It Takes a Village – Why Interprofessional Collaboration Improves the Health of Children

The healthcare needs of children are dynamic and ever-changing. Children depend on others to provide care and to recognize when care is needed. These needs are unlikely to be met by one individual or entity. The concept of “Team Based Care” is meant to address all the complex needs of a child by involving all individuals who touch the lives of children.¹

Collaboration and communication between healthcare professionals is becoming more common as health profession education has embraced interprofessional education as a vital component of the training for physicians, dentists, social workers, nurses, midwives and pharmacists.

Although dental caries is considered a disease treated by dentists, the risk factors have implications for overweight, obesity and diabetes and overall health. This makes it important to all healthcare professionals. Dental caries is the most common chronic disease of childhood and is mostly preventable. One of the keys to prevention is to provide education to parents regarding dietary habits, oral hygiene, fluoride use and other caries risk factors at a very early age. There is strong evidence to support the effectiveness of early dental visits as a means to identify children at risk, establish a dental home and prevent caries.^2,3

The American Academy of Pediatric Dentistry⁴, the American Dental Association and the American Academy of Pediatrics⁵ all recommend that children be seen for their first dental examination at the time the first tooth erupts or no later than one year of age. The percentage of children who meet this recommendation is low. A national survey conducted by the AAPD found that 74% of parents do not take their child to the dentist by their first birthday.⁶ In the U.S, physicians and nurses see young children for well child examinations and vaccinations at least 13 times before their 3^rd birthday and are in a position to assess caries risk and provide preventive interventions, including fluoride varnish. 

Recently, an oral health curriculum was developed for nondental health professionals⁷(www.smilesforlifeoralhealth.org). This provides physicians and nurses with the knowledge needed to perform caries risk assessment, apply fluoride varnish and provide oral health education.⁷ In most cases, in the U.S. these providers can also be reimbursed for this service, for children under 6 years.⁸ When disease indicators are identified, the child is referred to a general or pediatric dentist to establish care and have their caries lesions managed. Another recent study provides support for starting preventive efforts during pregnancy.⁹ In one group, dental treatment was provided to pregnant women combined with motivational interviewing, fluoride varnish for the infant and anticipatory guidance. The second group received the same intervention but started when the child was 2 or 3 years of age. The early intervention group had fewer dental caries than the delayed intervention group at the 3-year follow-up. This provides support for preventive oral health efforts by family physicians, midwifes and general dentists who are in a position to see and treat pregnant women. It also shows the importance of early care for children and establishment of a dental home.⁹

It is critical that all health care professionals who interact with young children and their families are aware of the factors that contribute to good oral and overall health, including a healthy diet, very limited use of added sugars in foods and beverages, oral hygiene practices and the preventive effects of topical fluoride.

¹Katkin JP, Kressly SJ, Edwards AR, Perrin JM, Kraft CA, Richerson JE, Tieder JS, Wall L. Task force on pediatric practice change. Guiding Principles for Team-Based Pediatric Care. Pediatrics. 2017;140(2). pii:e20171489.
²American Academy of Pediatric Dentistry. Policy on the Dental Home. Pediatr Dent. 2018-19; 40(6):29-30. 
³Nowak AJ, Casamassimo PS, Scott J, Moulton R. Do early dental visits reduce treatment and treatment costs for children? Pediatr Dent 2014;36(7):489-93. 
⁴American Academy of Pediatric Dentistry. Perinatal and infant oral healthcare. Pediatr Dent. 2018-19; 40(6):216-220. www.aapd.org/research/oral-health-policies--recommendations/perinatal-and-infant-oral-health-care/ 
⁵Hale KJ, American Academy of Pediatrics Section on Pediatric Dentistry. Oral health risk assessment timing and establishment of the dental home. Pediatrics. 2003;111(5 Pt 1):1113-6. 
⁶Hill BJ, Meyer BD, Baker SD, et al. State of Little Teeth Report. 2nd ed. Chicago, IL: Pediatric Oral Health Research and Policy Center, American Academy of Pediatric Dentistry; 2019. 
⁷Society of Teachers of Family Medicine. Douglass A, ed. Smiles for Life: a national oral health curriculum for family medicine. www.smilesforlifeoralhealth.org 
⁸AAP Division of Healthcare Finance. Fluoride varnish application by pediatricians should be paid with no cost-sharing. AAP News. September 6, 2016. www.aappublications.org/news/2016/09/06/PPAAC090616 
⁹Jamieson LM, Smithers LG, Hedges J, Aldis J, Mills H, Kapellas K, Lawrence HP, Broughton JR, Ju X. Follow-up of an Intervention to Reduce Dental Caries in Indigenous Australian Children: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open. 2019; 1:2(3):e190648.