SAN FRANCISCO — Identifying children at high risk for dental caries in a primary health care setting prevents the development of caries in early childhood, while creating more accessible and cost-effective oral health care, according to data presented at the 2016 AAP National Conference and Exhibition.
“Because children have multiple well-child pediatric visits in the early years of life, many lower socioeconomic status and minority children have much greater access to medical care than to dental care,” Margherita R. Fontana, DDS, PhD, of the department of cariology, restorative sciences and endodontics at University of Michigan’s School of Dentistry, told Infectious Diseases in Children.
Margherita R. Fontana
“If primary care providers can engage in oral health screening and anticipatory guidance (brushing with a fluoride toothpaste as soon as the first tooth erupts, dietary recommendations, etc.), apply fluoride varnish, and direct children at high risk of caries to a dental home, there is a large opportunity for the disease to be prevented, and enamel can be remineralized at the initial stages of dental caries, before irreversible damage occurs,” she added.
Fontana and colleagues performed a prospective, multicenter longitudinal study to investigate the association between caries risk and fluoride recommendations within the primary health care setting. They distributed a caries risk questionnaire to the primary caregivers of 1,326 children (49% girls; 13% Hispanic, 41% white, 33% black, 2% other, 10% multi-racial; 58% enrolled in Medicaid; 95% living in urban communities) who visited either Duke University, Indiana University or University of Iowa’s clinical medical research center.
Children were examined for caries at baseline at age 12 ± 3 months, and again after 18 months at age 30 ± 3 months. Of the 1,326 recruited children, 1,059 completed the 18-month examination. The researchers used a generalized estimating equations logistic regression model to assess questionnaire responses.
The examinations indicated that at age 30 months, 7% of children developed cavitated caries lesions that were significantly more likely to occur in children who were prescribed drops or tablets of fluoride from their physician or dentist at age 12 months (OR = 8.5) and children who received topical fluoride such as fluoride varnish from a primary care provider (OR = 2.47). Among those who received fluoride, 69% have never visited a dentist. Children enrolled in Medicaid were more likely to receive a fluoride recommendation compared with those not enrolled (Duke: 43% vs. 3%; Indiana: 2% vs. 1%; Iowa: 22% vs. 5%). However, less than half of the children enrolled in Medicaid received a fluoride recommendation overall.
Consumption of sugary drinks by children was significantly associated with topical fluoride and fluoride recommendation. Additionally, parents were more likely to receive fluoride if they consumed sugary snacks or checked their child’s teeth more often.
Fontana told Infectious Diseases in Children that the results she presented at AAP “involves a preliminary analysis of partial study data, yet it showed that increased fluoride receipt/prescription from a health care provider at child’s age 12 months was associated with the child’s Medicaid status and some known cariogenic (ie, leading to cavities) dietary behaviors.
“Since the majority of the children in this study had never been to the dentist, the data suggests risk factors could be alerting medical providers and/or parents to consider the child at higher caries risk and affect fluoride recommendation,” she added. “This is a positive finding as it suggests that if we can validate caries risk indicators, medical health care providers might be willing and able to easily incorporate them into their decision-making for use/recommendation of preventive fluoride strategies (as it may appear they are already doing this ‘informally’).
“Our data also showed some differences between states participating in our study regarding fluoride receipt/prescription from a health care provider, and this could be related to state-specific reimbursement policies.” – by Alaina Tedesco
Fontana MR, et al. Abstract # 319064. Presented at: AAP National Conference and Exhibition; Oct. 22-25, 2016; San Francisco, California.
Disclosure: Fontana reports funding by the National Institutes of Health.