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Oral health is a critical aspect of overall well-being, especially for young children. Untreated tooth decay is disproportionately prevalent among low-income children, posing significant health risks. The American Academy of Pediatrics (AAP) has established guidelines for pediatric clinicians to implement oral health care, but the effectiveness of these interventions has been inconclusive. A recent cluster randomized clinical trial (cRCT) aimed to address this gap by evaluating the impact of expanded theory-based oral health education on dental attendance and untreated decay among young children.
Study Design and Participants
The study involved 18 primary care practices in northeast Ohio, including 63 clinicians and 1023 parent-child dyads. The participants were recruited between November 2017 and August 2019, and each dyad was followed for three consecutive well-child visits (WCVs) from October 2018 to July 2022. The inclusion criteria required practices to have at least 20% Medicaid-enrolled children, use electronic medical records (EMR), and for children to be aged 3 to 6 years, Medicaid insured, and without serious medical conditions preventing participation in dental screening.
Intervention and Control Groups
The practices were randomly assigned to either the intervention or control group. The intervention group received multilevel interventions, including didactic education and skills training for clinicians. This training emphasized the chronicity of caries, the importance of baby teeth, and the role of cariogenic bacteria in transferring decay to permanent teeth. Clinicians were trained to communicate core oral health (OH) facts to parents, provide a prescription to visit the dentist, and document the OH encounter in the EMR.
In contrast, the control group clinicians received standard AAP-based oral health education and were asked to follow usual OH care recommended by AAP Bright Futures guidelines. No EMR documentation was required for the control group.
Visual Abstract. Multilevel Interventions and Dental Attendance in Pediatric Primary Care
Key Findings
The study's primary outcomes were dental attendance and untreated decay, assessed through clinical examinations and Medicaid claims data. The results revealed several significant findings:
Increased Dental Attendance in the Intervention Group: Clinical examinations demonstrated that children in the intervention group had 34% increased odds of dental attendance compared to the control group. This suggests that the expanded oral health education effectively encouraged parents to seek timely dental care for their children.
Lower Untreated Decay in the Intervention Group: The intervention group also showed clinically meaningful lower untreated decay. This finding indicates that the expanded education not only increased dental visits but also led to more comprehensive dental care, including sealants, fillings, and extractions.
Conflicting Results from Medicaid Claims Data: Interestingly, Medicaid claims data showed that children in the control group had increased odds of dental attendance but did not have lower untreated decay. This discrepancy highlights the limitations of relying solely on administrative data for assessing dental care outcomes.
Importance of Baby Teeth: The intervention emphasized the significance of baby teeth in preventing future caries. Clinicians in the intervention group effectively communicated that bacteria in cavitated baby teeth could easily attack newly erupting permanent teeth, underscoring the need for timely dental attendance.
Implications for Pediatric Dental Care
The study's findings have several important implications for pediatric dental care:
Effective Counseling by Clinicians: The expanded oral health training enabled clinicians to counsel parents more effectively, leading to increased dental attendance and reduced untreated decay. This suggests that enhancing clinician education can have a positive impact on children's oral health.
Need for Comprehensive Data: The conflicting results between clinical examinations and Medicaid claims data underscore the need for comprehensive data sources in assessing dental care outcomes. Relying solely on claims data may not provide an accurate picture of dental attendance and care.
Role of Baby Teeth: The study highlights the critical role of baby teeth in preventing future caries. Educating parents about the importance of baby teeth and the risks of untreated decay can encourage proactive dental care.
Potential for Broader Implementation: The success of the intervention group suggests that similar expanded oral health education programs could be implemented more broadly to improve pediatric dental care. A toolkit for dissemination has been developed to help clinicians incorporate this new education into their practices.
Conclusion
The cluster randomized clinical trial provides valuable insights into the effectiveness of expanded theory-based oral health education in increasing dental attendance and reducing untreated decay among young children. The findings suggest that clinicians receiving enhanced training can effectively counsel parents and promote timely dental care. As untreated tooth decay remains a significant issue among low-income children, these results underscore the importance of comprehensive oral health education and the need for accurate data sources in assessing dental care outcomes. By emphasizing the role of baby teeth and the chronicity of caries, clinicians can help ensure better oral health for future generations.
Read Paper│JAMA Network
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