The small number of dentists who treat children and are willing to accept Medicaid reimbursement is a significant concern. In most dental programs, dedicated pedodontic training is optional. The mismatch of number of qualified dentists to the growing population of such patients is projected to worsen in the coming years.23
Potential solutions to correct this mismatch of dental services accessible to the underserved have included26-31:
Addition of paraprofessional dental therapists (persons who have received two years’ training in a specific academic program) to the health care team, in public health clinics, schools, and other settings
Interprofessional dental education (ie, cross-training physicians, NPs, PAs, and RNs in preventive dental services)
An increasingly diverse array of competent providers who are trained, authorized, and compensated to provide evidence-based care
Removing licensure restrictions for non–US-trained dentists
Financial incentives for dentists to practice in dental Health Professional Shortage Areas
Improved education of parents regarding the benefits of routine dental services.
The Institute of Medicine (IOM)26 has challenged state legislatures to mandate a one-year dental residency to be completed among underserved populations before dental licensure is granted. This challenge reflects the IOM’s acknowledgement that dental services, essential to patients’ well-being, are grossly lacking in the US.
Dental Care Education for Parents
Healthy baby teeth help children eat well and speak clearly. Decayed and abscessed teeth cause the same degree of pain and suffering in young children as they do in adults. Thus, regardless of ethnicity or socioeconomic status, all parents should be routinely encouraged to oversee daily dental hygiene practices for their children; it is important for PCPs to explain to parents their expectations in this regard.
Dental care for children should begin as soon as the first tooth erupts. New teeth should be cleaned daily with a soft cloth and inspected by parents for any discolorations. From age 2 years until children are able to clean all dental surfaces adequately (age 7 or 8), parents should brush their children’s teeth at least once daily with a toothbrush, after applying a thin film of fluoride toothpaste. Children should undergo their first professional dental check-up at about age 1 year.19,26
Parents must be made aware of other factors that can impair their children’s dental health. For example, the foods most likely to promote dental decay contain highly fermentable carbohydrates, are highly processed and sticky, and cause oral pH levels to fall below 5.5 (at which point demineralization may occur).32 Examples include presweetened cereals, dried fruits, cookies, and potato chips. Cheese, peanuts, meat, and eggs are less cariogenic.
Other important teaching points are “don’ts”: putting a baby to bed with a bottle that contains anything but a sugar-free liquid; using spill-proof spouted cups filled with juice or other sugary drinks all day; serving a large proportion of cariogenic foods.
BREANNE, AGE 22
Breanne attends a community college, where she is studying business. She reports to the college health clinic, complaining of an intermittent sharp pain in one of her lower molars over the past four days, occurring when she eats or drinks anything cold.
Before she turned 21, Breanne received routine dental services under her parents’ insurance. Now a full-time student no longer covered by her parents’ plan, she has no income with which to purchase dental coverage. Years ago, Breanne received dental sealants on all of her molars in a school-based program, and she routinely brushes daily (see Figure 3). She says she “usually remembers to floss.”
Because of her pain, Breanne is medicated with an anti-inflammatory agent. She is referred to a nearby dental clinic for further evaluation.
