Pediatric Journal Highlights Need for Translational Research, Medical-Dental Collaboration to Improve Children's Oral Health
In a Special Issue of Academic Pediatrics,1 leading dental researchers, pediatricians, and policy experts review progress over the last nine years to fulfill key action steps for improving children's oral health and access to care, as initially presented in the 2000 Surgeon General Report—Oral Health in America and the 2003 National Call to Action to Promote Oral Health. The journal, published by the Academic Pediatric Association, presents updated background papers that were developed for the 2008 National Summit on Children's Oral Health, which was convened by the American Academy of Pediatrics to strengthen partnerships between the dental and medical communities to address the oral health needs of U.S. children of all sociodemographic backgrounds, plus children with special health care needs. The Special Issue is available online at no charge, and its release was promoted online by Medical News Today.2
The Special Issue deals broadly with the nation's progress to date in addressing challenges and overcoming barriers to close existing gaps in pediatric oral health care. The authors' evaluation focused on implementation of the following recommendations, from the 2003 National Call to Action, to reduce oral health disparities and the burden of dental disease:
- change perceptions of oral health;
- overcome barriers to care by replicating effective programs and proven efforts;
- build the science base and accelerate science transfer;
- increase workforce diversity, capacity and flexibility; and
- increase collaborations and public-private partnerships.
Several authors discuss advancements that have strengthened dental science and pediatric oral health over time, such as establishing the public health burden of dental caries, increasing utilization of dental sealants, and research innovations in tissue engineering and salivary diagnostics. Other authors emphasize that significant challenges still remain, plus critical, real-world gaps that have hindered progress in meeting the above goals: health disparities; cultural/language barriers; inadequate oral health literacy; limitations in the pediatric dental workforce.
The Special Issue on Children's Oral Health underscores the importance of translational research to integrate optimal, evidence-based interventions in clinical practice, and to replicate programs of proven effectiveness to reduce dental disease. As noted in an executive summary, "[t]here has been a lag between our understanding of etiological factors in caries and our ability to ensure the translation of this evidence into clinical practice…. More clinical transitional research is needed to assess promising interventions (such as xylitol to inhibit maternal transmission of cariogenic bacteria, or effectiveness of dietary counseling)."
In a Special Issue commentary, former U.S. Surgeon General Dr. David Satcher explains that the 2000 Oral Health in America report "emphasized recommendations to prevent oral diseases in children to promote lifelong health." To meet this common cause, Dr. Satcher calls for stronger collaboration across the dental-medical community to "close the gap between what we know and what we can and must do to improve the nation's general and oral health—starting with children."
Improving children's oral health throughout the U.S. will require significant leadership from public/private organizations to promote and support enhanced access to oral health care services, particularly for underserved populations. Dental caries is still the most prevalent chronic infectious disease in children, affecting over one-quarter of U.S. children under five years of age.3 As noted in the Special Issue, children from low-income households have the greatest amount of oral disease, which lends further support to the recommendation for increased dental-medical partnerships and improved integration between dental, medical and public health care systems.
The ADA is committed to helping dentists, the pediatric medical community, and other health professionals improve children's oral health and referral for dental services in collaboration with external agencies. Children should receive their first dental visit within six months of eruption of the first tooth and no later than 12 months of age. Appropriate public health interventions and prevention measures, such as oral hygiene instruction, community water fluoridation, and dental sealants, are recommended for patients of all ages and sociodemographic categories. Dentists are encouraged to provide appropriate oral health education and anticipatory guidance to parents, caregivers and children. The following ADA caries risk assessment forms can also be used when discussing potential risk factors with the caregivers of infants and children.
1. Special issue on children's oral health. Academic Pediatrics (November–December 2009), 9(6); 371–482. Available at: http://download.journals.elsevierhealth.com/pdfs/journals/1876-2859/PIIS187628590900309X.pdf.
2. Special issue of Academic Pediatrics reports on state of pediatric oral health in US. Medical News Today, December 9, 2009. Available at: http://www.medicalnewstoday.com/articles/173471.php. Accessed December 15, 2009.
3. Oral health improving for most Americans, but tooth decay among preschool children on the rise. CDC, National Center for Health Statistics, Office of Communication. April 30, 2007. Available at: http://www.cdc.gov/nchs/pressroom/07newsreleases/oralhealth.htm. Accessed December 28, 2009.
- ADA, ADAF join with AAP to train pediatricians as oral health advocates (ADA News; December 14, 2009)
- Oral Health Topics: Tooth Decay (Caries)
- ADA Statement on Early Childhood Caries
- Oral Health Topics: Diet and Oral Health
Document Posted December 2009