Abstract
BackgroundRisk-based prioritization of dental referrals during well-child visits might improve dental access for infants and toddlers. This study identifies pediatrician-assessed risk factors for early childhood caries (ECC) and their association with the need for a dentist’s evaluation.MethodsA priority oral health risk assessment and referral tool (PORRT) for children < 36 months was developed collaboratively by physicians and dentists and used by 10 pediatricians during well-child visits. PORRT documented behavioral, clinical, and child health risks for ECC. Pediatricians also assessed overall ECC risk on an 11-point scale and determined the need for a dental evaluation. Logistic regression models calculated the odds for evaluation need for each risk factor and according to a 3-level risk classification.ResultsIn total 1,288 PORRT forms were completed; 6.8% of children were identified as needing a dentist evaluation. Behavioral risk factors were prevalent but not strong predictors of the need for an evaluation. The child’s overall caries risk was the strongest predictor of the need for an evaluation. Cavitated (OR = 17.5; 95% CI = 8.08, 37.97) and non-cavitated (OR = 6.9; 95% CI = 4.47, 10.82) lesions were the strongest predictors when the caries risk scale was excluded from the analysis. Few patients (6.3%) were classified as high risk, but their probability of needing an evaluation was only 0.36.ConclusionsLow referral rates for children with disease and prior to disease onset but at elevated risk, indicate interventions are needed to help improve the dental referral rates of physicians.
Highlights
Risk-based prioritization of dental referrals during well-child visits might improve dental access for infants and toddlers
Overall design The PORRT forms were distributed to 11 medical providers trained to provide Into the Mouth of Babes (IMB) services practicing in two contiguous counties in North Carolina (NC)
Information regarding the need for a dental evaluation was provided for 917 (71%) of the 1,288 PORRT forms
Summary
Risk-based prioritization of dental referrals during well-child visits might improve dental access for infants and toddlers. The American Academy of Pediatrics guidelines recommend that infants receive an oral health risk assessment by their primary care provider prior to age 1 and a dental referral by age 1 when the dental workforce is available [2,3]. These guidelines are important because evidence suggests that physicians’ dental referrals can increase the likelihood and timeliness of a visit to the dentist, among high-risk children with early childhood caries (ECC) [4,5]. CDH is designed to strengthen the link between medical and dental homes and improve referral effectiveness
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