Oral Health Prevention and Toddler Well-Child Care: Routine Integration in a Safety Net System

Abstract

BACKGROUND AND OBJECTIVE Applying topical fluoride varnish (FV) to young children’s teeth is an effective therapeutic strategy for preventing early childhood caries (ECC). In 2008, the pediatricians at Contra Costa Regional Medical Center and Health Centers became concerned that our low-income pediatric patients had high rates of ECC and very limited access to dental care. We formed an interdisciplinary safety net-academic partnership with the University of California San Francisco to implement routine FV applications, along with oral health education, screening, and referral during well-child exams for children aged 1 to 5 years. METHODS Over 3 years, the team developed clinical policies, educational materials, billing, and support systems to facilitate implementation in the primary care setting. A pilot study was performed in 2 health centers; improvements to the implementation plan were made. A team of local providers and academic partners performed system-wide didactic and hands-on trainings and spread this intervention to the remaining 6 health centers. Continued improvement strategies and provider feedback were pursued with each measurement cycle. RESULTS In August 2012, 95% of all children aged 1 to 5 years who were seen for well-child checkups received a FV application and oral health education during their primary care well visit. Repeat measurement in April 2014 showed a sustained rate of 97% application of FV for children in this age group seen for well-child visits. CONCLUSIONS With institutional commitment and an academic partnership, a safety net institution can integrate routine FV applications and oral health interventions into well-child visits to reduce ECC.

Providers’ preferences for pediatric oral health information in the electronic health record: a cross-sectional survey

“…Recent studies suggest that including oral health information, such as oral health risk assessments and reminders for oral health referrals, in the electronic health record (EHR) can increase the provision of preventive oral health services in primary care. [9] [10] Although these initial results are promising, most EHRs in primary care settings do not include oral health information for pediatric patients [9, 10]. …”

Formative and Pilot Study for an Effectiveness-Implementation Hybrid Cluster Randomized Trial to Incorporate Oral Health Activities into Pediatric Well-Child Visits

“…The two pilot practices were given the option of whether or not to group the oral health questions together; automatic generation of the prescription and list of dentists depended on the capabilities of each practice’s EMR. Quality improvement (QI) studies have found that requiring providers to document the delivery of oral health services in EMR formalizes the behavior and increases the likelihood that it is performed [ 50 , 51 ]. Our pilot study showed that the four oral health questions can be easily incorporated into any practice’s EMR and documented by providers.…”

Assessment of risk factors for early childhood caries at different ages in Shandong, China and reflections on oral health education: a cross-sectional study

“…All of these results reflect that the knowledge and information provided by the current OHE in Shandong Province appears to be inefficient and that it underperforms in promoting the implementation of ECC prevention practices. However, many studies have confirmed that when a more systematic, proactive oral health intervention involving brushing training, referrals and dental care is implemented for a family with children, even if implemented by nondental professionals [53], it generally has a greater preventive effect against ECC [46,[54][55][56][57]. Therefore, a systematic and sound oral health care programme that involves clinical care, brushing training, referrals and so on is imperative [58], rather than just oral health education.…”