Landmark Conference Something to Smile About
On October 10, 2008, a landmark PEDS 21 preconference session entitled, "Oral Health in the 21st Century: Something to Smile About—Your Role in Children' s Oral Health" opened the American Academy of Pediatrics (AAP) annual conference in Boston, Massachusetts. Pediatricians, spurred by the increasing number of calls for access to dental care, and coupled with the availability of care for children aged 0-3 years, the formidable caries-reducing power of fluoride varnish, and a groundswell of community action groups, have sought an answer to enhance access.
The Oral Health Initiative is a program of the AAP whose mission is "To encourage and support child oral healthcare providers to conduct oral health-risk assessment, to provide education and preventive oral health services to families within the context of well-child care; and to promote the establishment of a dental home."
While the 2001 US Surgeon General' s Report, Oral Health in America, has been one of the most-cited references for keeping oral health as part of our general health, former Surgeon General David Satcher, the keynote speaker, was again calling for a renewed partnership for the sake of the children. Despite major efforts, and the Surgeon General' s report, oral disease continues to be a significant health threat.
Research indicates that early access to oral health is critical and because pediatricians and other child healthcare professionals are most likely to meet new mothers and infants, they can play an important risk-prevention role.
Renee Jenkins, MD, president of the AAP, said, "PEDS 21 was established to address the emerging issues that affect pediatric medicine. The AAP believes pediatricians and other child healthcare professionals have a role to play in addressing the heath disparities that face children today, and this is why we have identified oral health as one of our top issues in our national agenda for children. "The AAP was awarded a cooperative agreement by the federal Maternal and Child Health Bureau (MCHB) to implement the Pediatrics Collaborative Care (PedsCare) program.
Beverly Largent, DDS, represented the partnership of the American Academy of Pediatric Dentistry (AAPD)."The AAPD," said Dr. Largent, "has its mission to promote oral health for children." Dr. Largent, the president of the AAPD, referred to the dental home as a "compassionate, coordinated, and family-centered way to provide dental care under the supervision of a dentist." She also informed the audience that the AAPD has signed a $10 million, 5-year contract with the office of Head Start to provide dental homes for all Head Start children in the United States.
The president of the American Dental Association (ADA), Mark Feldman, DMD, focused on the dental professional community' s call to action. "The ADA is committed to building and fostering collaborative action to improve the oral health of America' s children, and pediatric physicians are critical to this enterprise. I realize that one of the goals of PEDS 21 is to enhance the visibility and leverage the voice of pediatric medicine in promoting healthcare policies and decisions that are in the best interests of children, and I am here supporting that goal." The ADA Foundation has provided a 3-year, $300,000 grant to AAP to support its efforts to train pediatricians in the oral health needs of children.
In conclusion, Dr. Feldman told the attendees that there is a need for a comprehensive public prevention and awareness campaign, including culturally and linguistically sensitive efforts from within the community.
The keynote address was given by former Surgeon General David Satcher, MD, PhD, director of the Satcher Health Leadership Institute at Morehouse School of Medicine, who noted, "The good news is that we are making progress…and we will get there." He continued that the follow through has been outstanding and commended the ADA,AAP, and AAPD in their collaboration. "We have to continue to do science…but we must also develop practices and policies that are consistent with science. Yet, when it comes to delivering services, we see the gap between what we know and what we do." He based his comments on data showing that, in 2000, $1.4 trillion was spent on healthcare and there were 39 million persons uninsured, and that this situation had worsened by 2008 to $2.3 trillion spent and 46 million persons uninsured. "We have to band together to make sure we are a nation that lives up to our promise." He reminded the audience of the 2010 goals: to improve quality of health and to eliminate racial and ethnic disparities.
"The first goal, quality of life, begins with children and this determines their quality of life in their later years. I think there can be no better example than oral health." When asked, "Given the financial constraints of the public health departments, how can the Oral Health Initiative penetrate and be a partner and a significant player in the dialogue of increased demand?"
Dr. Satcher replied, "Training and influence. We will have to do some educating first. That is what is so impressive about this program. I think that we start by educating people about the importance of oral health to overall health and also provide some examples of successful strategies and where to find them."
