Efficacy of Oral Health Promotion in Primary Care Practice

Poor oral health continues to be a major health concern for children worldwide. Within the United States, dental caries are the most common chronic childhood disease, occurring 5 times more frequently than asthma. Lack of proper oral health assessment and family education early in a child’s life increases their risk for developing dental decay resulting in difficulty eating, speech delays, poor school performance and can also negatively affect proper child development of self-esteem and social interaction. A major limitation to decreasing childhood dental disease includes shortages in pediatric dental services and dental providers who are both willing and able to provide services to uninsured children, as well as providing services to those children with Medicaid insurance. Therefore, improving oral health for children requires a more creative approach.  

Children rely on parents and caregivers to protect them and provide for their most basic needs. A parent’s knowledge and beliefs can directly impact the oral health care their children receive at home and their access to professional dental services. Caregivers who are lacking proper oral health knowledge may unknowingly encourage unhealthy oral health behaviors in their children resulting in poor oral health outcomes.

Nurse practitioners (NPs) are well suited to play a critical role in addressing oral health issues and frequently are providing care to those children suffering from poor oral health.  Children are seen on average of 10-12 times by a primary care provider for routine well child visits during their first two years of life.  These visits are unique opportunities for practitioners to engage families in oral health dialogues with an emphasis on the importance of primary care teeth, proper oral health hygiene and habits, as well as an opportunity for the practitioner to assist families in obtaining traditional dental services for the child by one year of age.

Purpose: The purpose of the mixed method study was to investigate the impact of oral health promotion visits delivered by a pediatric NP in a primary care practice on parental oral health beliefs and behaviors for their children ages 6 to 15 months.

Methods: One hundred parents of children were enrolled with 84 completing the study. The control group (n=40) received standard oral care during their routine well child care visits. The intervention group (n=44) received standard oral care during their well child care visits in addition to two enhanced oral health promotion visits. Both groups completed an early childhood oral health questionnaire during enrollment and again at the completion of the study. Those parents receiving the additional enhanced oral health promotions visit were asked to also respond to four open-ended questions in writing about their experiences during the enhanced oral health promotion visits.

Results: Results of the study revealed positive changes in parent’s perception of the importance of oral care for their children’s primary teeth compared to general healthcare needs (p<.05), parent’s responses to brushing their children’s teeth (p<.0001), the frequency of tooth brushing (p<.0001) and confidence in properly brushing their children’s teeth (p<.05), in both the control and intervention groups. At the completion of the study, when the children were 12 or 15 months old, 97.7% of parents in the intervention and 92.5% of parents in the control group were brushing their children’s primary teeth. There were no significant differences found between the two groups.  Additionally, parents in the intervention groups responded positively to their oral health experiences, which included learning about the importance of primary teeth, how to brush their child’s teeth the correct amount of toothpaste to apply and the benefit of having fluoride varnish applied to their child’s teeth.  Incentives such as a sippy cup, toothbrush and toothpaste provided to the child and family during their visits were also mentioned as a contributor to their positive experience.    

Conclusion: This study demonstrates how NPs can assist in filling the void that exists in providing basic dental healthcare to high-risk children. The result validated the usefulness of oral health programs included during well visits as a means to produce changes over time in parent’s oral health beliefs and behaviors that are critical to improving oral health outcomes. Integrating oral health promotion is a simple task with numerous benefits for children, families as well as the primary care practice through reimbursement measures for basic oral health services. 

Nurse practitioners are trained to provide anticipatory guidance and oral health promotion. With these skills, they are equipped to develop culturally sensitive programs that address the changes needed within families and the community to improve oral health outcomes. Due to the undersupply of dental providers, primary care providers can and should act to implement these programs and document their results.  The limited time required to perform standard oral health care, the potential economic benefit to the practice, and satisfaction of impacting children’s oral health are three important reasons to increase the number of programs like this in the U.S. as well as internationally.