Effects of physician-based preventive oral health services on dental caries
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Investigators from the University of North Carolina conducted a retrospective cohort study to determine whether preventive oral health services (POHS) offered during physician visits impacted oral health outcomes. The investigators used oral health surveillance data linked to North Carolina Medicaid files to identify children enrolled in kindergarten during the 2005–2006 school year who may have received POHS at a physician visit (including dental screening, oral health counseling, and/or application of fluoride varnish) from 2000–2003. Oral health surveillance data were collected as part of routine standardized screening by dental hygienists of all kindergarten students in North Carolina public schools. Outcome measures for the study included (1) “caries experience,” using a composite index of the number of decayed, missing, and filled primary teeth (DMFT), and (2) the number of untreated decayed teeth (DT) found at the screening, which was a measure of unmet dental need. Data on the number of physician visits that included POHS were estimated using Medicaid reimbursements for these services. The association between the dental health outcomes and number of POHS visits was assessed with regression analyses, after adjustment for potential confounding variables.

Of the 29,173 children meeting the inclusion criteria, 69.7% (20,322) had 0 medical visits with POHS. Among the 8,851 who received POHS 51.3% (4,540) had 1 visit, 29.3% (2,596) had 2 visits, 13.1% (1,160) had 3 visits, and 6.3% (555) had ≥4 visits. Children with ≥4 visits that included POHS had significantly fewer DMFT (adjusted mean 1.82) than those with 0 visits with POHS (2.21) or 2 visits that included POHS (2.03). The mean number of DT was not significantly different between children with ≥4 POHS visits and those with 0 visits (adjusted mean 0.77 vs 0.61).

The authors conclude that physician-based POHS can improve the oral health of children by reduction of caries experience.

Oral health is an essential part of health supervision of children and adolescents. Early childhood caries is the most common chronic disease in childhood and is preventable. Twenty-four percent of US children 2–4 years of age, 53% of children 6–8 years of age, and 56% of children 15 years of age have a history of untreated dental caries, filled teeth, or teeth missing as a result of dental caries. Further, significant oral health disparities exist in the United States based on poverty status, race, and ethnicity. The AAP, American Academy of Pediatric Dentistry, American Dental Association, and American Association of Public Health Dentistry all recommend a dental visit by 1 year of age. Unfortunately, many communities lack the resources to provide this important oral health care.

The results of this study reinforce the importance of the pediatrician’s role in providing POHS to impact oral health in their patients. Pediatricians have multiple opportunities to prevent caries development in children through dental screening...

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