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Home | Open Up! Addressing Oral Health at Well Visits

Open Up! Addressing Oral Health at Well Visits

August 13, 2018

By Eileen Crespo, MD, FAAP, Vice President of Medical Services, Delta Dental Minnesota; pediatrician at Hennepin Healthcare

Have you been to an adult dentist lately? If you have, you may have had your blood pressure measured. You might have thought that odd, but many dental practices are screening adults for high blood pressure. The goal is to screen and refer patients who may have regular dental care but may not be having regular medical care. The intention is to have dental and medical providers join efforts in collaborative patient care, working as a team.

In pediatrics, we are familiar with the concept of the medical home, a coordinated approach to providing comprehensive primary care for children, youth and adults. For many patients, the medical home might be comprised of primary care, medical specialties, social workers, community health workers and dieticians, but no oral health provider. The dental home is somehow separate, though poor oral health doesn’t follow arbitrary divisions.

We all have taken care of children with rampant dental decay that affects their overall health. From a sleepless night for a child with tooth pain or preoperative clearance for a child with special health care needs who needs surgical restorations for widespread dental caries, patients need an integrated approach that includes oral health as a basic primary care need.

Pediatrics has been ahead of many medical specialties with oral health counseling and fluoride varnish application (now required in Minnesota for reimbursement) at well child care checks. Some practices around the state and country are doing even more. From physically co-located dental/medical clinics to an integrated dental hygienist in a pediatric practice in a model championed in Colorado, providers are trying innovative approaches that highlight the concept that optimal health for children (and adults) includes oral health.

Given the success of the medical home model, I challenge you to consider how you can integrate oral health in your approach to overall health for every patient.
Use the Caries Risk Assessment tool available from the AAP: https://www.aap.org/en-us/Documents/oralhealth_RiskAssessmentTool.pdf

The role of the pediatrician means we wear many hats and help our patients navigate the complicated health system by acting as a partner. For oral health promotion, this may mean helping families find conveniently located and language-concordant clinics, asking about their last visit to a dentist and making a call to your friendly neighborhood pediatric dentist or general dentist to discuss patient needs. I have found that most dentists welcome this type of collaboration and patients win when we’re all on the same team.

A great way to integrate this work into your office is the AAP’s Brush, Book, Bed initiative typically used for well visits for children aged 6 months to 6 years. The AAP has an implementation guide that details how to bring this program to your clinic: https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/Oral-Health/Pages/Brush-Book-Bed.aspx

Brush, Book, Bed has a simple and clear message for parents:

Each night:
1. Help your children to brush their teeth
2. Read a favorite book (or two!)
3. Get to bed at a regular time each night.

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