Physicians and caries prevention. Results of a physician survey on preventive dental services

Knowledge, attitude, willingness and readiness of primary health care providers to provide oral health services to children in Niagara, Ontario: a cross-sectional survey

BACKGROUND

Most children are exposed to medical, but not dental, care at an early age, making primary health care providers an important player in the reduction of tooth decay. The goal of this research was to understand the feasibility of using primary health care providers in promoting oral health by assessing their knowledge, attitude, willingness and readiness in this regard.

METHODS

Using the Dillman method, a mail-in cross-sectional survey was conducted among all family physicians and pediatricians in the Niagara region of Ontario who have primary contact with children. A descriptive analysis was performed.

RESULTS

Close to 70% (181/265) of providers responded. More than 90% know that untreated tooth decay could affect the general health of a child. More than 80% examine the oral cavity for more than 50% of their child patients. However, more than 50% are not aware that white spots or lines on the tooth surface are the first signs of tooth decay. Lack of clinical time was the top reason for not performing oral disease prevention measures.

INTERPRETATION

Overall, survey responses show a positive attitude and willingness to engage in the oral health of children. To capitalize on this, there is a need to identify mechanisms of providing preventive oral health care services by primary health care providers; including improving their knowledge of oral health and addressing other potential barriers.

Paediatricians' awareness of children's oral health: Knowledge, training, attitudes and practices among Turkish paediatricians

BACKGROUND

In Turkey, 74.1% of children between three and six years of age develop dental caries.

OBJECTIVE

To assess the depth of oral health and dental knowledge among paediatricians in Turkey, to determine their level of oral health education and to determine factors that were associated with higher knowledge scores.

METHODS

A cross-sectional survey of demographics that assessed the participants' knowledge of oral and dental health, attitudes regarding oral health during well-child visits and opinions regarding infant oral health care visits was conducted. The outcome variables were the proportions of paediatricians who adhered to good clinical practice guidelines, recommended dental visits for children younger than one year of age, and having a knowledge score >50%.

RESULTS

The participant characteristics that were significantly associated with a greater mean number of correct answers were female sex, good clinical practice, confidence in detecting dental caries and the presence of a dentistry department in their hospital (P=0.001, P<0.001, P<0.001 and P=0.02, respectively). Only 13.9% of paediatricians referred children younger than one year of age to a dentist. After adjusting for the level of oral health education received during residency training, sex and having children, only the knowledge score was significantly associated with referring patients younger than one year of age to a dentist (P=0.01).

CONCLUSIONS

Some paediatricians' knowledge was found to be associated with practices that were in accordance with professional society recommendations. The lack of dental knowledge and training in residency limits the paediatricians' role in promoting children's oral health in daily practice.

Early childhood caries and infant oral health: Paediatricians' and family physicians' knowledge, practices and training

OBJECTIVES

To assess the knowledge of early childhood caries and to examine the current preventive oral health-related practices and training among Canadian paediatricians and family physicians who provide primary care to children younger than three years.

METHODS

A cross-sectional, self-administered survey was mailed to a random sample of 1928 paediatricians and family physicians.

RESULTS

A total of 1044 physicians met the study eligibility criteria, and of those, 537 returned completed surveys, resulting in an overall response rate of 51.4% (237 paediatricians and 300 family physicians). Six questions assessed knowledge of early childhood caries; only 1.8% of paediatricians and 0.7% of family physicians answered all of these questions correctly. In total, 73.9% of paediatricians and 52.4% of family physicians reported visually inspecting children's teeth; 60.4% and 44.6%, respectively, reported counselling parents or caregivers regarding teething and dental care; 53.2% and 25.6%, respectively, reported assessing children's risk of developing tooth decay; and 17.9% and 22.3%, respectively, reported receiving no oral health training in medical school or residency. Respondents who felt confident and knowledgeable and who considered their role in promoting oral health as "very important" were significantly more likely to carry out oral health-related practices.

CONCLUSION

Although the majority of paediatricians and family physicians reported including aspects of oral health in children's well visits, a reported lack of dental knowledge and training appeared to pose barriers, limiting these physicians from playing a more active role in promoting the oral health of children in their practices.

Knowledge of Flemish paediatricians about children's oral health--results of a survey

OBJECTIVE

To examine the knowledge paediatricians have about oral health in children.

METHODS

A questionnaire on oral health knowledge was mailed to all members of the Flemish Paediatric Association representing 350 out of 676 Flemish paediatricians. Questions concerned timing of the first dental visit, effects of thumb sucking, fluoride supplements, trauma, fluorosis, mutans streptococci and caries, prevention of dental caries, nursing bottle caries and use of sealants.

RESULTS

Two hundred seventy-six questionnaires (79%) were returned. Of the respondents, 71% said they have had some training on dental topics, and most rely on information brochures to be informed on dental subjects. Parents frequently questioned paediatricians about dental eruption. Paediatricians stated that the first dental visit should be scheduled at the age of 3. Eighty-three percent of the paediatricians stated that thumb sucking was harmful to dentition; 7% regularly prescribed fluoride supplements. Knowledge about fluorosis was moderate. Paediatricians judged community water fluoridation and tooth brushing after consuming erosive drinks as effective. The efficacy of dairy products was underrated. Seventy-three percent of the paediatricians were aware of nursing bottle caries, whereas only 39% were familiar with fissure sealing.

CONCLUSION

Initiatives are needed to improve knowledge about oral health of physicians involved in preventive health care of children.

