Pediatric oral health should be priority in primary care

PHILADELPHIA — Nearly half of all children and two-thirds of adolescents between the ages of 12 and 19 from families of low socioeconomic status have untreated tooth decay, putting pediatricians and primary care providers in a unique position to assess oral health status, according to recent presentation at the annual meeting of the American Association of Nurse Practitioners.

This statistic has demonstrated costliness, because 51 million hours of schooling are lost annually in this demographic due to oral health problems or dental visits.

“Early childhood caries are five times more common than asthma in childhood, and there are many hospitals and operating rooms that have a 6-month wait for operative dentistry under general anesthesia,” Judith Haber, PhD, APRN, BC, FAAN, from the Rory Meyers College of Nursing at New York University told Infectious Diseases in Children. “If oral health assessment, parent education and fluoride varnish application were provided — all of which are within scope of practice for primary care providers — we would have a significant impact on promoting oral health and preventing early childhood carries in children.”

To highlight oral health care disparities and to underscore the importance of this topic as a population health concern, Haber assessed the current morbidity, access and cost of oral health care. According to her presentation, an oral-systemic connection can be observed with many diseases, including respiratory diseases, diabetes and cardiovascular disease.

Including an oral health assessment into a standard head, eye, ear, nose, throat (HEENT) exam could be an effective way to make sure this area is considered. Instead of looking past the oral cavity and directly to the oral pharynx, Haber suggests “stopping, looking and listening” in the intraoral cavity to complete a head, eye, ear, nose, oral health, throat (HEENOT) approach.

In this approach, the provider should assess for loose teeth, bleeding or inflamed gums, white spots, as well as ulcers and lesions. The underside of the tongue, according to Haber, should also be examined with the floor and the roof of the mouth. When these processes are complete, a provider can determine a risk level. Depending on a patient’s history, a specialist or dentist may be referred.

“The bottom line is that we don’t want oral health to be the missing piece of whole-person care,” Haber said in her presentation. “We hope that this makes people think about it more and be more willing to integrate it into their practice where they all make a difference in the lives of patients every day of the year.” – by Katherine Bortz

Reference:

Haber J, et al. Putting the mouth back in the body: Integrating oral health and primary care. Presented at: American Association of Nurse Practitioners National Conference; June 20-25, 2017; Philadelphia.

Disclosure: The researchers provide no relevant financial disclosures.