A Pediatric Oral Health Initiative in a Primary Care Setting: A Quality Improvement Project

Purpose:  To integrate a pediatric oral health program, a dental home concept in a rural primary care office. 
Background:  Early childhood caries is a serious and prevalent public health problem. Globally, 2.4 billion adults and 621 million children are affected by dental caries, which makes dental caries one of the most common chronic conditions for the world population. Despite the global oral health initiatives, dental caries continues to be a widespread problem. Locally, there is a lack of fluoridated water systems along with limited services in rural Pennsylvania. Vulnerable populations have been greatly affected. Causes of dental caries include poor diet, lack of fluoridated water, improper brushing, environmental factors, and lack of services. Family practice providers have an opportunity to use primary prevention to decrease the incident of dental caries.  
Methods:  A conceptual model Oral Health Delivery Framework which emulates the Plan Do Study Act method was implemented in a rural primary care office. The Oral Health Risk Assessment Tool, education, fluoride application, and a referral to dentistry were completed. Quality improvement methods were used to integrate oral health in a primary care setting and measured the improvements made.  
Results: Outcome data demonstrated a significant improvement on oral health exams, fluoride varnish application, dental referrals, and education. There was a positive effect on children getting established with a dentist, completing the dental home concept.   
Conclusion: Dental caries is still a major problem worldwide, though it can be prevented. Children have multiple well-child visits in early childhood which gives frequent opportunities to offer anticipatory guidance, caries risk screening, and preventive treatment. Evidence based research suggests primary care can assist in assessment and integration, identifying patients with unmet dental needs and promote a dental referral.