A Gap in the Mouth

Laird Harrison


July 26, 2013

In This Article

Fixing the Problem

The American Academy of Pediatric Dentistry (AAPD) and the American Dental Association now recommend that everyone establish a relationship with a dentist -- a "dental home" -- by the end of their first year of life, or by the time their first tooth appears.[6] Not all parents get that advice, and fewer follow it. Only 2% of children have seen a dentist by their first birthdays.[7]

Even those who know that they should take their baby to a dentist sometimes can't find one they can afford. One half of all Americans lack dental insurance. Many general dentists don't feel comfortable working with very young children, and only 38% accept payment through Medicaid or the Children's Dental Insurance Program.[8] Pediatric dentists are more inclined to see patients through these programs, but they make up only 5% of active dentists.[8]

That's led policy-makers and even some dentists to realize that primary care providers have an important role to play in oral health. "Pediatricians see their patients 6-12 times between birth and age 3, and the dentist will be lucky to see them once," said Dr. Schmidt.

So what can pediatric care providers do to help?

Leading health policy organizations have differed in their response to this question. Some, including the American Academy of Family Physicians and the Centers for Disease Control and Prevention, have recommended prescribing fluoride to children who are not receiving recommended amounts in drinking water.

The American Academy of Pediatrics (AAP), in consultation with the AAPD, has gone further. It recommends that pediatric care providers play a role in screening patients for caries, counseling them about ways to improve their oral health, and referring them to dentists, as well as prescribing or applying fluoride.[9]

The division of opinion may have to do with the quality of the research available. In reviewing the literature, the US Preventive Services Task Force concluded that there was good evidence to recommend applying fluoride varnish or prescribing fluoride supplements in some instances, but not enough evidence for screening, counseling, and referrals.[4] (It didn't find any compelling evidence against screening and referrals either.)


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