The AAP Sets a Course
The AAP recommends that practitioners screen children for caries risk. This involves both a physical examination and a medical history. Both the AAPD and the National Maternal & Child Oral Health Resource Center provide tools for this purpose. Taking a medical history comes naturally for most pediatric care providers. Questions about diet, hygiene, fluoride, and family history should figure in these conversations, as the AAP guidelines point out.
Many pediatric care providers will feel less familiar with the task of examining a baby's mouth for caries. The AAPD can help there, as well, with an online training module. The Society of Teachers of Family Medicine (STFM) also offers an online curriculum. Toddlers don't always like to have their mouths examined, so dentists have developed a "lap-to-lap" technique for holding them during the procedure, as seen in this video.
After assessing the child's risk, the practitioner can then offer guidance about diet and hygiene, as well as sucking on pacifiers, sleeping with a bottle, and avoiding injury. The AAP gives the basics in its guidelines.
It is not all obvious. For example, AAPD President Warren Brill, DMD, MS, points out that eating a candy bar and washing it down with a glass of water could do less harm than sucking on a lollipop for an hour, even if the lollipop contained less sugar, because it would increase the length of time that sugar level is elevated in the mouth. "With any food that contains sugar, it's not how much you eat, but how often," he said.
Pediatric care providers can also play an important role in prescribing, and even applying, fluoride. Depending on the water they drink and other considerations, some children may benefit from fluoride supplements. The AAP Website gives details on how to assess fluoride intake and prescribe supplements when needed. Painting fluoride varnish on a child's teeth may also reduce their risk for caries. The STFM offers a fluoride varnish curriculum as well.
A growing number of Medicaid programs reimburse nondental primary care providers for applying fluoride varnish, conducting risk assessments, counseling parents, and other oral health services. In June 2013, the AAP surveyed the Medicaid programs in the 50 states and the District of Columbia regarding coverage for caries prevention services provided by nondental professionals; this information appears in an online table that allows providers to check on reimbursement in their own state.
Pediatric care providers can also play a role in referring patients to oral health providers, Dr. Brill says. For patients with financial resources who reside in big cities, finding a dental office is not likely to be difficult. But low-income patients and those living in remote areas can face big challenges. Dr. Brill recommends contacting local dental societies, state dental associations, and dental schools to find out about low-cost programs, and practitioners who accept Medicaid. Some public health clinics offer low-cost oral healthcare as well.
Oral health programs in some schools may also be a source of preventive care, said Dr. Brill. In particular, some school districts offer sealants that protect teeth from decay, although these programs don't take the place of a dental home, he said.
Making a referral doesn't end the process, Dr. Krol points out. Both practitioners must continue to communicate so that they can coordinate a patient's needs.
Medscape Pediatrics © 2013 WebMD, LLC
Cite this: A Gap in the Mouth - Medscape - Jul 26, 2013.