The Dental Home and Age One Visit: The Centerpiece of Children’s Oral Health Care Improvement

1. The Dental Home and Age One Visit: The Centerpiece of Children’s Oral Health Care Improvement Philip H. Hunke, DDS, MSD President American Academy of Pediatric Dentistry Presented to the Oral Health and School Readiness National Symposium, Nov. 2-3, 2006

2. The Dental Home • “The dental home is the ongoing relationship between the dentist and the patient, inclusive of all aspects of oral health care delivered in a comprehensive, continuously accessible, coordinated, and family-centered way. Establishment of a dental home begins no later than 12 months of age and includes referral to dental specialists when appropriate.” (AAPD Definition)

3. The Dental Home • Reflects the AAPD’s clinical guidelines and best principles for the proper delivery of oral health care to all children, with special consideration of infant/age one patients. • Complete policy available on-line at: http://www.aapd.org/media/Policies_Guidelines/P_DentalHome.pdf

4. The Dental Home • Enhances the dental professional’s ability to assist children and their parents/care givers in the quest for optimum oral health care, beginning with the age one visit for successful preventive care and treatment as part of an overall oral health care foundation.

5. The Dental Home • Endorsed by the American Dental Association, the Academy of General Dentistry and the American Academy of Pediatrics. • They support this pivotal oral health care initiative to help ongoing public awareness of the importance of infant/age one oral health care and will continue to collaborate with the AAPD in promoting the overall health and well-being of young patients.

6. Workforce to provide infant oral health exams? • The AAPD is working closely with the Academy of General Dentistry (representing 35,000 members) to ensure adequate availability of pediatric and general dentists to perform infant oral health exams. AAPD also has Affiliate (general dentist) members.

7. The Dental Home Strong evidence for its benefits: • An influential research paper from the October 2004 issue of Pediatrics[1], the official journal of the American Academy of Pediatrics, which found that seeing children earlier for oral health examinations and preventive services saves money. Pediatric dental faculty at UNC-Chapel Hill led by Dr. Jessica Y. Lee spearheaded the research, which examined a cohort of 9200 Medicaid children in North Carolina between 1992 and 1997. [1] Savage MF, Lee JY, Kotch JB, Vann WF. Early preventive dental visits: effect on subsequent utilization and costs. Pediatrics 2004;114:418-423.

8. Key Findings from Pediatrics article • The average cost per child who had a dental visit before age 1 was $262. This doubled to $546 when the child’s first visit was not until ages 4-5. (these costs are per child over the 5 years of the study, not annual costs); • Medicaid-enrolled children who had an early preventive dental visit were more likely to use subsequent preventive services and experience lower dentally related costs;

9. Key Findings from Pediatrics article • 348 children in the study were treated in the operating room under general anesthesia before age 5, and 70% of those children did not have a previous preventive dental visit.

10. Dr. H. Pitts Hinson, 2005-06, President, AAPD • “It is gratifying to know that we have the support of the dental and health care community in our ongoing efforts to ensure quality oral health care of all our children.” • “The age one dental visit represents a key moment in the development of lifelong habits for dental health and we’re proud that the AAPD can offer parents and caregivers resources that assist them in making the best informed choices—it’s something to be proud of.”

11. AAPD Dental Home Web Resource Center

12. Dr. John Rutkauskas, Executive Director, AAPD • “By establishing a Dental Home and taking preventive steps recommended by the pediatric dentist, parents can avoid their children contracting early childhood caries—which is extensive devastating tooth decay that results in pain, failure to thrive, and in many cases, extensive and costly restorative work.”

13. The Dental Home Provides… • Comprehensive oral health care including acute care and preventive services in accordance with AAPD periodicity schedules. • Comprehensive assessment for oral diseases and conditions.

14. The Dental Home Provides… • Individualized preventive dental health program based upon a caries-risk assessment and a periodontal disease risk assessment. • Anticipatory guidance about growth and development issues, (ie, teething, digit or pacifier habits).

15. The Dental Home Provides… • Plan for acute dental trauma. • Information about proper care of the child’s teeth and gingivae. This would include prevention, diagnosis, and treatment of disease of the supporting and surrounding tissues and the maintenance of health, function, and esthetics of those structures and tissues.

16. The Dental Home Provides… • Dietary counseling. • Referrals to dental specialists when care cannot directly be provided with the dental home. • Education regarding future referral to a dentist knowledgeable and comfortable with adult oral health issues for continuing oral health care; referral at an age determined by patient, parent and pediatric dentist.

17. AAPD Policy Statement • “The AAPD advocates interaction with early intervention programs, schools, early childhood education and child care programs, members of the medical and dental communities, and other public and private community agencies to ensure awareness of age-specific oral health issues.”

18. The Dental Home and the Mission of the AAPD • The mission and strategic goal(s) for the AAPD are: • An oral disease-free population. • Access of appropriate oral health care for all children and patients with special health care needs. • To be centered around the Dental Home

19. The Age One Visit • The AAPD recommends the child’s first visit to be no later than age one, but preferably when the first tooth erupts. • By visiting the dentist at that time, a Dental Home can be established and Anticipatory Guidance be made part of the child’s total health care experience.

20. Anticipatory Guidance • A new paradigm of enhancing growth & development, caries prevention and overall oral health

21. Anticipatory Guidance • The paradigm: oral health education, professional examinations, preventive procedures and dietary instructions from approximately age 6 months through 2 years.

22. Anticipatory Guidance • It is a step-by-step program taught by the dental professionals in an office to care givers and is tailored to each specific child. • It is a time-intensive procedure that includes, but is not limited to examinations, prophylaxis, diet analysis, home care instructions, supplemental fluoride, both topical and systemic, and general feeding instructions.

23. Anticipatory Guidance • It is applicable for the office visits and procedures carried out when an infant/toddler is brought in for information and education of the care giver vis-à-vis what needs to be done to insure healthy development of the dentition. It includes any professional treatments that may be indicated.

24. Meshes with Caries Risk Assessment Tool (CAT) • CAT provides a means of classifying dental caries risk at a point in time and therefore, should be applied periodically to assess changes in an individual’s risk status. • http://www.aapd.org/media/Policies_Guidelines/P_CariesRiskAssess.pdf

25. Questions-Comments Thank you for inviting AAPD to share information about the dental home and its impact on school health readiness.