A Predictive Model for Primary Care Providers to Identify Children at Greatest Risk for Early Childhood Caries.

Purpose: The purpose of this study was to create an early childhood caries (ECC) risk-screening tool that fits into the primary care provider (PCP) well-child workflow. Methods: Integrated health records were employed to develop a predictive model for infants/toddlers at ECC risk; 2,009 patients with 12-, 15-, or 18-month well-child visits and at least one dental visit were used to develop a predictive model for ECC risk at the first dental visit. Independent model validation used 880 18- to 48-month-olds at their first dental appointment after at least one well-child visit. Results: Age at the first dental visit strongly predicted caries risk (odds ratio for one-year increase in age equals 2.11; 95 percent confidence interval equals 1.80 to 2.47). Three factors predicted high-caries risk: breast feeding status, preferred language not English, and no-show rates for pediatric clinic visits greater than 20 percent. All three non-age risk factors in well-child exams prior to 18 months predicted 42 percent probability of having caries if present for the first dental visit at 18 months. If that child was not seen until four years of age for the first dental visit, the probability of high caries risk increased to 83 percent. Model performance for independent validation was very close to expected performance. Conclusions: Existing clinical documentation plus a validated predictive model enables an effective caries risk assessment within well-child visits.

Primary care interventions to reduce childhood obesity and sugar-sweetened beverage consumption: Food for thought for oral health professionals.

OBJECTIVES: Childhood obesity remains a significant threat to America's children. Health care leaders have increasingly called upon oral health professionals to integrate healthy weight promotion and enhanced sugar-sweetened beverage counseling into their professional practices. The aim of this scoping review is to examine recent evidence regarding the effectiveness of primary care childhood obesity interventions that have potential for adoption by oral health professionals. METHODS: Medine, and PubMed were searched from 2010 to 2016 for review articles and studies reporting patient outcomes or policy outcomes relevant to primary care childhood obesity interventions for children ages 2-11 years. Additional articles were accessed through relevant websites, journals, and references. Our screening criteria included interventions that could be adopted by oral health professionals. RESULTS: Forty-two articles met inclusion criteria. Effective interventions fell into four domains: family-based programs, motivational interviewing, office-based practice tools, and policy interventions. Despite strong evidence linking the consumption of sugar-sweetened beverages to childhood obesity, our review did not find evidence of primary care programs effectively targeting and reducing childhood sugary drinks. CONCLUSIONS: Effective primary care interventions for addressing childhood obesity have been identified, although only short-term effectiveness has been demonstrated. Dissemination of these practices as well as further research and advocacy are needed. Childhood obesity and poor oral health share many common risk factors. Additional research should focus on the benefits and feasibility of widespread interdisciplinary medical-oral health collaboration in addressing the two most prevalent diseases of childhood.

Oral Health Prevention and Toddler Well-Child Care: Routine Integration in a Safety Net System.

BACKGROUND AND OBJECTIVE: Applying topical fluoride varnish (FV) to young children's teeth is an effective therapeutic strategy for preventing early childhood caries (ECC). In 2008, the pediatricians at Contra Costa Regional Medical Center and Health Centers became concerned that our low-income pediatric patients had high rates of ECC and very limited access to dental care. We formed an interdisciplinary safety net-academic partnership with the University of California San Francisco to implement routine FV applications, along with oral health education, screening, and referral during well-child exams for children aged 1 to 5 years. METHODS: Over 3 years, the team developed clinical policies, educational materials, billing, and support systems to facilitate implementation in the primary care setting. A pilot study was performed in 2 health centers; improvements to the implementation plan were made. A team of local providers and academic partners performed system-wide didactic and hands-on trainings and spread this intervention to the remaining 6 health centers. Continued improvement strategies and provider feedback were pursued with each measurement cycle. RESULTS: In August 2012, 95% of all children aged 1 to 5 years who were seen for well-child checkups received a FV application and oral health education during their primary care well visit. Repeat measurement in April 2014 showed a sustained rate of 97% application of FV for children in this age group seen for well-child visits. CONCLUSIONS: With institutional commitment and an academic partnership, a safety net institution can integrate routine FV applications and oral health interventions into well-child visits to reduce ECC.