Pediatrician referrals influence younger kids' dental visits

Aug 23, 2010

Parents of 2- to 5-year-olds are nearly three times more likely to take their child to the dentist if the child's physician recommends it than if no such recommendation is made, according to a study in Pediatrics (August 2010, Vol. 126:2, pp. e435-e441).

In contrast, the decision to make a dental visit by parents of 6- to 11-year-old children is unaffected by the doctor's suggestion, the data suggest.

Heather Beil, M.P.H., a doctoral student, and R. Gary Rozier, D.D.S., M.P.H., a professor in the department of health policy and management at Gillings School of Global Public Health at the University of North Carolina at Chapel Hill, arrived at these results by examining information from the 2004 Medical Expenditure Panel Survey.

They determined that 47% of 2,031 2- to 5-year-olds had been advised that year by a healthcare provider to have a dental checkup and that 39% had done so. Conversely, 37% of 3,237 6- to 11-year-olds had been given this recommendation by a physician and 60% had done so.

And, at first glance, the researchers believed that being advised to see the dentist increased the overall likelihood of doing so, but on multivariate analysis they found this was the case only with 2- to 4-year-olds. Children in this age group were 2.89 times more likely to have a dental visit if their physician had suggested it. The odds were even for the older children.

Children in both age groups who were advised to see a dentist within two or more years were not any more likely to see a dentist than were kids who had never been advised to do so.

Having a parent who, at the time of the survey, was a regular user of dental care significantly increased both age groups' likelihood of having a dental visit. It also increased the children's probability of getting this recommendation in the first place.

Another significant factor in whether the children were advised to see a dentist was their having a regular source of medical care -- although this did not affect whether the children actually went to a dentist. Living in a city also increased both groups' chances of getting a recommendation to visit a dentist, but it only increased the actual probability of seeing a dentist in 6- to 11-year-olds.

The main take-home point of the study findings is the "gap between the clinical guidelines that [recommend] all children be referred to a dentist by a physician by age 3 -- or age 1, according to some guidelines -- and the actual rates of referral we found," Beil said.

Two local programs currently under way are designed to bridge the gap, Dr. Rozier noted.

"A demonstration project in North Carolina called Into the Mouths of Babes has been reimbursing physicians for providing preventive dental services -- screening and referral as needed, counseling of parents, fluoride application for children -- for young children enrolled in Medicaid," Dr. Rozier told DrBicuspid.com. "And an intervention called Carolina Dental Home is training physicians in the appropriate referral of young children, training dentists in how to care for young children, and strengthening the linkage between physicians and dentists to ensure successful referrals."

Data on the programs' effectiveness are expected to be published "relatively soon," he noted.