures were lower among those without dental insurance, with preventative services, residing in a non-metropolitan statistical area, black race, Hispanic ethnicity, and residing outside the northeast. CONCLUSIONS: The data indicate that dental insurance is not the only barrier to children’s dental care. Certain racial and ethnic groups and lower familial income are negative predictors for dental care.  Preventative services lower dental expenditures and prevent caries. Therefore the return on investment for preventative services is positive. Health reform should enact policies encouraging preventative dental services