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Preventive oral care in primary pediatric care can help reduce disparities in children's oral health

The U.S. Surgeon General has called for a national oral health plan to eliminate disparities in oral health for all Americans. The first part of that plan should focus on children, according to James J. Crall, D.D.S., Sc.D., of the University of Connecticut Health Center. Dr. Crall is a former dental scholar-in-residence at the Agency for Healthcare Research and Quality.

In a recent commentary, Dr. Crall and his colleagues note that by mid-childhood, more than 50 percent of children have detectable tooth decay (dental caries), and by late adolescence about 80 percent have acquired this preventable infectious disease. They point out that childhood oral disease has significant medical and financial consequences that may not be appreciated because of the separation of medicine and dentistry. The infectious nature of dental caries, their early onset, and the potential of early interventions require an emphasis on preventive oral care in primary pediatric care to complement existing dental services. However, many pediatricians lack critical knowledge to promote oral health.

Low-income and minority children and those with special health care needs are at greatest risk of inadequate access to dental care and poor oral health. For example, only one in five children covered by Medicaid receives the preventive oral care for which he or she is eligible. Children from low-income and minority families have poorer oral health outcomes, fewer dental visits, and fewer protective sealants than other children. Water fluoridation is the most effective measure in preventing dental caries, but only 62 percent of the Nation's water supply is fluoridated. Lack of fluoridation may disproportionately affect poor and minority children.

The researchers recommend financial incentives for prioritizing Medicaid Early and Periodic Screening, Diagnostic, and Treatment dental services; managed care accountability; and integration of medical and dental professional training, clinical care, and research. Their work is supported by AHRQ's User Liaison and Research Translation Program under a small business purchase order (R40281601D).

See "Disparities in children's oral health and access to dental care," by Wendy E. Mouradian, M.D., M.S., Elizabeth Wehr, J.D., and Dr. Crall, in the November 22, 2000 Journal of the American Medical Association 284(20), pp. 2625-2631.

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