The study by Jamieson et al1 compared the outcome of offspring’s carious primary teeth between 2 mother-child dyad groups; one group engaged in prevention and upstream rehabilitation of maternal oral health during pregnancy and early infant life and the other group beginning at age 2 years or later. The study’s 2 main findings were the benefit to the early intervention group (reduced caries) and the need for periodic reinforcement (diminishing caries differences over time). These results are important in that they support 2 underused oral health prevention and promotion tools, namely, infant oral health and the dental home. Both are concepts and practices amenable to pediatric primary care and general dental practice, but which remain largely underused in developed countries despite growing evidence, as in this report, of significant clinical benefit.
The recommended age for oral health assessment by both physicians and dentists has steadily declined, at least in policy. In 1967, the American Academy of Pediatrics published Standards of Child Health Care2 that included guidance for pediatricians on the care of a child’s teeth at age 2.5 years and then a referral at age 4 years for dental care. In 1994, Bright Futures: Guidelines for Health Supervision of Infants, Children and Adolescents3 actively promoted a recommendation for assessment of oral health and referral if needed in infancy in well-child care. Following the lead of the American Academy of Pediatrics in promoting the medical home, the concept of the dental home4 in 2002 presented guidelines for critical periods in the child’s life for establishing preventive routines, periodic examinations, and interventions when indicated in a comprehensive, continuously accessible, coordinated, and family-centered way. Today, most organizations recommend physicians perform a caries risk assessment for children as early as age 6 months and refer those at high risk and all children at age 12 months to a dental home.
Although evidence supports reduced caries incidence and cost of services for children who received an early preventive dental visit, primary care medical and dental professionals continue to be reluctant to provide oral health services or conduct oral health early visits, respectively. Common reasons include workload issues, incompatible practice models, parental reluctance or disinterest, inadequate reimbursement, and in some cases lack of understanding of what they can do for an infant with few teeth and no sign of disease.
Infant oral health pays it forward. Cumulative studies support long-term benefit,5,6 even if started at ages older than those in the study by Jamieson et al.1 Part of that study’s value rests in its being a secondary analysis of a randomized clinical trial, adding that form of evidence to numerous studies based primarily on large databases of billing claims. Pediatricians and family care practitioners have an excellent opportunity to provide early education and intervention for all children during the well-child care examination. Because health care professionals have frequent and early contact with families, they can influence the oral health of young children by incorporating oral health prevention and early referrals into their practices. Dentists can partner with physicians should care be needed. These investigators implemented maternal oral health into their research plan, and that aspect of referral fits nicely into current general dental practice.
Of note in this report is also the authors’ attention to retention of the anticaries influence of intervention.1 Their results suggest that periodic assessment, reinforcement of behaviors, and modification of approaches based on real-life changes have benefits in retaining the caries preventive benefit halo of early intervention. This finding should encourage primary care physicians who cannot locate a dentist referral to continue to provide intervention until referral is successful to keep caries under control.
The report adds to our knowledge and should inspire us to see young children, who clearly can benefit from this intervention, particular minority children and those who live in poverty. Dental caries affects these groups disproportionately. Studies are underway to identify infants at high risk for dental disease based on variables that are routinely collected by primary care professionals during well-child care visits.7 Positive predictive findings may lead to a computer-based caries risk screening tool integrated into the workflow of a primary care professional’s well-child care visit to aid in identifying and referring those at highest risk for dentist-moderated intervention and help facilitate consistent integration of oral health intervention into well-child care visits.
Published: March 15, 2019. doi:10.1001/jamanetworkopen.2019.0673
Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2019 Casamassimo PS et al. JAMA Network Open.
Corresponding Author: Paul S. Casamassimo, DDS, MS, College of Dentistry, The Ohio State University, Columbus, OH 43205 (firstname.lastname@example.org).
Conflict of Interest Disclosures: None reported.
Casamassimo PS, Nowak AJ. Benefits of Early Dental Care Now Hard to Refute. JAMA Netw Open. 2019;2(3):e190673. doi:10.1001/jamanetworkopen.2019.0673
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