First Step to a Healthy Smile: Preventive Oral Health in Primary Care Settings

Oral health is an important marker of overall health in young children, and is the most common infectious disease of childhood, with rates of cavities double in low income children. Primary care settings are an emerging solution for providing preventive oral health services (fluoride varnish, risk assessment, and anticipatory guidance) to low income children. A community health assessment conducted in Contra Costa County, California explored the barriers and opportunities to providing preventive oral health services to low income children under the age of three in primary care settings. Qualitative data was collected in summer 2009 from interviews with seven oral health experts, 17 surveys with primary care providers, and 35 surveys with low income caretakers. Two main findings emerged from the data 1) primary care providers face a number of significant systemic and logistical challenges (such as obtaining fluoride varnish, being reimbursed by Medicaid, and working with shortages in time and medical staff) to providing preventive oral health services to low income children, and 2) many primary care providers do not currently have the oral health knowledge and resources that they would need to provide preventive oral health services to low income children. Providing training to all primary care staff, improving Medicaid reimbursement, and standardizing preventive oral health services during well child visits will improve the oral health of low income children and reduce oral health disparities. Best practices for this county will be able to stand as a model for the rest of the state and nation.