Early Childhood Caries and Infant Oral Health: Knowledge, Practices and Training of Canadian Pediatr

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Early Childhood Caries and Infant Oral Health
Knowledge, Practices and Training of Canadian
Pediatricians and Family PhysiciansPreeti
Prakash BDS MS
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Introduction

• Dental caries is the single most common chronic
  childhood disease.
• Early childhood caries (ECC), is a particularly
  virulent form of tooth decay that affects the
  primary dentition of infants and toddlers.
• Distinguishing characteristics of ECC
• type and numbers of teeth affected,
• rapidity with which the decay develops, and
• occurs on teeth that are otherwise at low-risk
  for developing tooth decay.

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Prevalence (update)

• 1-12 of children in the developed countries
• 70 in developing countries and within
  disadvantaged populations of developed countries
  (Immigrants and ethnic minorities - Milnes AR et
  al., 1996)

• 60-85 of Aboriginal preschool children in Canada
  (Albert RJ, 1988 Milnes et al., 1993 Lawrence
  HP et al., 2002)
• 9.6 of 5 year-olds in Toronto are affected
  (Leake JL et al., 2000)
• 14.5 among those children born outside Canada
  (Leake JL et al., 2000)

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ECC, A Concern?

• High prevalence among disadvantaged
  populations
• Preventable disease
• Difficult behavioral management of infant and
  toddlers

• Increased costs due to hospitalization for
  treatment under GA
• (Kelly M 1987 Jones DB et al., 1992 Milnes AR
  et al.,1993 Ramos-Gomez et al., 1996 Tinanoff
  N 1997 Griffin SO 2000 Lawrence HP et al.,
  2002)
• Limited access to dental services
• Long-term sub-optimal health

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Health Care in Canada
Universal publicly funded health care
system Known to Canadians as medicare Provides
access to universal, comprehensive coverage for
medically necessary hospital and physician
services. Services are administered and
delivered by the provincial and territorial
(i.e., state or regional) governments Provided
free of charge. Dental care NOT included as
part of the universal health care Dental care
fee-for-service and privately delivered
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Role of the Family Physician and Pediatrician

• First professional contacts of children a doctor
  will see a child 11 times for well-baby care
  before age 3.
• Can contribute to prevention through early oral
  screening, counseling and dental referrals.

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Well-Baby Checklists

• Child health supervision tools and guides advise
  primary care providers to counsel families on
  teething, dental care, and when to recommend the
  first dental visit.
• (e.g., Rourke Baby Record, Recommendations for
  Preventive Pediatric Health Care by the American
  Academy of Pediatrics)

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Early Visit to the Dentist6 months 1 year

• The Canadian Dental Association (CDA)
• The American Academy of Pediatric Dentistry
  (AAPD)
• American Academy of Pediatrics (AAP)
• Establishment of a dental home

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Study Objectives

• To assess the knowledge of ECC among random
  samples of pediatricians (P) and family
  physicians (FP) in Canada, who provide primary
  care for children younger than the age of 3
  years.
• To examine current preventive oral health-related
  practices during well-baby visits.
• To determine what oral health education and
  training received during medical and specialty
  training.
• To determine their willingness to support oral
  health promotion (OHP) activities and to examine
  barriers, if any, to performing the activities

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Research Methodology

• National survey
• Cross-sectional, mailed, self-administered.
• Random sample of Pediatrician (P) and Family
  physicians (FP). Sample size of 964 P and FP each
  (based on estimated proportion of 50 carrying
  out OHP activities, precision 5, and 50
  response rate).
• Inclusion criteria - FP and P who provide primary
  care/well-child care for children younger than 3
  years of age. Excluded specialists.
• Survey implementation Three consecutive
  mailings and a final telephone call.
• Dillman DA. Mail and Internet surveys. The
  Tailored Design Method. 2nd edition. New York
  Wiley 2000.

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Research Methodology (Contd)

• Survey instrument - Three-page, double-sided
  questionnaire, cover letter, and stamped, return
  envelope.
• Sections
• Oral health-related practices
• Oral health knowledge
• Oral health promotion activities
• FPs Ps oral health education/training
• FPs Ps background information

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Data Analysis

• Outcomes
• Proportions of physicians
• Conducting visual examinations of the oral cavity
  and teeth during well-baby visits
• Counseling parents or caregivers regarding
  teething and dental care
• Assessing the childs risk for developing tooth
  decay
• Recommending the first dental visit when the
  child is less than 1 year of age

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Data Analysis (Contd)

• Main Explanatory Variable
• Oral health education and training ( yes/no
  number of hours quality CME on oral health
  topics in the past 5 years)
• Other Independent Variables
• Knowledge of ECC
• Confidence and Perceived importance of their role
  in promoting oral health

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ResultsResponse Rates

• 1,928 surveys mailed
• 884 pediatricians and family physicians
  ineligible
• Of the 1044 eligible (1928-884), 537 completed
  surveys
• Response rate of 51.4 (237 pediatricians and 300
  family physicians)

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Practice Characteristics
T-test , ! Chi-square test, plt 0.05
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Practice Characteristics
! Chi-square test, Mann-Whitney-U test,
T-test, plt 0.05
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Knowledge
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Confidence
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Oral Health-Related Practices
! Chi-square test, plt 0.05
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Steps Taken When a Child is Identified With Tooth
Decay
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Primary Source of Oral Health Education and
Training
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Oral Health Education and Training
T-test , Chi-square test, plt 0.05,
CME-Continuing Medical Education
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Perceived importance of physicians role in oral
health promotion
79 of pediatricians and 51 of family physicians
considered their role in promoting the oral
health of infants and toddlers as very
important.
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Willingness to Lift the Lip, Advise Parents on
preventive dental care and Refer children with
ECC to the dentist
Pediatricians (n237)
Family Physicians (n300)
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Perceived Barriers for Carrying Out OHP
Activities
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First Preventive Dental Visit
Chi-square test, plt 0.05
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Factors associated with physicians carrying out
oral health related activities
Adjusted OR (95 CI, logistic regression),
adjusted for physician type, yrs in practice,
practice location, of well baby visits, of
ECC cases seen per month and proportion of recent
immigrants.
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Information on Oral Health Topics
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Most Preferred Methods for Receiving Oral Health
Information
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Discussion

• Knowledgeable in some aspects of oral health
• Uncertainties - knowledge of transmission of ECC
• - diagnosis of early signs of
  tooth decay
• Considered their role as important
• Received little training on oral health topics
• Previous studies report similar findings wrt oral
  health knowledge and training
• A study of US pediatricians reports 19
  pediatricians reported recommending a first
  dental visit with in the first year compared to
  3 in this study (Lewis et al., 2000)

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Summary

• Uncertainties regarding knowledge of transmission
  of ECC and diagnosis of early signs of tooth
  decay, regardless of physician type.
• Involved in preventive oral health-related
  practices.
• Very important role in the oral health of
  children.
• Lack of dental knowledge and training identified
  as significant barrier.

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Thank You!
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CommitteeDr. H.P. Lawrence DDS MSc PhDDr. B.
Harvey MD PhD FRCPC Dr. W. McIsaac MD MSc
CCFPDr. H. Limeback BSc DDS PhDDr. J.L. Leake
DDS DDPH MSc FRCDCSupported by University of
Toronto, Faculty of Dentistry Research fund
Citation Prakash P, Lawrence HP, Harvey BJ,
McIsaac WJ, Limeback H, Leake JL. Early childhood
caries and infant oral health Pediatricians and
family physicians knowledge, practices and
training. Pediatrics and Child Health 2006
11(3)151-7.