New Odds Show Delayed Dental Visits Are a Bad Gamble

CHICAGO — New research supports the vital importance of early dental visits, preferably at age 1, to protect children’s oral health, according to a 2018 study conducted through the American Academy of Pediatric Dentistry (AAPD), the leading authority on children’s oral health. The study with over 2,000 infants conducted at Nationwide Children’s Hospital, Columbus, Ohio, produced a predictive model that suggests the odds of a child having tooth decay at the first dental visit more than doubles for every year of increased age.

“If we do the math, a child who has a first dental visit at age 5 has nearly 20 times the odds of having cavities at that visit than a child who has a first dental visit at age 1,” says Paul Casamassimo, DDS, MS, chief policy officer of the AAPD’s Pediatric Oral Health Research and Policy Center. “By delaying the first dental visit, parents take an unnecessary gamble on their child’s oral health.”

The study offers additional clues to assist health care professionals identify tooth decay risk in young children before even looking in their mouths. Starting at the 18-month well-child visit, health care providers can use five variables to assess the odds of future or present tooth decay risk. The five variables are:

• Age of the child
• History of a preventive dental health visit
• Duration of breastfeeding (past age 1)
• No-show rate (such as broken appointments, etc.)
• Preferred spoken language

While most pediatric providers consider oral health screening and access to dental care an integral part of children’s overall health, adoption of available caries risk assessment tools is low due to competing time demands at the well-child visit. “During the first year of the study, health care providers we visited overwhelmingly expressed the need for something simpler to predict caries risk, preferably from information already in the medical record,” says Casamassimo. A full report of this study can be found on the AAPD website at: http://www.aapd.org/assets/1/7/DentaQuest-RE-4dig.pdf.

“Knowing a toddler is at risk for cavities based on information routinely gathered from the well-child visit has the potential to engage health care providers in oral health and encourage needed referrals for dental care,” says Casamassimo. “An easy-to-use caries-risk assessment model based on general medical factors may facilitate a consistent integration of oral health intervention into well-child visits.” This study suggests a predictive model may help health care providers identify children at low, moderate and high risk of future cavities. It identifies children needing a higher level of primary care intervention, observation for early childhood caries and increased urgency in obtaining a dental home.

Children referred to dental care as a result of having large predictive model values would be much more likely to have dental caries or be “high” risk for dental caries at the time of their first visit to a dental clinic, thus offering valuable preventive services in a targeted, efficient and cost-effective manner.

“Caries or caries-risk predictive variables in the Electronic Health Record (EHR) accessible to health care providers performing well-child exams allow for enhanced oral health intervention and facilitation of urgent referrals to oral health providers for children at risk,” says Diane Dooley, MD, a pediatrician, principal investigator and associate clinical professor at the University of California San Francisco Department of Family and Community Medicine. “With such a tool, primary care providers could administer a caries-risk assessment as a part of the well-child visit without taking time from other equally important health concerns. It also allows for the development of cost-effective systems to address the risk factors and barriers to oral health access, especially among low-income families from non-English speaking households,” states Dooley.

According to Arthur Nowak,DMD,  a principal investigator and Fellow of the AAPD Pediatric Oral Health Research and Policy Center, “The AAPD and the American Academy of Pediatrics (AAP) recommend a first dental visit by a child’s first birthday. An early dental referral is particularly critical to a child’s oral health, especially when factors associated with risk for tooth decay are present. The value of a Dental Home early in life is demonstrated in both clinical data and children’s smiles.”

Building a predictive model is just the first step. A pilot study of the model is being conducted at Nationwide Children’s Hospital. Data from patients who visited the Baby Dental Clinic in 2017 are being analyzed to determine if the predictive model’s abilities hold true in a new study population.

This 3-year project was funded by a grant from the DentaQuest Foundation and developed in partnership with an interdisciplinary team made up of representatives from pediatric, family physician, nurse practitioner and physician assistant professions.