U of M DENT 5402 - The Role of the Primary Care Medical Provider in the Prevention of Childhood Caries

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1The Role of the Primary Care Medical Provider in the Prevention of Childhood Caries The Role of the Primary The Role of the Primary Care Medical Provider Care Medical Provider in the Prevention in the Prevention of Childhood Caries of Childhood Caries Amos S. Amos S. DeinardDeinardI) History over the past 40+ years• Training (absence of)• Medical School• Pediatric Residency and, by report, Family Medicine Residency• General presumptions• Dentists available in community • Mouth not viewed as part of the body.• Exceptions to that approach• Federal Children and Youth and Maternal and Infant Care programs • Dental care – required, either on site or by contact. • Federally Qualified Health Centers/Rural Health Centers • Dental care – required, either on site or by contact• Medicaid (late ’60’s) and SCHIP• Dental care is a covered service through community resources. • However, less availability of community dental resources over past 15 years (Public Programs (Medicaid/SCHIP); Uninsured) • Impact on those populations • Dental Survey 1998-99• Question - how many CUHCC patients >3 years of age got dental care over the course of a 12 month period?• Design - UCARE – Managed care/fee for service• Findings - only 30% got care anywhere•Remedy –• Pediatric Dental Initiative 1999-2001• Rationale – frequency of well-child visits up to school-age• Who – children 12-60 months of age• What - medical provider (MD; NP)/dentist• Activities• Medical Provider (Questionnaire) • usual demographics – age, sex, race, sibs•dental care history• brushing history•parent•child• parent’s dental history•Dentist•Examination• D/M/F•Presence of plaque•S. mutansculture•Plan•Education• Varnish application• Dental clinic visit scheduled • Data analysis (N= 372)• Decay present in:• 21% of 2 yr olds• 40% 2 – 3 yr olds• 58% 3 – 4 yr olds• 60% 4 – 5 yr olds• Ethnicity and decay• 56% - NA & H• 44% SEA• 30% W & O• 24% - A/AA• Failed appointments• < 3 to > 3 – No difference•Other factors• premature birth, significant medical problems, recurrent otitis media, multiple coursesof antibiotics – No difference•DHS Task ForceII) Surgeon General’s Report - 2000• Public Programs (Medicaid; SCHIP) and uninsured children•Mouth ispart of body•Morbidity• Dental caries – most common chronic illness of children •5 x asthma•7 x hay fever• Impact on school performance (active and passive) • Disproportionately more common in low income and minority children (i.e., health disparity (one of many; others, e.g., asthma, immunizations, obesity (diet)))• 80 % of disease found in 25% of children despite fluoridation of water2• Time lost from school - 51 million hours in 1999• Impact on parent(s)• Racial disparities• AA – 4x• Immigrants•Reasons for medical provider involvement in Dental Care• Dentists’ unavailability (unwillingness (reimbursement); inability (fear of one and two year olds))• Shortage of dentists (retirement vs. matriculation)• North Carolina experience (Olson Huff)III) Medical Providers’ Involvement •WhoMDPediatricsFamily PracticeNPPediatricsFamily PracticePA•Why• Importance of Primary/Secondary Prevention• Cornerstone of Primary Care of Children • To fill void and address need•When• Well-child visits (2 weeks through 5 years (N= 12))•What• AAP Policy (Tooth Decay Prevention)• Medical providers to assess patients’ dental health and add caries prevention (parent education; fluroide varnish)• Dental “Home” (age 12 mo., not 3 years) • But, is it really a “home”? (inconsistency of coverage). Rather, emphasize regular care (medical and dental)• Five As of Public Health (affordable, available, accessible, accountable, culturally acceptable) when establishing a practice•Content•Episodic/Comprehensive• Emergencies/Triage• 24/7• Bilingual• Referral network• Schedulers• Prescriptions• Anticipatory Guidance• 1°/2° Prevention• Risk assessment ≥ 6 mo• Risk assessment/intervention form• Preexisting risk factors• Early tooth eruption (<6 months)• Overlapping/crowded incisors• Poor parental dental health •Bottle to bed• Frequent snacking (3 or more times/day)• Oral health care questions• Does someone clean the child’s teethdaily? • Is fluoride – containing toothpaste used? (ADA seal of approval)• Does the child take fluoride supplements?• Does the child go to bed with a bottle?• Does the child use a pacifier?• Procedures• Fluoride varnish application •Education • Parent informed that dental referral is needed because of caries/other problems• Was dental referral/appointment forcaries/pathology assessment made by provider or caregiver? •Objectives• Ascertain interest of Primary Care medical providers in 1°/ 2° dental prevention • Gain AAP/AAFP support• Gain DHS/Health Plan support• Gain dental profession support • Develop dental health educational materials for primary care providers • Printed matter (providers; patients’ parents; clinic staff)• Atlas (for providers) • Develop training program for medical providers • Web-based• Lift the lip (> 6 months) • Varnish application• High risk• Reimbursement (Health Plans/DHS) (D-1203)3• Anticipatory guidance• Infectious nature and how to minimize (theoretically totally preventable)• Feeding practices• Caregiver’s oral health• Tooth brushing (toothpaste)• Flossing•Fluoride • Water supply (test)• Formula (bottled water) • Supplementation• Source of regular dental care – referrals for all • Develop dental health education for introduction into prenatal and pediatric programs• Methods and Materials• Mailing N = 2,750• Response - >200 (MD, NP, PA, DDS, RDH)• Attended AAP/AAFP Board Meetings• Discussed issues with DHS and Council of Health Plans • Developed printed educational materials – GRA • Developed atlas – P/G et al. • Critiqued by 8 dentists• Developed web-based training http://meded1.ahc.umn.edu/fluoridevarnish/• Gained University approval to award CME credit (2004 only) • Developed questionnaire for survey of prenatal patients’knowledge about dental health (student)• Used results of survey to create educational materials (Honors undergraduate student)• Worked with OB clinic nurses to incorporate education


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U of M DENT 5402 - The Role of the Primary Care Medical Provider in the Prevention of Childhood Caries

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