Children Now Insider: Pediatricians are Preventionists

How primary care can play a key role in children’s oral health

By Dr. Susan Fisher-Owens, Guest Author

November 22, 2019

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Do pediatric and family practice providers try to prevent obesity by encouraging breastfeeding, and reducing sugar-sweetened beverages consumption?

Do they try to prevent disease by vaccinating children and demonstrating good handwashing hygiene?

Do they screen and assess for developmental delays, depression, and eating disorders?

Of course!

No self-respecting health care provider would overlook obesity and not counsel families on behavior modification to avoid its negative effects; nor skip vaccines because the diseases are not that common or they are not specialists in infectious disease; nor avoid asking about development, behavior, or mood concerns. Unfortunately, many pediatric providers still do not realize that early childhood caries (ECC) (i.e., dental disease) is even more common than childhood asthma. And, in addition to the pain it causes, ECC has serious impacts on a child’s nutrition, speech, self-esteem, and ability to learn—not to mention the long-term effects on their systemic health and even their ability to eventually secure stable employment as adults. In fact, ECC is the most common chronic disease in childhood and, according to parents, the top unmet health need.

The good news: ECC prevention can be accomplished without negatively impacting a provider’s bottom line or cycle times by utilizing the tools we already employ for obesity, asthma, and other diseases!

As a pediatrician, asking about a child’s and family’s health and health-seeking behaviors is a standard part of my well-child exam. I already ask about diet, so with only a few additional questions I gather the information needed to assess a child for ECC—questions such as consumption of fluoridated tap water if available, hygiene habits, and the health of parents’ and siblings’ teeth. It is important to embrace teachable moments in the clinic as well, such as when a parent attempts to “clean” a dropped pacifier by putting it in their mouth – I quickly let parents know that ECC is an infectious disease and is spread by sharing saliva. It is gratifying to be able to talk with parents about ways they can easily prevent dental disease and avoid the associated pain it causes their child, which often keeps them (both) up at night. Motivational interviewing has been shown to be successful with ECC and is a great way for providers to practice this skill.

Further, we assist in preventing ECC by applying fluoride varnish in the medical clinic. In accordance with the United States Preventive Services Task Force, primary care pediatric medical providers can and should apply fluoride varnish during well-child visits. Fortunately, it takes less than a minute to apply. Even better, we can recover our expenses while reducing the financial burden to the overall health care system!

The Every Smile Counts! (ESC!) Medical-Dental Learning Collaborative, with support from Children Now and the Sierra Sacramento Valley Medical Society, is sponsoring a free event to help primary care providers learn how to use this intervention to benefit patients, as well as screen for risks, and counsel on behaviors. Medical and dental providers will be in attendance to discuss how to improve the relationship and communication between these two essential health care services, including the referral process.

Non-pediatric providers are welcome too. We will detail the many ways oral health affects systemic health, in children and adults—for conditions with high prevalence, cost, and morbidity such as diabetes, stroke, and heart disease—because the biggest predictor of adult dental disease is ECC. We will also discuss the myths and truths about fluoride. Pediatric providers are vital in the prevention of ECC, and all providers can support health and well-being of the family and community. By preventing ECC we can ultimately reduce the long-term negative effects of this preventable disease on the entire body, from childhood through adulthood.

I look forward to sharing this information with you on December 4th. Register for the event here:

Let’s work together to make Every Smile Count!

Dr. Susan Fisher-Owens, MD, MPH, FAAP is a pediatrician in San Francisco, CA and is affiliated with UCSF Medical Center and Zuckerberg San Francisco General. She received her medical degree from George Washington University School of Medicine and has been in practice for almost 20 years. She is a Professor of Pediatrics and of Preventive and Restorative Dental Sciences at the University of California, San Francisco School of Medicine and School of Dentistry. Previously, Dr. Fisher-Owens served as a member of the American Academy of Pediatrics Oral Health Executive Committee.