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Early childhood programs emphasize team effort

Dentists, pediatricians nationwide work together to improve children's oral health

In an effort to combat the most common chronic disease affecting children, North Carolina policymakers launched a program in 2000 to help reduce caries rates of very young low-income children.

The Into the Mouths of Babes program allows dentists and pediatricians and family physicians in their communities collaborate to build an interdisciplinary approach to better oral and overall health for their patients.

To overcome barriers that might prevent parents/caregivers from bringing their young child for dental visits, the program encourages primary care providers to incorporate preventive oral health services for children enrolled in Medicaid during well-child visits. Pediatricians assess children for dental caries and risk status, apply topical fluoride, counsel parents on the hows and whys of good oral health and refer children to a dentist who can provide a dental home. The physicians receive reimbursement for up to six oral health visits in children between 6 months and 3-½ years of age.

Within the first six years, about 3,000 pediatricians in almost 600 practices were trained to participate in the program and results showed dramatic increases in oral health services for children in this age group.


Dr. Clements

Dr. Rozier
"Pediatricians and family medicine doctors in North Carolina have embraced this program with enthusiasm," said Dennis Clements, M.D., chief, primary care pediatrics at Duke Medical Center in Durham, N.C. "We are working together to keep children healthy. In some areas there are few pediatric dentists so a pediatrician providing fluoride varnish has been a huge help in trying to reduce dental caries in children under the age of 3. Dentists work collaboratively with pediatricians to educate them about healthy eating habits and caries identification. Their training helps us to triage and refer children that need to see a dentist."

The IMB program continues to expand and involve new partners, said Dr. R. Gary Rozier, professor of health policy and management at the University of North Carolina Chapel Hill.

"Evaluation studies conducted since the initiation of the program in 2000 have found it to substantially increase access to preventive dental services for young, high-risk children who otherwise would be unlikely to use these services in dental offices, reduce caries-related treatments and costs, avert hospitalizations and improve oral health status," Dr. Rozier said. "Parents express a high level of satisfaction with receiving oral health services in primary medical care settings. And the number of preventive dental visits in medical settings in North Carolina reached more than 130,000 for children younger than 3-½ years of age statewide last year."

Dr. Rozier says efforts to strengthen medical and dental collaboration to address disparities in oral health still continue in North Carolina. And both physicians and dentists have access to a wealth of resources that address incorporating oral health services into well-child visits, applying fluoride, referral guidelines and other tips.

"We recommend that dentists become familiar with risk assessment protocols developed for and being used by physicians so that they can appreciate the role that physicians play in oral health, what they expect dentists to do and how they expect dentists to relate to them," Dr. Rozier said. "General dentists also can check with their state pediatric or pediatric dental societies, state dental public health program or Medicaid programs to see if formal education opportunities or ongoing medical-dental collaborations exist in their state. Many online educational resources are available to support infant and toddler oral health care, some of which provide continuing education credits."

The problem of early childhood caries, and the philosophy behind using the IMB program to address it, is not unique to North Carolina.

The ADA and the American Academy of Pediatrics have been working together to help strengthen collaboration nationwide in a variety of ways, and pediatricians and dentists are collaborating nationwide to improve the oral health of underserved children.

The goals of the AAP's Oral Health Initiative, launched in 2002, are to promote oral health care in primary pediatric settings by offering guidance to families about oral hygiene, diet, fluoride and the importance of the first dental visit at 1 year of age; to educate and advocate for primary pediatric care professionals to apply fluoride varnish; and to educate policymakers and payers about the importance of reimbursement for pediatric oral health care. The ADA is one of more than 30 partner organizations for the initiative.

With funding from the ADA Foundation, the AAP has trained pediatricians in most states to be Chapter Oral Health Advocates. These advocates provide at least four training sessions per year on incorporating oral health into the medical home, advocate for children's oral health issues at the state and local level, serve as an access point for others in their community working to improve children's oral health and build relationships with dental colleagues and societies in their community to improve access to oral health care.


Dr. Braun

Dr. Crystal
"Caries is the most common problem I see in my young patients," said Patricia Braun, M.D., a pediatrician in Denver and an Oral Health Chapter Advocate. "Physicians are slowly becoming aware of the burden of dental disease in their young pediatric populations and that the disease is largely preventable. Programs like the AAP COHA program are instrumental at raising awareness in the medical world of the importance of oral health to overall health."

Dr. Braun said patients get high quality oral and overall health care when dentists and pediatricians can work collaboratively.

"The best model for me is when I can partner with a dentist to meet the dental needs of my patients," said Dr. Braun. "I can teach the family of the importance of oral health and provide them with early preventive care but ultimately, my patients need a dentist who will see them at a young age and if they have Medicaid."

"Good oral health is a gateway to overall health. And healthy children are the strength of our communities in the future," said. Dr. Yasmi O. Crystal, clinical associate professor of pediatric dentistry at New York University College of Dentistry and member of the ADA Council on Access, Prevention and Interprofessional Relations. "It is important that everyone understands that the same risk factors that result in dental caries are the ones that are causing obesity, diabetes and cardiovascular disease. We can and should work as a team with other health care specialists and primary health care providers to make our population healthier. It's time to come to terms with the fact that we are all on the same team."

Dr. Crystal stresses that dental intervention at the earliest stages of a child's life not only benefits the child and the family, but also reduces the need for extensive and expensive restorative and surgical treatments that require general anesthesia.

"Nobody I know enjoys treating these cases," Dr. Crystal added. "Operating rooms across the country have long waiting lists of six months or longer. The benefit of getting more early referrals would help the dentist and the patient have a more pleasant experience and it emphasizes preventive strategies which help increase patient and family compliance and result in better health outcomes."

There are a variety of opportunities for dentists to collaborate with pediatricians in their own communities, added Dr. Crystal, and collaborations tie in to the ADA's Action for Dental Health campaign, launched last year.

The ADH campaign is designed to:

• provide care now to people who are suffering, including the uninsured who are more likely to visit an emergency room for relief from dental pain, the elderly in nursing homes, and children from low-income families;

• strengthen the dental safety net with more private practice dentists working with health centers and participating in Medicaid;

• emphasize prevention and education through community water fluoridation, Community Dental Health Coordinators and stronger collaboration between dentistry and medicine.

"ADA members have a call to action to take advantage of programs and resources that help dentists work collaboratively with pediatricians and help reach children in dire need," said Dr. Crystal.

AAP's section on oral health—a group of pediatric dentists, pediatricians and other allied health professionals—is interested in learning about and improving children's oral health through collaborative efforts. The section focuses on educating pediatricians through multiple forums, advocacy for children's oral health and improving relationships and communication between the dental and medical homes.

AAP offers affiliate membership opportunities for dental professionals and associate memberships for pediatric dentists who are members of the American Academy of Pediatric Dentistry.

For more details, visit aap.org and search for Children's Oral Health.

For more information on the ADA's Action for Dental Health campaign, visit ADA.org/8585.aspx.