Educating pediatricians on children's oral health: past, present, and future

OBJECTIVE

The American Academy of Pediatrics (AAP) policy Oral Health Risk Assessment Timing and Establishment of the Dental Home encourages pediatricians to play an important role in the oral health of children. The purpose of this study was to determine how well pediatricians are prepared to play the AAP suggested role in children's oral health by examining the oral health content of their educational process.

METHODS

This article reviews current medical education guidelines, programs, surveys, and pediatrician experiences in oral health training at the undergraduate, graduate, and continuing medical education levels.

RESULTS

Although some medical schools, residency programs, and continuing medical education efforts do include oral health in their curricula, the practice is not widespread. Professional and oversight organizations such as the Association of American Medical Colleges, the Council on Medical Student Education in Pediatrics, Association of Pediatric Program Directors, AAP, and the pediatric Residency Review Committee do not include oral health in key guidelines and surveys of the medical education continuum. When surveyed, pediatricians state that the time spent on oral health education at each level of training is inadequate.

CONCLUSIONS

Overall, the level of oral health training for pediatricians at the undergraduate, graduate, and continuing medical education levels is inadequate to provide pediatricians with the competencies required for the provision of quality oral health care to children. Despite this inadequacy, educational efforts are under way and various tools and guidelines are available in a few locations. In addition, numerous opportunities exist for the organizations responsible for pediatrician education to ensure that curricula are designed and adopted to achieve these competencies, faculty are trained to teach these competencies, and program accreditation and certification are closely linked to acquisition of these competencies. Ensuring the success of such efforts will require cooperation between many organizations and disciplines and a genuine commitment to improve pediatric education and medical care for children.

Challenges of and strategies for changing prescribing practices of health care providers

Problems related to inappropriate prescribing practices of physicians in general are well recognized. Dietary fluoride supplements have been implicated as one of the contributing factors in an increase in dental fluorosis. Inappropriate prescribing practices of providers have been cited as a major factor in this implication. Numerous studies of physicians and dentists have documented a lack of knowledge and inappropriate prescribing practices regarding fluoride supplements. The purpose of this paper is to identify barriers to changing fluoride-prescribing practices of health care providers and to suggest strategies for implementing change. To increase optimal and appropriate use of fluoride supplements, educational interventions are necessary for all user groups--detail men and women, physicians, dentists, pharmacists, nurse practitioners, dental hygienists, and the public. In addition, environmental supports for the educational activities in the form of policy, regulation, standards of care, and guidelines are recommended for consideration.

Factors associated with the use of fluoride supplements and fluoride dentifrice by infants and toddlers

Dental fluorosis may be associated with the inappropriate use of fluoride dentifrices and/or dietary fluoride supplements by young children, especially for those who consume optimally fluoridated water. Studies to date have used retrospective designs that rely on anamnestic responses of adults to determine fluoride exposures in their children. The 1986 National Health Interview Survey (NHIS) collected information on current use of fluoride-containing dental products (dentifrices, drops, tablets, and mouthrinses) by all household members during home interviews. This report contains information obtained from adults for 1,996 children younger than two years of age. Nearly half of the children used fluoride dentifrices or dietary fluoride supplements. Eleven percent of the children younger than one year of age and nearly 60 percent of children between one and two years of age reportedly used a fluoride toothpaste. Dietary fluoride supplements were used about equally in these age groups (about 16%). The use of a fluoride dentifrice was similar across racial-ethnic groups, but the use of dietary fluoride supplements was less among blacks and Hispanics. A significantly higher proportion of children whose respondent knew the purpose of water fluoridation used some type of fluoride product. Because young children tend to swallow dentifrices, the findings of this study suggest the need for educational programs targeted to parents and health care providers regarding the appropriate use of fluorides and the risk of fluorosis when they are used inappropriately.

Fluoride prescription practices of Ohio physicians

In 1985 a fluoride supplement survey was mailed to all members of the Ohio Academy of Family Physicians and the Ohio chapter of the American Academy of Pediatrics. The response rate after two mailings was 60.2 percent. Of the respondents who were identified as either family physicians or pediatricians, 76.6 percent reportedly prescribed fluoride supplements for at least some of their child patients. Pediatricians were more likely to prescribe fluoride supplements than were family physicians. Younger physicians also were more apt to prescribe fluoride supplements than were their older colleagues. Only 6.2 percent of those physicians who prescribed fluoride adhered to a minimum protocol of inquiring about the fluoride content of the child's drinking water, having the water analyzed when the fluoride content was unknown, and continuing fluoride supplements until at least age ten. Medical schools, and especially residency programs, should include a preventive dental segment that uses a state-specific protocol for the prescription of fluoride, including where water may be analyzed. For those already in practice, the preferred method of providing information may be short articles in local journals or newsletters. Public health dentists should assist the medical profession in this educational process.

Priorities to preserve fluoride uses: rationales and strategies

Well-planned, new initiatives are required to preserve fluoride uses, especially water fluoridation. Discussed are barriers to fluoride promotion, evidence about public and health-care providers' knowledge and opinions about fluoride use and decision making, implications of sources of public information on fluorides, consequences to professionals and the public of being misinformed about fluorides, and four general strategies for promoting fluorides under varying conditions. Educational and political initiatives must be appropriate to state needs and conditions. Four broad categories of actions include: diagnosis and planning for education/promotion; public and professional education under both noncontroversial and controversial conditions, political persuasion where required, and changing the context of fluoridation decision making to prevent public referenda on public health measures.