UW Today

August 10, 2011

Physicians, dentists plot new approaches to childrens oral health

UW Health Sciences/UW Medicine

A baby has his first dental exam.

A baby has his first dental exam.

“Physician and Dentist: Together Managing Early Childhood Oral Health,” held July 28-29 at the Hotel Deca, was intended to launch a national dialogue and working partnership among pediatricians, family physicians and pediatric dentists. The initiatives goal is to effectively manage early childhood caries  disease in at-risk patients ages birth to 3 years.

“This problem clearly calls for fresh approaches,” said Dr. Joel Berg, chair of the UW Department of Pediatric Dentistry, which jointly sponsored the symposium with Seattle Childrens. “Were spending more than $12 billion each year in the United States to fix childrens decayed teeth. On top of that, nearly three of 10 toddlers and preschoolers are thought to be affected by early childhood caries.  Our kids lose more than 51 million school hours annually to dental issues.”

Dr. Joel Berg, chair of pediatric dentistry

Dr. Joel Berg, chair of pediatric dentistry

“This is our most prevalent childhood disease,” said Berg, who is also president-elect of the American Academy of Pediatric Dentistry. “Its most frustrating aspect is that the disease is almost entirely preventable.” He said that more physician involvement is especially critical in light of the fact that many children do not see a dentist until age 3, when they may already have had 12 to 15 well-child physician visits.

More than 70 leaders in medicine and dentistry gathered for the symposium, co-moderated by Berg and Dr. F. Bruder Stapleton, UW chair of the UW Department of Pediatrics, associate dean of the UW School of Medicine and chief academic officer and senior vice president at Seattle Childrens.  Speakers included administrator Marcia Brand of the U.S. Department of Health and Human Services and the UW School of Medicines Dr. Frederick Rivara, a pediatrician and researcher who recently chaired the Institute of Medicine committee on oral health.

Stapleton cited figures from a recent Journal of the American Medical Association article showing that 75 percent of children under 18 with insurance had seen a dentist in the past six months, as opposed to only 25 percent of those without insurance. This, he said, underscored a need for physicians and dentists alike to be advocates for children.

Dr. Bruder Stapleton, chair of pediatrics

Dr. Bruder Stapleton, chair of pediatrics

The foundation was also a major underwriter of The Center for Pediatric Dentistry, a UW-Seattle Childrens joint venture that began operation at Seattles Magnuson State Park a year ago. The new program, which is directed by Berg, emphasizes early intervention, with dental visits starting by age 1.

Another state program with UW participation,  Access to Baby and Child Dentistry (ABCD), includes training in oral health screening and fluoride varnish application, referral plans, and reimbursement for services.  ABCD has been lauded by the American Academy of Pediatric Dentistry, the Washington Health Foundation, the W.K. Kellogg Foundation and the Children’s Defense Fund.

Aside from physician-dentist collaboration, the symposium attendees also discussed benefits of early caries risk assessment at age 1, effective sharing of electronic health records between physicians and dentists, and improved medical and dental oral exam training.

Dr. Jessica Lee of the University of North Carolina, who chairs the AAPD Council on Scientific Affairs, highlighted the success of early intervention in her state. There, several federally funded projects have focused on early childhood health for young and vulnerable children up to age 5.

The results have been dramatic, with a 49 percent reduction in operative services by 18 months of age and an 18 percent reduction in surgical procedures by age 6.  One project also demonstrated that physicians who were trained alongside pediatric dentists can detect oral health disease in children with 88 percent accuracy in individual teeth, and 95 percent accuracy in children overall, Dr. Lee reported.

Nor does oral examination and treatment add significantly to the time a pediatrician or family physician spends with a child, she said: “An oral exam takes less than a minute; fluoride varnish, one to two more minutes.”

Another key issue at the symposium was medical school training in oral health.  Rivara, vice chairman of the Department of Pediatrics at the UW, noted that 70 percent of medical schools have less than five hours of oral health in their curriculum, and that 10 percent have no oral health education at all. Citing data gathered for the IOM reports, he also said that among pediatricians, 50 percent have no oral health training in medical school or residency.

However, he said that the UW School of Medicine is considered a model in this area. The school has started to implement a comprehensive oral health curriculum, and results show that students have more confidence in the identification of oral disease and improved attitudes toward oral health care.

Rivara also said that medical and dental care should no longer be viewed as separate, but instead should be viewed as care of the whole individual, using a proactive, collaborative approach.

Dr. Marcia K. Brand, deputy administrator of the federal Health Resources and Services Administration (HRSA) of the Department of Health and Human Services, said that HRSA supports projects that seek to integrate oral health and primary care for children through academic programs. In her video presentation, she also noted that the agency has funded 12 four-year pilot projects to help further define effective dental/medical collaboration.

“We cannot adequately address the challenges we face to provide coordinated oral health access to kids by simply bending the existing care system,” she said. “We need to consider new things, new providers, and training and new protocols for existing providers.”

Symposium speakers agreed that improved records-sharing and other technology will also be key factors in reaching the overall goal.

Said Berg: “What we need is a specific risk-assessment identifying tool at the 12-month checkup, and we dont have that yet.” He said he believed such a tool could be like a wand that would scan a babys teeth at and just below the tooth surface, to indicate risk level and the appropriate intervention. He also foresaw a combination of algorithms that assess historical, social and environmental factors.

The symposium is intended to be the first in an annual series, with published goals and benchmarks, according to Berg and Stapleton. Symposium members plan to develop a comprehensive medical and dental solution to serve as a national standard for successfully fighting ECC among at-risk children.

“We need to move away from the old model of  ‘drilling and filling and t
oward a model of prevention,” Berg said.