Primary Health Care Providers' Advice for a Dental Checkup and Dental Use in Children

Department of Health Policy and Management, UNC Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC 27599, USA.
PEDIATRICS (Impact Factor: 5.47). 08/2010; 126(2):e435-41. DOI: 10.1542/peds.2009-2311
Source: PubMed


In this study we estimated factors associated with children being advised to see the dentist by a doctor or other health provider; tested for an association between the advisement on the likelihood that the child would visit the dentist; and estimated the effect of the advisement on dental costs.
We identified a sample of 5268 children aged 2 to 11 years in the 2004 Medical Expenditures Panel Survey. A cross-sectional analysis with logistic regression models was conducted to estimate the likelihood of the child receiving a recommendation for a dental checkup, and to determine its effect on the likelihood of having a dental visit. Differences in cost for children who received a recommendation were assessed by using a linear regression model. All analyses were conducted separately on children aged 2 to 5 (n = 2031) and aged 6 to 11 (n = 3237) years.
Forty-seven percent of 2- to 5-year-olds and 37% of 6- to 11-year-olds had been advised to see the dentist. Children aged 2 to 5 who received a recommendation were more likely to have a dental visit (odds ratio: 2.89 [95% confidence interval: 2.16-3.87]), but no difference was observed among older children. Advice had no effect on dental costs in either age group.
Health providers' recommendation that pediatric patients visit the dentist was associated with an increase in dental visits among young children. Providers have the potential to play an important role in establishing a dental home for children at an early age. Future research should examine potential interventions to increase effective dental referrals by health providers.

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    • "Several studies have reported on the utilization of pediatric and family medical providers, including physicians, physician assistants, and nurse practitioners, to help promote children's oral health (Rozier et al, 2003; dela Cruz et al, 2004; Riter et al, 2008; Beil and Rozier, 2010). A recent study suggested that health providers' recommendation that pediatric patients visit the dentist was associated with an increase in dental visits among 2 to 5 year-old children (Beil and Rozier, 2010). However, there were many difficulties to integrate oral health into primary care services. "
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    ABSTRACT: This study explored the barriers and facilitating factors among lay health workers (LHWs) and primary care providers (PCPs) in implementing a multi-level program to promote children's oral health care in a rural Thai community. Twelve focus groups and 11 in-depth interviews were conducted with LHWs and PCPs who implemented the program from January 2008 to January 2009. The findings showed that the PCPs encountered the constraints of time and human resources, lack of ownership, and problem of coordination with the district hospital. The barriers among LHWs during home visits were related to their assumption of caregiver's knowledge, some conflicting beliefs, and limited counseling skills. The facilitating factors were the training program, caregivers' positive feedback, and available resources such as brochures and toothbrushes. The PCPs identified LHWs as the main facilitators of the program and indicated that policy should be developed for better integrating oral health services in local health Centers. This study provides a better understanding of the barriers and facilitating factors to promote children's oral health in rural Thai communities. While the barriers to integrating oral health activities to primary care are complex, the use of LHWs to promote the children's oral health was feasible and should be supported.
    The Southeast Asian journal of tropical medicine and public health 03/2013; 44(2):332-43. · 0.72 Impact Factor
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    • "Considering that the consensus recommendation for professional dental organizations is the universal age 1 dental visit, the large number of risk factors present in this population, and the published literature on the rate of dental referrals by primary care providers, the opinions of physicians about the need for dental evaluation (6.8%) appears to be less than optimal. A national study found that 44.6% of low-income parents of children 2-5 years of age were advised by a non-dental provider to schedule a dental check-up [4]. A study of dental referrals by physicians participating in IMB found an overall referral rate of 2.8%, lower than the one found in this study [5]. "
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    ABSTRACT: Risk-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. A 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. In 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. Low 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.
    BMC Pediatrics 05/2012; 12(1):49. DOI:10.1186/1471-2431-12-49 · 1.93 Impact Factor
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    • "It is essential for the promotion of optimal oral health. Primary healthcare physicians should provide anticipatory guidance and educate parents and young children after the first tooth erupts or by 12 months of age [20]. "
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    ABSTRACT: As children represent the future, ensuring that they receive proper health care should be a primary concern of our societies. Epidemiological research underpins the importance of effective child health care strategies, and highlights the need for accurate data collection; such surveys are currently lacking in Taiwan. In our descriptive studies, we compared the differences of the ten most common diseases in the year 2000 and 2009 among Taiwanese children. Data for a total of 174,651 and 142,200 visits under eighteen years old were collected from the National Health Insurance Research Database in year 2000 and 2009. A maximum of three outpatient diagnostic codes (the International Classification of Disease [ICD], ninth revision) could be listed for every visit. Data were categorized according to the principal diagnoses, age and different specialties of physicians. Respiratory tract infection was the most common disease (58.21% to 44.77%). Teeth (4.90% to 5.16%) and eye (2.52% to 3.15%) problems were the also in the list of top ten diseases. In year 2009, the rate of allergic rhinitis was 2.87% in 7-18 years old group. Pediatricians were the first option for consultation, followed by ear, nose and throat specialists and family physicians. However, for the school age children group, the role of pediatricians with regards to children's health care showed a decrease in its importance. The amount of information relevant to child health care is rapidly expanding. The ten most common diseases of the present analysis may serve as baseline data for future evaluations of the changes of type of diseases among children.
    Italian Journal of Pediatrics 09/2011; 37(1):43. DOI:10.1186/1824-7288-37-43 · 1.52 Impact Factor
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