Oral Health Opinions and Practices of Pediatricians: Updated Results From a National Survey

Abstract

Background Professional guidelines and state Medicaid policies encourage pediatricians to provide oral health screening, anticipatory guidance, and fluoride varnish application to young patients. Because oral health activities are becoming more common in medical offices, the objective of this paper was to assess pediatricians’ attitudes and practices related to oral health and examine changes since 2008. Methods As part of the 2012 Periodic Survey of Fellows, a random sample of 1638 members of the American Academy of Pediatrics was surveyed on their participation in oral health promotion activities. Univariate statistics were used to examine pediatricians’ attitudes, practices, and barriers related to screening, risk assessment, counseling, topical fluoride application among patients from birth to 3 years of age. Bivariate statistics were used to examine changes since 2008. Results Analyses were limited to 402 pediatricians providing preventive care (51% of all respondents). The majority of respondents supported providing oral health activities in medical offices, but fewer reported engaging in these activities with most patients. Significantly more respondents agree they should apply fluoride varnish (2008=19%; 2012=41%), but only 7% report doing so with >75% of patients. Although significantly more respondents reported receiving oral health training, limited time, lack of training and billing remain barriers to delivering these services. Conclusions Pediatricians continue to have widespread support for, but less direct involvement with oral health activities in clinical practice. Existing methods of training should be examined to identify methods effective at increasing pediatricians’ participation in oral health activities.

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

“…12 Although most state Medicaid programs reimburse for fluoride varnish delivered in medical offices, 12 the practice is not common nationally. 13 Medicaid-enrolled kindergarten students included in our sample were found to have a high prevalence of untreated caries. Approximately 1 in 4 students had caries that showed no evidence of treatment.…”

“…46,47 Nationally, approximately half of pediatricians screen most patients for caries. 13 Although physicians are more likely to refer infants and toddlers with obvious disease, dentists prefer that they refer before disease is present. 48 Finally and importantly, evidence supports the conclusion that primary care referrals increase the use of dental homes, but that they are only partially effective in achieving continuity of care between medical and dental settings.…”

“…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.…”

“…11,12 Several states reimburse physicians through their public insurance programs for dental screenings and oral health counseling, and almost all reimburse physicians for the application of fluoride varnish. 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.…”

Pediatric Workforce Issues

“…Further, although they know the benefit of fluoride varnish, few physicians regularly apply it for their patients, citing barriers including lack of training and reimbursement. 48,49 By 2011, 42 states had adopted a policy to support preventive dentistry initiatives for physicians. 50 Two examples of these types of initiatives are discussed later.…”