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Opportunities for Interprofessional Collaboration Between Physicians and Dentists in Treatment of Pediatric Patients
TAKE-HOME MESSAGE
- Data from the 2011 National Survey of Children's Health were used to examine the frequency of pediatric visits to physicians and dentists by patient age. Children aged 0 to 5 years visit the physician significantly more than the dentist, while children age 10 to 17 years visit the dentist significantly more than the physician. Given this asymmetry, collaborative care and interprofessional education is important to improve overall patient well-being.
- Physicians may continue to incorporate caries prevention and dentist referral for young children, and dentists may increasingly incorporate healthy living counseling and systemic health monitoring to routine visits of older children and adolescents.
– James Boynton, DDS
abstract
This abstract is available on the publisher's site.
Access this abstract nowPurpose
The purpose of this study was to examine national data for trends in pediatric patient visits to dentists and physicians that may inform future interprofessional practice.
Methods
Data for 95,677 children, aged zero to 17 years, captured between 2011 and 2012 from the National Survey of Children's Health were examined to compare the number of visits made to dentists and physicians at each year of age.
Results
The average age was 8.9±5.2 (standard deviation) years; 28.6 percent were receiving Medicaid. Comparisons showed that, while physician visits were more common than dentist visits at younger ages, children aged nine years and older had more dentist visits than physician visits per year (P<0.001). Stratified analyses showed similar patterns in the frequency of physician and dentist visits within boys (P<0.001), girls (P<0.001), English speakers (P<0.001), and non-English speakers (P<0.001).
Conclusions
Physicians have an opportunity to address oral health in younger children, and dentists have an opportunity to address systemic health for older children. For five-year-olds and younger, physicians should incorporate oral health evaluations and dentist-referrals. For nine-year-olds and older, dentists should provide counseling on healthy weight, nutrition, and human papillomavirus (HPV) vaccination; monitoring for diabetes and asthma; and screening for smoking, vaping, and sleep apnea.
Additional Info
Disclosure statements are available on the authors' profiles:
Opportunities for Age-Specific Interprofessional Collaboration Between Physicians and Dentists in Pediatric Patients
Pediatr Dent 2020 May 15;42(3)203-207, D Okuji, D Kritz-Silverstein, H Pham, E Chen, Y Wu, WY ChanFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
This well-designed, cross-sectional study by Okuji and colleagues was designed to address an important pediatric population health issue by examining a large national dataset, the National Survey of Children’s Health (NSCH), to determine the frequency of dental versus physician visits by age for young children; this reveals opportunities for interprofessional collaboration to improve oral health and overall health outcomes. It is interesting that the investigators hypothesized that children older than 2 years of age visit a dentist more frequently than a physician when it is well-documented that children have 12 well-child visits with a pediatric primary care provider by age 3 years (AAP), but only 1 dental visit by age 1 year and then only one every 6 months, depending on the risk assessment. National data report a high percentage of well-child visits by age 1 in comparison with the percentage of dental visits by the end of the first year and beyond.1 The findings of this study align with national data rather than supporting their hypothesis.
Of greater interest to me, is that, while the authors examine opportunities for interprofessional medical–dental collaboration, they only do so between physicians and dentists. They omit any mention of significant primary care providers, pediatric (n = 10,730) and family nurse practitioners (n = 188,500), as well as physician assistants (n = 111,500), who are major contributors to well-child care and committed to integrating pediatric oral health with overall health.2,3 The authors appropriately address the need for increased exposure to oral health content and clinical competencies in medical school curricula, including interprofessional experiences that integrate pediatric oral health with overall health conditions like diabetes, asthma, obesity, sleep apnea, and human papilloma virus (HPV). There is an increasing number of such initiatives.4-6 Nurse practitioner and physician assistant programs also have made significant strides in integrating oral health in their programs.2-4 Data from a national nurse practitioner survey conducted by the Center for Integration of Primary Care and Oral Health (CIPCOH) reveal that, of responding pediatric nurse practitioner programs (50/74), 100% are integrating oral health in their curriculum; 93% of responding family nurse practitioner programs (106/252) also report investing in oral health curriculum integration.2
A strength of this study is recognition that, for children, access to oral health screening, fluoride varnish application, anticipatory guidance for caregivers, and referrals to dental homes in primary care settings are more prevalent than access to dental care. In fact, primary care practices are incentivized to integrate oral health given available additional reimbursement for these services. Pediatric primary care providers need to re-visit well-child standards of care to fill this access gap by integrating oral health so that it is a nationally required “best practice.” Similarly, the authors highlight that dental professionals also need to revisit their “best practices” so they begin to “think out of the box” and consider how they can address general health promotion issues while children from age 1 to 18 years are having dental checkups. Obesity, diabetes, HPV, smoking, and vaping are only a few of the health problems that are linked to overall population health outcomes and cost-effectiveness. They all provide excellent opportunities for members of the oral health team, dentists, dental hygienists, and dental therapists to collaborate with their primary care colleagues, physicians, nurse practitioners, and physician assistants about the whole-person care needs of their mutual patient population. The authors highlight a very important key to success in promoting pediatric medical–dental collaboration; that is, professional development programs, continuing education offerings that make clinicians feel competent in widening the lens through which they perceive the scope of services they are comfortable offering in their clinical practice setting.
References