Family physicians identify early childhood caries risk and protective factors with oral health screening

Objective: Early childhood caries (ECC) prevalence among young children exhibits disparities with higher rates among Latinos. This study aimed to identify which risk and protective factors are associated with untreated ECC at an urban San Francisco Family Health Center (FHC).

Methods: Family medicine physicians referred children 0-5 years to the oral health (OH) screening clinic at the FHC. Physicians interviewed parents about ECC risk (more than 3 daily sugary snacks, nighttime bottle usage containing juice or soda, and parents or siblings with decay) and protective factors (parent has dentist, brushes child's teeth with fluoride toothpaste, child drinks bottled water (BW) and has dental home). Physicians conducted oral exams to identify visible ECC, applied fluoride varnish, and triaged dental referrals. Data from the OH clinic registry was retrospectively analyzed for untreated caries and logistic regression conducted using STATA 10.0.

Results: Approximately 94% of 239 children (mean age=1 year) had Medicaid insurance, 70% identified as Latino, and 54% drank BW. By age two, 61% had ECC. Age (OR= 1.70, 95% CI: 1.33-2.17) was significantly associated with ECC development, while drinking BW (OR= 1.69, 95% CI: 0.98-2.77) was a risk factor. Drinking BW was the only associated and modifiable risk factor.

Conclusion: ECC screening in primary care is important for ECC identification, prevention, reinforcement of OH messages for families (i.e. drink fluoridated tapwater), and dental referral, preferably at 12 months or earlier to avoid ECC in this high-risk underserved urban setting. Drinking preferences may be an important modifiable interventional OH message.