Professional dental organizations such as the American Academy of Pediatric Dentistry and the American Dental Association pay much attention to the development of special policies and recommendations to support child health and prevent the onset of various dental complications. Dental caries, also known as tooth decay, is one of the most prevalent chronic diseases that is observed among children who are younger than six years of age (Bhaskar, McGraw, & Divaris, 2014).
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There have been annual increases in the occurrence of dental caries, which indicates that health issues, including lifestyle, lack of healthy food, and oral health maintenance knowledge, are not the only challenges in the discussion about dental management and care (Beil, Rozier, Preisser, Stearns, & Lee, 2014). There are many socioeconomic and financial problems such as racial disparities, poverty level, and stress factors that must be addressed. This project is an evidence-based literature review based on the effectiveness of early preventive visits among pediatric patients recommended by the American Dental Association and American Academy of Pediatrics.
Statement of the Problem
The American Dental Association and American Academy of Pediatrics have introduced several policies, including “Bright Futures” and “Dental Home”. The Bright Futures, which is a prevention initiative of the American Academic of Pediatrics, recommends that all children receive an oral risk assessment by their pediatrician at the six- and nine-month wellness visits. Also, the American Dental Association encourages “Dental Home,” a program that describes the relationships between a dentist who is a primary dental care provider and a patient and includes a comprehensive oral evaluation, beginning no later than age one.
Though these policies and interventions have helped to promote dental visits among a young population, research has proven that dental problems are an epidemic issue and continues to increase among children (Zwicker, Dudley, & Emery, 2016). The cases of unattended dental caries cause children to experience pain and discomfort, affecting their school performance. For this reason, it is necessary to improve the preventive measures of early childhood caries. Thus, the topic is chosen to help in the reduction and prevention of early childhood caries that has proven to be a problem in the society.
The purpose of the study is to gather and evaluate relevant literature about the value of early dental preventive visits, dental services, and care management available to children between six months and four years in order to create a list of recommendations for the future management of childhood dental health for dentists, as primary health providers, and parents, as legal representatives of patients’ interests. It is expected to investigate the literature published during the last five years and identify the latest policies developed by specialized organizations.
In this project, the main research question is as follows, “Regarding the information taken from the evidence-based literature, how effective are early dental preventive visits at avoiding childhood caries for two-year-old children as compared to five-year-old children or older?”. Due to the investigation of the existing literature on early childhood dental care, it is possible to answer this main question specifically addressing the following questions:
- What are the current recommendations for dental preventive visits for children aged two years, five years, and older?
- What is the role of a dentist as a primary dental care provider during preventive child visits?
- What is the role of parents in preventing childhood caries?
- What improvements and recommendations can be given in terms of preventive dental care for children aged two years, five years, and older?
Review of Relevant Literature
Dentistry, like other branches of medicine, undergoes considerable changes regularly, including improvements in care, management, and communication. Today, much attention is given to the development of pediatric dentistry. In comparison to the use of dental care services by adults, which has dramatically decreased, children’s dental care utilization has risen during the last decade (Vujicic, 2015).
In modern literature, researchers indicate that early oral health care should be well documented and advocated so that parents and other caregivers have access to it whenever they want (Bhaskar et al., 2014). Wellness visits, dental preventive services, child dental screening, and childhood caries will be discussed in this literature review to prove the importance of current research. This review will also clarify what steps have been already taken to promote pediatric dental care and what recommendations and suggestions may be offered regarding the current state of affairs.
Wellness Visits and the Role of Healthcare Organizations
Early childhood caries (ECC) is one of the most frequent chronic childhood health problems (Braun et al., 2017). With the help of an analytical cohort, Divaris et al. (2014) come to the conclusion that approximately 90% of infants and children of the pre-school age have visited a dentist. A wellness visit, also known as a “hands-off” visit or a well-child visit, is a visit to a doctor during which age-appropriate screening and education are offered, and health history and risk factors are considered (Blackburn, Morrisey, & Sen, 2017).
