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Early Childhood Caries Prevention in the Medical Home
Robert Anderson, MD, FAAP
Summer 2000
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This summer the Iowa Chapter of the American Academy of Pediatrics, with the assistance
of the EPSDT program, is implementing an initiative to reduce the incidence of early
childhood caries (ECC). Pediatricians will pursue a comprehensive approach to ECC
prevention for children from birth to three years of age. The initiative includes an
education component that reviews ECC risk factor identification, screening techniques,
and fluoride varnish <%=Application("")%> (With fluoride varnish, primary care providers in the
United States can reduce early childhood caries by an estimated 25% to 45% in high-risk
populations.)
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Early childhood caries (ECC) affect a child’s primary, or baby, teeth. Among certain
populations, it has a frequency as high as 50%. Because of the health burden of dental decay and
the cost of restoration, all primary health care providers should be aware of ECC, and should
intervene with prevention strategies.
Oral health screening is called for in the EPSDT guidelines. Essential prevention strategies include:
- Oral health screening at each EPSDT visit
- Risk assessment
- Anticipatory guidance
Identifiable caries in a patient would result in referral to a dentist, as indicated by EPSDT
guidelines. Thus, the child’s "medical home" can refer a child to their "dental
home."
Reimbursement for dental care
To facilitate reimbursement for the additional service provided to the child, the Division of
Medical Services of the Iowa Department of Human Services has proposed reimbursement for oral
health services, to include:
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Services rendered by physicians acting within their scope of practice for the purpose of
identifying and preventing tooth decay.
- Limited oral screenings.
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Application of topical fluoride (this adds only minutes to the dental screening exam that is
outlined by Dr. Kanellis in the fall ‘99
issue of this newsletter.
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