Other featured speakers included Jim Crall, DDS, ScD, professor and chair of pediatric dentistry at University of California, Los Angeles, who, as a dentist, reviewed etiology and disease processes, as well as the family dynamics and cost of delivery and preventive services. AAP president Jenkins, professor of pediatrics and child health at Howard University, discussed oral health as a component of overall health and well-being, the impact of oral disease on the community, and the impact of oral disease on the individual. Speaking as a pediatrician looking at the child in the well-child spectrum, common social determinants, developmental and medical impact, disease prevalence, and lack of early intervention are concerns. "I think we can begin to talk about more of the similarities of the medical and dental home models and work together to keep the basic characteristics in terms of accessibility, comprehensiveness, continuity, and family centeredness. So that, whatever home you start out from, the program would allow you access to another."
The next steps that Dr. Jenkins listed were: educating pediatricians as part of the group, additions in oral health risk assessment, how to integrate the medical records with the dental home, how to integrate educational competencies in professional training, universal coverage for medical and dental health issues, and, finally, how to engage parents and communities.
Steve Downs, MD, MS, director, Children' s Health Service Research, Indiana University, addressed "Community Crossroads: How PEDS and DDS Can Work Together." "To get oral health into the pediatrician' s office we must demonstrate and make clear its priority in preventive care and expected risk reduction, prospectively validate risk assessment tools that fit office routines where caries risk assessment is a guide for what puts a child at risk, and provide precise guidelines for what to do to ensure seamless handoff from medical to dental homes. Collaboration between medical and dental disciplines includes early childhood caries (ECC) prevention, child abuse detection, recognition of bulimia, and obesity prevention. Finally, pediatricians and dentists must be willing to work together on rational division of labor, exploring different models, evaluating effectiveness, and sharing insights," he explained.
Martha Ann Keels, DDS, PhD, of Duke Children' s Hospital at Duke University Medical Center, began her address stating that, "For optimal oral health, we need to start the dialogue, educate one another, enhance the pediatrician triage, and increase dentist accessibility. Infants (irrespective of risk) should have a dental home by age 1 or by 6 months after the eruption of the first tooth." Dr. Keels presented a comprehensive review of oral concerns in children.
Best Practices at the state level followed these excellent presentations. For North Carolina: Gary Rozier, DDS,MPH, professor of health policy and administration at UNC Chapel Hill; for Iowa: Jody Murph, MD, MS, associate professor of pediatrics, University of Iowa Children' s Hospital; and, from Washington state: Wendy Mouradian, MD, MS, associate dean and professor of pediatric dentistry and pediatrics at the University of Washington. The dynamic composition of the audience signaled how important this topic of dental and medical healthcare interaction is to many stakeholders—dentists, physicians, public health schools, hygienists, nurses, state health directors, community health associations, foundations, insurance companies, and medical and dental school representatives.
For example, Lt. Charles Brucklier, RDH, director of the Dental, Clinical, and Preventive Support Center, Oklahoma City Inter-Tribal Health Board, US Public Health Service, and Indian Health Service, is a strong proponent of varnish treatments. He learned how to work with physicians to conduct oral exams and apply sealants and varnishes. "A child is brought to the pediatrician before they even see a dentist. Families often live far from the clinics and they bring their children to the doctor long before dental care begins. If we can introduce a little dentistry into the well-baby visits, this will go a long way. Imagine a dental hygienist working in a pediatrician' s office; it would be so easy for me to set this up in any office and it does not cost a lot of money," Lt. Brucklier said.
David Krol, MD, of Toledo, Ohio, is a pediatrician whose background as an oral health fellow at Colombia University College of Dental Medicine began his career in health policy, education, and advocacy. Dr. Krol questioned, "So how does a pediatrician fit into the oral health picture?" The answer, he said, is that both healthcare providers are facing all the same issues: "disparities, financing problems, workforce issues; so in this microcosm of the whole health sphere (ie, oral health) you would see and address all of the issues that you would want to address in healthcare in general." This conference was sponsored by Proctor & Gamble Professional Oral Health, and others.
