Dental Primary Care
Dental Home
Footnotes

Dental Primary Care

Professional guidelines (and Medicaid statutory requirements) for addressing pediatric oral health needs are predicated on early and periodic clinical examinations to assess for evidence of pathologic changes or developmental abnormalities, diagnoses to determine treatment needs, and follow-up care for any conditions requiring treatment. These recurring periodic oral assessments ("dental checkups") are generally coupled with routine preventive services (self-care instructions, fluoride applications, dental sealants, etc.) and increasingly seek to incorporate assessments of risk factors that elevate the likelihood of destructive changes if allowed to persist. This pattern of periodic assessments, preventive services, and necessary follow-up care also generally applies for adults, who collectively are more susceptible to the development of periodontal disease, oro-pharangeal cancers, and other soft tissue abnormalities. A large and growing proportion of the U.S. population that has adopted this pattern of care faces relatively few barriers to accessing services because of household income levels and/or private dental insurance. They enjoy unprecedented levels of oral health status. However, access for low-income children remains a challenge. ⁵

Dental Home

Primary pediatric oral health care is best delivered in a "dental home" where competent oral health care practitioners provide continuous and comprehensive services. Ideally a dental home should be established at a young age (i.e., by 12 months of age in most high-risk populations) while caries and other disease processes can be effectively managed with minimal or no restorative or surgical treatment. An adequate dental home should be expected to provide children and their parents with:

1. An accurate examination and risk assessment for dental diseases,
2. An individualized preventive dental health program based upon the examination and risk assessment,
3. Anticipatory guidance about growth and developmental issues (e.g., teething, thumb or pacifier habits),
4. Advice for injury prevention and a plan for dealing with dental emergencies,
5. Information about proper care of the child's teeth and supporting structures,
6. Information about proper diet and nutrition practices,
7. Pit and fissure sealants,
8. A continuing care provider that accomplishes restorative and surgical dental care when necessary in a manner consistent with the parents' and child's psychological needs,
9. Interceptive orthodontic care for children with developing malocclusions,
10. A place for the child and parent to establish a positive attitude about dental health,
11. Referrals to dental specialists such as endodontists, oral surgeons, orthodontists, pediatric dentists ⁶ and periodontists when care cannot be directly provided within the dental home, and
12. Coordination of care with the infant/child's primary care medical provider.

Footnotes

5. Kaste LM, Selwitz RH, Oldakowski RJ, Brunelle JA, Winn DM, Brown LJ. Coronal caries in the primary and permanent dentition of children and adolescents 1-17 years of age: United States, 1988-1991. J Dent Res. 1996 Feb;75 Spec No:631-41.
6. Pediatric dentists often function as primary dental care providers for children, but also may serve as referral outlets for difficult-to-treat children initially seen by general dentists.