Dental Treatment by Pediatricians Effective for Kids

Laird Harrison

April 03, 2014

Primary care physicians can reduce tooth decay in indigent children by providing them with fluoride treatment, oral health education, exams, and referrals, a new study shows.

"Programs targeting vulnerable populations through medical offices can reduce disparities in oral health among preschool-aged populations," Leo N. Achembong, BDS, MPH, from the North Carolina Department of Health and Human Services in Raleigh, and colleagues write.

The researchers published their results online March 31 in Pediatrics.

Many children do not see dentists regularly, and lack of oral care is particularly common among children younger than 3 years — and even more so among those whose families cannot afford private dentistry.

In effort to address the gap, 46 state Medicaid programs in the United States reimburse physicians for some preventive dental services, the researchers write. Most of these programs started after 2006.

North Carolina launched its Into the Mouth of Babes Program (IMBP), in 2000. The program trains physicians to paint fluoride varnish on the teeth of their youngest patients, to examine the health of the children's mouths, to teach the children and their caregivers about caring for the kids' mouths, and to refer them to dentists to treat decayed teeth and other oral disease.

The program provides services to children enrolled in Medicaid from the time of the first tooth eruption until age 42 months. It has expanded steadily, reaching about 80,000 children in 2011.

To measure its effectiveness, Dr. Achembong and colleagues counted the number of decayed, missing, and filled teeth (DMFT) among 920,505 5-year-old children. They found that the rate increased from 1.53 DMFT per child in 1998 to 1.84 in 2004 and then dropped back to 1.59 in 2009.

The researchers controlled for major trends other than IMBP services that might have affected the oral health of children in the program: the percentage of Hispanic children, the percentage of participants eligible for subsidized lunches, and access to preventive care.

Because they conducted their study using schools as the basic unit, the authors used statistical techniques to control for differences among schools.

Looking county by county, they found that the more time the kids spent getting care through the program, the fewer DMFTs they were likely to have.

Table. Predicted Effects of IMBP Visits, Using 2009 Data

Effect Measured No Implementation +500 Visits per County +1000 Visits per County +2000 Visits per County +4000 Visits per County
IMBP visits per child 0 0.22 0.25 0.31 0.45
Mean 5-year change in DMFS 0.135 −0.161 −0.199 −0.273 −0.447

The authors also found that the IMBP visits had a bigger effect in schools with a higher proportion of students who qualified for subsidized lunches, a marker for poverty.

They estimate that the IMBP could have its maximum effect if it could expand from a current level of 0.75 to 3.02 visits per child. However, they also conclude that IMBP cannot completely eliminate disparities in oral health by itself; it will have to be combined with other "community- and practice-based strategies effective in reducing dental caries."

The study was funded by the US Health Resources and Services Administration. The authors have disclosed no relevant financial relationships.

Pediatrics. Published online March 31, 2014. Abstract


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