Such visits are usually recommended by organizations such as the American Academy of Pediatric Dentistry (AAPD) and the American Dental Association (ADA) as soon as children celebrate their first birthday, as this is the period when the first teeth usually appear (Bhaskar et al., 2014). Wellness visits aim at helping parents understand what kind of dental care they can offer to their children, what preventive steps they should take, how to promote normal growth and development for their children’s teeth, and how to develop appropriate oral habits.
The Role of Healthcare Organizations
The AAPD and the ADA are organizations which work to develop guidelines and opportunities for people to improve their health and avoid complications, including effective preventive strategies to address the problem of caries among preschool-aged children (Divaris et al., 2014). “Bright Futures” is a well-known initiative introduced by the AAPD which offers oral risk assessments to children between their six- and nine-month wellness visits (Beil et al., 2014). Additionally, the establishment of the AAPD’s “Dental Home” policy encourages building relationships between dentists and their patients and promotes comprehensive pediatric care with a single dentist to create a series of oral evaluations and higher awareness of dental management (Bhaskar et al., 2014).
These initiatives and policies ensure that children or their parents can ask for help and feel confident that they will get it, but not all parents understand what steps they should take to support their children’s dental health. Some of them consider it enough to only clean teeth and regularly neglect dental visits until the pain starts bothering a child (Vujicic, 2015). For this reason, the establishment of a good relationship between the primary dental care provider and the parent should be among the first steps taken.
Medicaid is a social health care program which provides many people with health coverage. This program also provides patients, especially children, with comprehensive dental care as well as educational meetings during which doctors communicate with parents to explore opportunities for their children to have good dental health (Cruz & Chi, 2017). It is recommended that parents learn about these programs and initiatives so that they may use all available opportunities.
Early Dental Preventive Visits
According to the AAPD guidelines, early dental preventive visits (EDPVs) may be either primary or secondary dental care, including caries examination, prophylaxis, fluoride varnish, nutrition, and home care guidance (Bhaskar et al., 2014). As a rule, well-child visits start at the age of six months and continue for the next three years (Braun et al., 2017).
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Follow-up visits should also be discussed during these EDPVs, though at the age of four years, many children start visiting schools where their health falls under the control of specially educated health care providers. Parents may use the services that these providers offer to diagnose a health problem, understand when to visit a dentist, and to learn what kind of care they should be offering to their children. There are many existing systems for knowledge exchange which can be used to create relationships between parents and dental care providers (Cruz & Chi, 2017).
The effectiveness of early dental visits has been considerably discussed in many recent articles from different perspectives. Despite this, many parents continue putting their children’s health at risk by avoiding dental visits for no immediately evident reasons.
Therefore, this study will be developed to consider the question of if the current body of modern evidence-based literature is enough for parents to consistently schedule early dental preventive visits among children between the ages of six months (the period when first teeth may appear), two years, five years, and the period before children are commonly enrolled in schools. Pre-school children should be provided with a solid portion of care and education because they may recognize pain and report on it, address dentists, and ask parents for help.
The intention of this study is to investigate literature about the value of early dental preventive visits among children. To achieve this goal, it is essential to choose the method and the direction of research properly. This literature review will summarize the results of many recent available studies in the fields of dental medicine and healthcare and provide a sufficient level of evidence which will be able to conclusively prove how effective early dental preventive visits can be.
Inclusion criteria will include peer-reviewed articles from scientific journals is expected in various types of study, including randomized control trials and cohort studies. Still, the studies should have been published within the last five years, meaning that all publications before 2012 will be excluded, unless it is considered a seminal work. In addition, all articles should be fully available online, and no abstracts or brief statements of the articles can be used for the current study. Only studies which were researched and developed in the United States will be included.
Gathering and analysis of the studies should be organized in several stages. First, a search engine should be defined. Work with such databases as Cochrane, TRIP, PubMed, PsycINFO, and SAGE Journals Online is required. PubMed is a database that comprises millions of articles on biomedical topics from different journals and books. The Cochrane Library is a credible online source where a collection of six databases is found to explain the nature of healthcare decision-making processes, caregiving, and high-quality health recommendations.
