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New Approach to Oral Health Education at Well-Child Visits Yields Great Outcomes for Young Patients

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UH Clinical Update | October 2024

Dental cavities (caries) are the most common chronic condition of childhood – more common than asthma or ADHD. Nevertheless, in most traditional medical training models, dental care and assessment tends to be overlooked. Now, a pair of new studies from UH Rainbow Babies & Children’s Hospital has identified a potentially better approach to this problem – and one that works for both families and clinicians.

Investigators from UH Rainbow (Dr. Sarah Ronis) and the School of Dental Medicine at Case Western Reserve University (Dr. Suchitra Nelson) enrolled 18 Northeast Ohio pediatric practices in a randomized clinical trial. Eligible participants from these practices included 1,023 Medicaid-enrolled preschoolers ages 3 to 6 who were seen for three consecutive well-child visits, along with a parent or guardian.

Clinicians in half the practices received traditional oral health education to pass on to families -- avoiding sugar and sweetened beverages, as well as the importance of brushing teeth and seeing the dentist. Clinicians in the remaining practices instead received a multi-level intervention. It included education about caries as a chronic disease, as well as a prompt and four questions in the EMR to discuss oral health. Clinicians in the intervention group also received a list of Medicaid-accepting dentists in the area to provide to families.

The major difference in oral health education was emphasizing caries as a chronic condition, says Sarah Ronis, MD, PhD, Director, Center for Child Health and Policy at UH Rainbow and one of the leaders of the project.

“The message is that caries are the result of an infection that sits in your gum line,” she says. “When you have cavitated untreated baby teeth and you lose those baby teeth, your adult teeth move through that field. You then reinfect the adult teeth. Baby teeth really matter.”

The research team recently published its promising results in the journal JAMA Network Open. They show that children whose clinicians received the multi-level intervention were 34% more likely to see a dentist and have “clinically meaningful” lower untreated tooth decay, when compared with children in the control group.

“The main trial findings were that the different way of teaching and thinking about dental cavities -- framing it as a chronic illness -- paired with the EMR documentation cues and the prescription to see the dentist were more effective than usual care in getting kids in to see the dentist and treating their existing caries,” Dr. Ronis says.

In separate qualitative research, published in the journal AJPM Focus, the team also found that the intervention was well-received by clinicians.

“We interviewed participating clinicians from both arms,” Dr. Ronis says. “The training itself, they said, made good intuitive sense and was well-accepted. The visual aids, like the flip charts that the team had developed that both train the clinicians and that the clinicians could use to coach parents, were really helpful, as were the lists of the dentists that would accept kids with Medicaid.”

Clinicians also noted the oral health training increased their knowledge and confidence when addressing the issue with parents -- and importantly that it required less than two minutes in their workflow with no financial consequences.

Dr. Ronis says she hopes the success of this project will lead more clinicians to receive the oral health training – and to ideally receive CME or MOC credit for it. It’s a win-win for patients and clinicians.

“The intervention took minimal time without a decrease in patient load, and the oral health EMR prompts were beneficial at follow-up visits,” she says.

If you’re interested in receiving the oral health education materials from this study, please email Sarah.Ronis@UHhospitals.org.

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