The Role of the Pediatrician in the Oral Health of Children: A National Survey

Abstract

ABSTRACT. Objectives. To assess pediatricians' knowledge, attitudes, and professional experience regarding oral health, and to determine willingness to incorporate fluoride varnish into their practices.Background. Poor and minority children suffer disproportionately from dental caries and have limited access to dental care. In a recent analysis of national survey data, the General Accounting Office reported that poor children had 5 times more untreated decay than did children from higher income families. Untreated decay can lead to problems with eating, speaking, and attending to learning. Children who are poor suffer 12 times the number of restricted activity days because of dental problems, compared with more affluent children.Despite higher rates of dental decay, poor children had one half the number of dental visits compared with higher income children in 1996. Medicaid's Early Periodic Screening Diagnosis and Treatment (EPSDT) program is intended to provide regular dental screenings and appropriate treatment but has apparently played a limited role in improving access to dental care for poor children. According to a report by the Office of the Inspector General of the Department of Health and Human Services, only 20% of children under 21 years of age, who were enrolled in Medicaid and eligible for EPSDT, actually received preventive dental services.By increasing their involvement in oral health prevention during well-child care visits, pediatricians may be able to play an important role in improving the dental health of their patients who have difficulty obtaining access to professional dental care. However, it is unclear to what degree pediatricians are knowledgeable about preventive oral health and the extent to which they may already be participating in prevention and assessment. Also, little is known about the incidence of dental problems in pediatric practice, and whether pediatricians perceive barriers to their patients' receiving professional dental care. Finally, it is important to know how pediatricians value the promotion of oral health and whether they would be willing to take on additional activities aimed at its improvement. We addressed these questions in a national survey of pediatricians.Design. We surveyed a national sample of 1600 pediatricians randomly selected from the American Medical Association Master File to assess their knowledge, current practice, and opinion on their role in the promotion of oral health; experience with dental decay among patients and in referring patients for professional dental care; and willingness to apply fluoride varnish.Results. Of 1386 eligible survey recipients, 862 returned surveys for a response rate of 62%. Respondents reported seeing dental problems regularly. Two thirds of respondents observed caries in their school-aged patients at least once a month. Of the respondents, 55% reported difficulty achieving successful dental referrals for their uninsured patients and 38% reported difficulty referring their Medicaid patients. More than 90% of the respon...

<b>Knowledge of pediatricians and the importance of interdisciplinarity in attention to oral health in early childhood

“…This result, which represents a deficient knowledge, was similar to that of Lewis, Grossman, Domoto and Deyo (2000), who found only 9% of correct answers, and Reis et al (2015) who reported only 18.8% of all questions answered correctly. Thus, the results showed that knowledge of pediatricians still is below expectations, whereas the questions were accessible and objective, for which it was only necessary to have a basic knowledge of the subject.…”

“…Thus, the results showed that knowledge of pediatricians still is below expectations, whereas the questions were accessible and objective, for which it was only necessary to have a basic knowledge of the subject. Taking into consideration that these professionals have a fundamental role in the promotion of oral health in early childhood, it is essential that correct and up-to-date information is available on the main problems that may compromise oral health of children, and on ways to prevent them (Lewis et al, 2000), making the multidisciplinary approach indispensable, with an objective of integral attention to offer better health conditions to children.…”

Factors That Influence Receipt of Recommended Preventive Pediatric Health and Dental Care

“…Many pediatricians are willing to incorporate preventive dental guidance, fluoride application, and identification of dental problems into their practices, although they have received little formal training, have limited knowledge of dental health issues, and have experienced difficulties in making dental referrals. 37 To encourage pediatricians to provide their patients with accurate guidance, the AAP might consider clarifying its preventive care standards to describe more specifically the frequency of recommended preventive dental visits.…”

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

“…In addition, a recent national survey found that many pediatricians lack the current scientific knowledge needed to promote children's oral health. 7 The Maternal and Child Health Bureau and Health Resources and Services Administration developed a guide, Bright Futures in Practice: Oral Health, to address the oral health needs of children and families. 8 This guide recommends that primary care physicians provide regular dental screenings, oral health risk assessments, oral health education, and dental referrals when needed.…”