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