TRIP is a medical database where clinical research evidence is given. PsycINFO and SAGE Journals are two online sources where it is easy to add inclusive criteria, identify a required discipline, and mention the subject on which journal articles can be offered. It does not take much time to work with such databases and find appropriate literature for current research. Additionally, specific terms should be mentioned for use in a search engine.
For this study, specific terms are “dental home”, “dental preventive services”, “early dental preventive visits”, “childhood caries”, and “early dental screening”. Once this is done, it is necessary to filter a time period “from 2014 till now”. The number of sources, the quality of information, and the evaluation of the facts should be taken into consideration to consider whether this material is enough for an effective promotion of early dental preventive services.
It is expected that, at the end of the study, all research questions will be answered, all goals which have been set will be met, and a thorough understanding of the importance of the topic chosen for the analysis will be gained. There are many credible sources which discuss the effectiveness of early dental preventive visits, but there is no clear answer or discussion if this material is sufficient for patients, including children and their parents as their caregivers, to make rational decisions. Communication between providers of dental care and children between the ages of six months and four years, or their parents, must be developed. Parents should know how to develop such relationships, prevent childhood caries, and support children during their first dental visits.
After considering the chosen articles, it is necessary to compare the differing results of various studies and investigate the conditions which impact when children should visit dental clinics. The role of such organizations as the ADA and the AAPD, as well as the importance of their initiatives like “Bright Futures” and “Dental Home”, must be discussed in terms of early dental preventive visits. This project should help readers understand how and when early dental preventive care should be organized.
The potential audience of this study includes researchers of medical, healthcare, or nursing issues, or people who want to take good care of their children, and providers of dental care. Policymakers will also be able to use this study due to its recognition of recent policies in the fields of dentistry and medicine.
The evaluation of the results should help to develop several recommendations for parents and caregivers in regards to their children aged two years, five years, and older. It is necessary to understand if preventive visits in dentistry may differ regarding the age of patients and develop the recommendations relying on age as a significant factor.
In general, this study may become a significant contribution to the discussion of the effectiveness and importance of early dental preventive care and how to best make people aware that it will positively impact their children. Evidence-based literature should be used as support, with the help of which it is possible to identify early dental preventive visits as an urgent topic for discussion and promotion among the population.
Beil, H., Rozier, R.G., Preisser, J.S., Stearns, S.C., & Lee, J.Y. (2014). Effects of early dental office visits on dental caries experience. American Journal of Public Health, 104(10), 1979-1985.
Bhaskar, V., McGraw, K.A., & Divaris, K. (2014). The importance of preventive dental visits from a young age: Systematic review and current perspectives. Clinical, Cosmetic and Investigations Dentistry, 6, 21-27.
Blackburn, J., Morrisey, M. A., & Sen, B. (2017). Outcomes associated with early preventive dental care among Medicaid-enrolled children in Alabama. JAMA Pediatrics, 171(4), 335-341.
Braun, P. A., Widmer-Racich, K., Sevick, C., Starzyk, E. J., Mauritson, K., & Hambidge, S. J. (2017). Effectiveness on early childhood caries of an oral health promotion program for medical providers. American Journal of Public Health, 107(1), 97-103.
Cruz, S., & Chi, D. L. (2017). Research evidence use in early and periodic screening, diagnostic, and treatment dental Medicaid class action lawsuits. Dental Clinics, 61(3), 627-644.
Divaris, K., Lee, J.Y., Baker, A.D., Gizlice, Z., Rozier, R.G., DeWalt, D.A., & Vann, W.F. (2014). Influence of caregivers and children’s entry into the dental care system. Pediatrics, 133(5), 1268-1276.
Vujicic, M. (2015). Solving dentistry’s ‘busyness’ problem. The Journal of the American Dental Association, 146(8), 641-643.
Zwicker, J., Dudley, C., & Emery, J.C.H. (2016). It’s not just about baby teeth: Preventing early childhood caries. SPP Research Paper, 9(14), 1-19.