Promotion of Oral Health and Prevention of Dental Caries Among Children in Primary Care

Abstract

Dental caries is the most common chronic disease of childhood in the US, 1 with approximately 23% of children aged 2 to 5 years experiencing caries in their primary teeth. 2 Dental caries disproportionately affects children of low socioeconomic status and minority race and ethnicity, 2 with a higher prevalence among Mexican American children (33%) and non-Hispanic Black children (28%) than among non-Hispanic White children (18%). 3 Poor oral health adversely affects overall health, and dental caries is associated with pain, tooth loss, missed school days, poorer academic performance, and costly restorative care. 4,5 Access to dental care remains limited in many communities, especially for young children, those insured through Medicaid, and patients with special heath care needs. 6 A dental visit by age 1 year is recommended by the American Academy of Pediatrics, American Academy of Pediatric Dentistry, and the American Dental Association, 7,8 yet only 2% of US children will have seen a dentist by their first birthday, despite an estimated 10% already having dental caries. 9 Conversely, 87% of children have at least 1 visit with a health care professional by age 1 year. 9 Therefore, primary care clinicians are well-positioned to deliver preventive oral health services, which are proven to reduce caries in young children. 10 Leveraging the numerous routine medical visits during the first year of life to initiate preventive measures (eg, application of fluoride varnish) and provide oral health guidance regarding nutrition and dental hygiene can help address the gap in dental care access. 11 However, few primary care clinicians nationwide report providing basic oral health services. In a 2012-2014 cross-sectional analysis of claims data for 6 275 456 children enrolled in Medicaid in 39 states, only 8% received fluoride varnish from their primary care clinician, 12 and in another study examining 328 661 billing claims, less than 5% of privately insured children aged 1 to 5 years received dental fluoride varnish application. 13 In 2014, the US Preventive Services Task Force (USPSTF) recommended that pediatric primary care clinicians prescribe oral fluoride supplementation starting at age 6 months for children whose water supply is deficient in fluoride and also recommended application of fluoride varnish to the primary teeth of infants and children starting at tooth eruption through age 5 years (B recommendations). 14