The Knowledge and Practice of Pediatricians in Children's Oral Health

A Scoping Review

Virginia Dickson-Swift; Amanda Kenny; Mark Gussy; Colleen McCarthy; Stacey Bracksley-O'Grady


BMC Oral Health. 2020;20(211) 

In This Article

Abstract and Introduction


Background: Dental caries is a significant public health problem and one of the most common chronic conditions affecting children. The potential for the non-dental workforce to improve children's oral health is well documented. For well over a decade, there have been calls for pediatricians to address children's oral health, but the incorporation of oral health screening, referral, and oral healthcare in pediatric practice remains underdeveloped. Developing action to strengthen the role of pediatricians' in children's oral health requires an understanding of their current knowledge and practice. In this scoping review, we aimed to comprehensively map what is known about the knowledge and practice of pediatricians regarding children's oral health.

Methods: Arksey & O'Malley's five-stage review process was used to comprehensively map studies undertaken on pediatrician's knowledge and practice regarding children's oral health. Key search terms were developed and a total of 42 eligible articles are included in the review.

Results: The studies were conducted in 19 countries. The majority (41/42) were quantitative, with over 90% using self-reported surveys. Only four studies used previously validated survey tools, with most adapting questions from previous studies. Observational designs were used in two studies and one used qualitative methods. Sample size ranged from 15 to 862. Oral health knowledge amongst pediatricians was reported to be mostly poor, with many gaps in key areas including age for first dental visit, dental caries and oral health risk assessments. Studies on the translation of oral health knowledge to practice were limited, with wide variation in rates of assessment. Few studies assessed actual practice.

Conclusions: This scoping review highlights growing international interest in the role of pediatricians in children's oral health. Findings demonstrate that pediatricians have limited knowledge and understanding in critical areas, including; initial clinical signs of dental caries, recommended age for first dental visit, etiology of dental caries and recommended use of fluorides. Barriers for pediatricians include inadequate education and training, time constraints in practice and lack of referral pathways. Development of a validated tool to assess knowledge and practice is needed. This review provides a starting point to guide future research and areas for systematic reviews.


Internationally, there is a growing focus on the role of the non-dental workforce in improving oral health outcomes, particularly for children.[1,2] The World Health Organization (WHO) identifies oral health as important for interprofessional practice within the primary health sector.[3] While oral health promotion should be part of the role of a range of health professionals, the key role of pediatricians in children's oral health has been identified for well over a decade.[4,5] Recommendations for the role have included screening, anticipatory advice, and referral to dental services before 12 months of age.[5,6] Despite role identification, routine oral health screening and referral by pediatricians remains limited.[7–10]

Dental caries (tooth decay) is one of the most common chronic diseases affecting children. It is a significant public health problem in early childhood, with negative impacts across the lifespan.[11–15] Globally, 60–90% of children are affected, with rates of dental caries higher than childhood asthma.[5,15] Dental caries is a progressive disease and can be reversed if managed early, but if left untreated, becomes more complex over time.[9] Unmanaged dental caries progresses to cavities with a major impact on child health and wellbeing, including pain, ability to eat and chew, body weight, growth, self-esteem, and communication.[14] The impact of chronic pain/discomfort related to dental caries on child cognitive development has been documented, with poor school attendance and lack of concentration commonly reported.[16]

There are multiple determinants for poor oral health in children including social disadvantage, socioeconomic status, age, gender, geographic location, and lifestyle factors.[3,17,18] While there has been an overall decline in childhood dental caries rates in developed countries, children in developing countries and children from disadvantaged backgrounds within developed countries continue to experience dental caries at unacceptable levels.[18–20]

In 1998, the first national survey on the role of pediatricians in child oral health was conducted in the United States (US) to assess knowledge, attitudes and professional experience.[9] While pediatricians believed oral health could be an important aspect of their practice, few reported any oral health activity. Lack of training was commonly reported. Some have argued that the incorporation of oral health into medical schools and the role of pediatricians, together with appropriate resources, would enhance access to dental care for all children.[7,9] In 2003, the role of pediatricians in improving the oral health of children was included in a US oral health national call to action.[4] Since that time, the role of pediatricians in oral health has been reinforced and now includes recommendations for pediatric oral health risk assessments from 6 months of age.[7–10] However, there is evidence that the incorporation of oral health in pediatric practice remains underdeveloped.[21]

Despite global calls to strengthen oral health in pediatric practice, there have been no reviews that have brought together the evidence on the knowledge and practice of pediatricians regarding children's oral health. As the first review in this field, our purpose was to complete a broad mapping and synthesis of the evidence base. Scoping review methodology is used to scope a body of literature without excluding studies based on design or quality.[22] This approach aligned with our review aim. Consistent with recommendations of Munn and colleagues[22] our purpose was to identify all available studies, provide commentary on those studies, and identify key knowledge gaps. Authors highlight that scoping reviews are useful as the first step in developing a more focused systematic review and are an important starting point to guide further research.[22,23]