Improving the Quality of Oral Health Screening for Young Children in Primary Care

Written by Melody G. McCulley, Katherine Prihoda, & Cynthia Ayres

doi: https://doi.org/10.13178/jnparr.

Abstract

Introduction: Early childhood caries (ECC) is the most common chronic disease to occur in childhood and is often neglected in primary care. Despite the American Academy of Pediatrics’ recommendation to conduct oral health risk assessments (OHRs), fluoride varnish (FV) applications, oral health anticipatory guidance, and dental referrals during well-visits for children six months old to five years old, primary care providers do not consistently implement these practices.

Objective: The purpose of this quality improvement project was to increase utilization of these evidence-based guidelines at a federally qualified health center in Southern New Jersey.

Methods: The project methods involved implementing a routine screening protocol and clinical reminder system to increase OHRAs, anticipatory guidance, FV applications, and dental referrals for children six months old to five years old during well-visits. Three nurse practitioners and one physician were educated about a routine pediatric oral health screening protocol and clinical reminder system that was then utilized over a three-
month period. The protocol involved use of a standardized questionnaire and screening tool, electronic clinical reminders, and written patient education during all well-visits for children six months old to five years old. Retrospective chart reviews were used to evaluate for practice improvement, before and after implementation of the project.

Results: After a three-month period, 129 randomly selected medical records for well visits in this age group revealed 94.6% improvement in oral health risk assessments, 14.7% increase in children identified as high caries-risk, 30.2% increase in oral health anticipatory guidance, and 100% improvement in dental referrals.

Conclusions: This project’s significant clinical findings suggest that a standardized protocol can improve implementation of pediatric oral health screening guidelines in primary care. Evidence shows these practices will likely lead to decreased incidence of
ECC and improved overall health throughout the lifespan.

Keywords: early childhood caries, dental caries, pediatric oral health screening, fluoride varnish, primary care, quality improvement projects