Accuracy of Pediatric Primary Care Providers’ Screening and Referral for Early Childhood Caries

Abstract

ABSTRACT. Purpose. Tooth decay is one of the more common diseases of childhood. Slightly >40% of US children are already affected by the time they reach kindergarten. Primary care physicians can play an important role in prevention and control of this disease because of their ready access to this population. Unlike dentists, they see a large percentage of children during their infant and toddler years. However, few studies have been conducted on oral screenings and referrals by primary care physicians or the effectiveness of their oral health preventive activities. The purpose of this study was to determine the accuracy of pediatric primary care providers' screening and referral for Early Childhood Caries.Methods. We sought to compare independent, blinded oral screening results and referral recommendations made by primary care providers with those of a pediatric dentist, considered for purposes of the study to be the reference gold standard. The study was conducted at a private pediatric group practice in North Carolina. The practice was selected because it serves a large volume of Medicaid patients and includes a large number of pediatric primary care providers (11 pediatricians and 1 nurse practitioner). Study participants included Medicaid-eligible children younger than 36 months of age with erupted teeth. The pediatric primary care providers in this practice received 2 hours of training in infant oral health. The training consisted of a review of the study methods and clinical slides illustrating dental caries in various stages of progression. Specific instructions were given to the providers on how to recognize a cavitated carious lesion and how to determine when a dental referral is needed. Providers were instructed to refer any child with 1 or more cavitated carious lesions, soft tissue pathology, or evidence of trauma to the teeth or mouth. Before commencing the study, calibration and a comparative analysis were performed to establish reliability and validity of the examinations performed by the pediatric dentist. Both a pediatric dentist and a pediatric primary care provider conducted a dental screening on each child and recorded carious teeth and whether a dental referral was needed. Sensitivity and specificity were calculated to compare the pediatric primary care providers' screenings to the gold standard (pediatric dentist) in 3 categories: caries at the tooth level, caries at the patient level (1 or more affected teeth), and need for referral.Results. The final study sample consisted of 258 preschool-aged children (122 males and 136 females) with a mean age of 21.2 months (standard deviation [SD]: 9.13).One hundred eighty-four (71.3%) of the participants were white, 58 (22.5%) were black, and 16 (6.2%) were Hispanic.Tooth Dental Referral: The pediatric dentist referred a total of 27 (10.5%) children to a dentist. Two of these children were referred for trauma and the other 25 were referred for cavities. The pediatric primary care providers referred a total of 23 (8.9%) children to a dentist. Two ref...

Knowledge , Attitude and Practices among Gynecologists regarding Oral Health of Expectant Mothers of Vadodara City , Gujarat

“…(2) Mothers play an important role in child's development; oral health counseling is especially important for the mother. Gynaecologists, due to frequent contacts with family are in an ideal position to provide guidelines for improving oral health care to the mothers (3,4) Pregnancy is a time when a woman strives to be particularly aware of the need for health. Health information is of much interest to her and her family, and health professionals can more easily motivate her to follow guidelines towards a sound physical health.…”

Study of Medical Interns’ Knowledge Level about Children’s Oral Health Between 2011 and 2012 in Medical Universities in Tehran, Iran

“…Pierce et al conducted a 2-hour instruction course for practitioners, and their findings showed that the practitioners diagnosed 70% of children with oral/dental health problems and referred them to dentists. Therefore, sufficient instruction, even for a short time, may increase practitioners' discernment (16). In another study, McCunniff et al found that the number of children referred to dentists by their practitioners was twice as many as children who were not referred to dentists (17).…”

Effects of Physician-Based Preventive Oral Health Services on Dental Caries

“…11,40 Pediatricians can identify children with cavitated lesions with an acceptable level of accuracy, but they are less accurate in identifying and assessing individual risk factors 13,14,44,45 and tend to underrefer. 46,47 Nationally, approximately half of pediatricians screen most patients for caries.…”

“…12,13 The literature suggests that physicians will adopt these services and provide quality care that is effective in increasing access to preventive services, reducing treatment needs, averting hospitalizations, and lowering Medicaid costs. [14][15][16][17][18][19][20] Studies reporting improved oral health have either provided circumstantial evidence on the basis of administrative claims 18,19 or have not examined comprehensive services, which include fluoride varnish applications. 15 This study extends previous work by evaluating the impact of comprehensive POHS, which includes screening and risk assessment, fluoride varnish applications, and parental oral health counseling, provided in medical offices by nondental providers, on the dental caries experience of children enrolled in North Carolina's (NC's) Medicaid program.…”