Oral Health Content of Early Education and Child Care Regulations and Standards

Almost two out of every three U.S. children younger than five receive child care from someone other than their parents. Health promotion in early education and child care (EECC) programs can improve the general health of children and families, but little is known about the role of these programs in oral health. We identified U.S. EECC program guidelines and assessed their oral health recommendations for infants and toddlers

Care coordination among pediatricians and dentists: a cross-sectional study of opinions of North Carolina dentists

Abstract: Background: Care coordination between physicians and dentists remains a challenge. This study of dentists providing pediatric dental care examined their opinions about physicians’ role in oral health and identified factors associated with these opinions. Methods: North Carolina general and pediatric dentists were surveyed on their opinions of how physicians should proceed after caries risk assessment and evaluation of an 18-month-old, low risk child. We estimated two multinomial logistic regression models to examine dentists’ responses to the scenario under the circumstances of an adequate and a limited dental workforce. Results: Among 376 dentists, 52% of dentists indicated physicians should immediately refer this child to a dental home with an adequate dental workforce. With a limited workforce, 34% recommended immediate referral. Regression analysis indicated that with an adequate workforce guideline awareness was associated with a significantly lower relative risk of dentists’ recommending the child remain in the medical home than immediate referral. Conclusions: Dentists’ opinions and professional guidelines on how physicians should promote early childhood oral health differ and warrant strategies to address such inconsistencies. Without consistent guidelines and their application, there is a missed opportunity to influence provider opinions to improve access to dental care

Dental Fluoride Varnish Application During Medical Visits Among Children Who Are Privately Insured

This cross-sectional study examines fluoride varnish application rates during well-child medical visits and identify characteristics associated with fluoride varnish receipt

Oral Health Activities of Early Head Start and Migrant and Seasonal Head Start Programs

Guidelines recommend that Migrant and Seasonal Head Start programs (MSHS) address the dental needs of children of migrant and seasonal farmworkers. This study describes parent- and child-oriented oral health activities of North Carolina’s MSHS programs and compares them with non-migrant Early Head Start (EHS) programs using data collected from a questionnaire completed by teachers and family services staff. MSHS staff reported engaging in more oral health activities than EHS staff, which was confirmed by results of logit and ordered logit regression models. Despite promising findings about the engagement of MSHS staff, participation in oral health activities is lower than recommended. Differences between EHS and MSHS programs might be due to differing needs of enrolled children and families or to different approaches to meeting the needs of families

Oral Health Activities of Early Head Start Teachers Directed toward Children and Parents

Objectives—This cross-sectional study examined Early Head Start (EHS) teachers’ oral health program activities and their association with teacher and program characteristics. Methods—Self-complete questionnaires were distributed to staff in all EHS programs in North Carolina. Variables for dental health activities for parents (4 items) and children (4 items) were constructed as the sum of responses to a 0-4 Likert-type scale (never to very frequently). Ordinary least squares regression models examined the association between teachers’ oral health program activities and modifiable teacher (oral health knowledge, values, self-efficacy, dental health training, perceived barriers to dental activities) and program (director and health coordinator knowledge and perceived barriers to dental activities) characteristics. Results—Teachers in the parent (n=260) and child (n=231) analyses were a subset of the 485 staff respondents (98% response rate). Teachers engaged in child oral health activities (range=0-16; mean=9.0) more frequently than parent activities (range=0-16; mean=6.9). Teachers’ oral health values, perceived oral health self-efficacy, dental training, and director and health coordinator knowledge were positively associated with oral health activities (P<0.05). Perceived barriers were negatively associated with child activities (P<0.05). Conclusion—The level of oral health activity in EHS programs is less than optimal. Several characteristics of EHS staff were identified that can be targeted with education interventions. Evidence for effectiveness of EHS interventions needs to be strengthened, but results of this survey provide encouraging findings about the potential effects of teacher training on their oral health practices

Barriers to Pediatricians’ Adherence to American Academy of Pediatrics Oral Health Referral Guidelines: North Carolina General Dentists’ Opinions

Purpose—The purposes of this study were to: (1) assess knowledge, attitudes, and behaviors of North Carolina general dentists (GDs) regarding American Academy of Pediatrics (AAP) dental referral guidelines; and (2) determine factors that influence pediatricians’ ability to comply with AAP guidelines. Methods—One thousand GDs were surveyed to determine barriers toward acceptance of physician referrals of infants and toddlers. The primary outcome using ordered logistic regression was GDs’ acceptance of children described in five case scenarios, with different levels of risk and oral health status. Results—GDs believed pediatricians should refer patients at risk for caries to a dentist. While 61 to 75 percent of GDs were willing to accept low caries risk referrals of infants and toddlers, only 35 percent would accept referrals when caries was present. Predictors of referral acceptance were correct knowledge about AAP guidelines (OR=2.0, 95%CI=1.2-3.3), confidence in pro- viding preventive care to infants and toddlers (OR=2.6, 95%CI=1.3-4.9), and agreement that parents see importance in dental referrals (OR=2.1, 95% CI=1.2-3.6). Conclusions—This study identified factors influencing acceptance of pediatrician referrals for the age one dental visit among North Carolina GDs and highlighted challenges pediatricians face in referring young children for dental care

Cost-effectiveness of Preventive Oral Health Care in Medical Offices for Young Medicaid Enrollees

Dental caries is the most common preventable chronic disease among preschool children. The pediatric primary care setting provides an alternative site to deliver preventive oral health. This study estimates the cost-effectiveness of a medical office-based preventive oral health program in North Carolina (“Into the Mouths of Babes,” IMB)

Comparing Medical and Dental Providers of Oral Health Services on Early Dental Caries Experience

Objectives. Most state Medicaid programs reimburse nondental primary care providers (PCPs) for providing preventive oral health services to young children. We examined the association between who (PCP, dentist, or both) provides these services to Medicaid enrollees before age 3 years and oral health at age 5 years

Examining Continuity of Care for Medicaid-Enrolled Children Receiving Oral Health Services in Medical Offices

Children living in poverty encounter barriers to dentist visits and disproportionally experience dental caries. To improve access, most state Medicaid programs reimburse pediatric primary care providers for delivering preventive oral health services. To understand continuity of oral health services for children utilizing the North Carolina (NC) Into the Mouths of Babes (IMB) preventive oral health program, we examined the time to a dentist visit after a child’s third birthday

Oral Health Opinions and Practices of Pediatricians: Updated Results From a National Survey

Professional guidelines and state Medicaid policies encourage pediatricians to provide oral health screening, anticipatory guidance, and fluoride varnish application to young patients. Because oral health activities are becoming more common in medical offices, the objective of this paper was to assess pediatricians’ attitudes and practices related to oral health and examine changes since 2008