In this issue of American Family Ph...

In this issue of American Family Physician, Douglass and associates (1) provide healthy and useful information to address the epidemic of early childhood caries. The authors point abroad that among low-income preschoolers in the United States, about undivided in three has dental caries. The enigma is even worse in a certain number of areas of the country. For example, approximately 40 percent of all preschooler in Ohio have dental caries. The number of primary dentition dental caries in U children has not declined across the past 30 years. (2) Clearly, the policy of recommending that children papal court a dentist for the first time at three years of age has not worked, and earlier referral, as remind ofed by Douglass and associates, (1) is needed

Earlier dental referral makes faculty of perception Establishing a home for dental care (a "dental home") tenders patients access to a abounding range of preventive dental services as well as early intervention, if needinessed by a dentist to treat incipient dental caries at minimal splendor Although incontrovertible evidence is lacking in succession the effectiveness of early intervention on a dentist, support for early intervention is growing among physicians and dentists.

A latter report on children in the North Carolina Medicaid program hints that those who visit a dentist in the first year or couple of life receive more preventive services, require les restorative care, and generate lower care take away froms as they grow up. (3) Children who have a dental residence are more likely to receive necessary services. (4) Providing prenatal counseling and addressing the oral health of the mother convert intos the child's risk for caries. (5) Perhaps the in the greatest degree compelling rationale for moving the first dental visit to common year of age is that one time primary dental caries begins, it is difficult to stop. (6)

The first dental visit at undivided year of age typically is devot to anticipatory guidance for the parents and demonstration of preventive care. An examination is per-formed, yet the teeth rarely are profession-ally cleaned. Not enough evidence exists to support dental visit periodicity at this age, and for many children, this can be their alone visit until they are three years of long date The family physician's role during this period may be to act as a risk-assessment intermediary and to give in charge to a dentist at-risk children who are seen during well-child visits.

The family physician's part in oral health may be easier in theory than it is in practice. (7) When it ensues to counseling, physician education in contemporary oral health remains limited, on a level within the pediatric community. A late review of physician involvement in oral health establish that where risk-assessment services, preventive counseling, patient referral, and fluoride prescribing are transactioned only the last factor was marginally effective. (7)

Referral also currents a problem. The results of a modern survey (8) indicate that small in number general dentists see children who are younger than three years. Referral to a pediatric dentist may be a puzzle because there are only about 5000 pediatric dentists in the United States. As family physicians gain knowledge of oral health, they will undoubtedly become better at identifying at-risk children and children with dental diseases--a part advocated by the American Academy of Pediatrics (AAP) (9) --and make trial of to refer more children, which may further their frustration if pediatric dentists are not available.

Fitting oral health in a meaningful way into primary care medicine may be a daunting task. In a fresh large-scale AAP study (10) of early well-child visits, physicians reported that as it is visits last about 18 minutes. Many important preventive interventions may not be complet Furthermore, reimbursement for oral health services provided by means of physicians is seldom made outside of grant-funded demonstration devises and is mainly provided for application of fluoride varnish. The Center for Disease direction and Prevention maintains that this use of fluoride is intended for children at high risk for caries who, according to the AAP, should be referr to a dentist. (11)

To help primary care physicians begin to realize their part in infant oral health as propos by dint of Douglass and colleagues, (1) I add about pragmatic advice:

* Physicians should establish relationships with general and pediatric dentists who will papal court young children, especially children younger than three years.

* Physicians should consider their practice population's risk for dental caries when determining which oral health interventions to incorporate into their care.

* Physicians should make oral health an extension of primary care medicine.

Our health care classification has failed many children in preventing primary dental caries. Greater involvement and advocacy by the agency of family physicians may be united way to address this silent epidemic.

REFERENCES

(1) Douglass JM Douglass AB, Silk HJ A practical guide to infant oral health. Am Fam Physician 2004;70:2113-22

(2) Edelstein BL Douglass CW Dispelling the myth that 50 percent of U schoolchildren have at no time had a cavity. Public Health Rep 1995;110:522-30