Teeth First! Teeth First!

Making Rhode Island’s Children Healthier: Addressing Oral Health in Primary Care

Written by: Peter Pogacar, MD, FAAP

When I was a pediatric resident training to become a pediatrician, we received very little instruction regarding children's teeth and oral health in general. We spent the majority of our time in the hospital taking care of the very sick. Most of the oral health problems we encountered were due to the advanced treatments or medications the children were enduring. We were involved with specialists treating every organ system in the human body, but I don't remember even once consulting with the pediatric dentists. However, the more I gravitated towards primary care, the more I focused on healthy children and keeping them that way. Prevention became a major focus and I spent a lot of energy acquiring the knowledge and the skills necessary to give my patients the best chance to avoid the hospital altogether. 
It wasn't until years after my formal training that I realized how little I knew about oral health and oral disease prevention. At first this deficiency seemed almost natural—after all, I was not a dentist. Oral health was their job and the rest of the body was mine. This reasoning seems almost silly in retrospect. 
A turning point came when I traveled to Chicago to spend a few days discussing and learning about the pediatrician's role in oral health. We learned the essentials of the oral exam and how to search for signs of dental weakness where disease can gain a footing. Most importantly, we learned how to discern who was at high-risk, when to refer and which patients would benefit most from fluoride varnishing. The procedure itself was simple, fast and could easily be mastered by a medical assistant. 
In 2009, I gave a Grand Rounds lecture at Hasbro Children’s Hospital on applying fluoride varnish. It was the culmination of my role as the Oral Health Advocate of Rhode Island's Chapter of the Academy of Pediatrics. I was delighted to hear that many state's Medicaid programs were willing to pay pediatricians for this work, opening the door for possibly a major step forward in caring for the entire child. The Grand Rounds was a means of spreading the idea to my colleagues in my state. Slowly, things began to change. 
There were and continue to be barriers to focusing on oral health and the application of fluoride varnish in the pediatrician's office. The number one limiting factor is time. We only have a short visit and there is a lot to discuss; diet, exercise, sleep, education, general mood, family, high-risk behaviors, etc. Now we want to add more to the equation plus we want pediatricians to become versed in the oral health exam and add a fluoride varnish procedure?  
Nonetheless, many accepted the challenge to improve the care of their patients. They went online and reviewed the information modules provided by the Academy of Pediatrics. They stocked the equipment and trained their staff. They learned how to bill and how to get paid for this work. More and more the mouth is beginning to rejoin the rest of the body as this effort gains momentum and Rhode Island children are healthier because of it. 
TeethFirst! Creating healthy smiles for a lifetime.