摘要：Objectives. To assess an oral health promotion (OHP) intervention for medical providers’ impact on early childhood caries (ECC). Methods. We implemented a quasiexperimental OHP intervention in 8 federally qualified health centers that trained medical providers on ECC risk assessment, oral examination and instruction, dental referral, and fluoride varnish applications (FVAs). We measured OHP delivery by FVA count at medical visits. We measured the intervention’s impact on ECC in 3 unique cohorts of children aged 3 to 4 years in 2009 (preintervention; n = 202), 2011 (midintervention; n = 420), and 2015 (≥ 4 FVAs; n = 153). We compared numbers of decayed, missing, and filled tooth surfaces using adjusted zero-inflated negative binomial models. Results. Across 3 unique cohorts, the FVA mean (range) count was 0.0 (0), 1.1 (0–7), and 4.5 (4–7) in 2009, 2011, and 2015, respectively. In adjusted zero-inflated negative binomial models analyses, children in the 2015 cohort had significantly fewer decayed, missing, and filled tooth surfaces than did children in previous cohorts. Conclusions. An OHP intervention targeting medical providers reduced ECC when children received 4 or more FVAs at a medical visit by age 3 years. Early childhood caries (ECC) is the most common chronic childhood health condition. 1–4 Although preventable, 3,5,6 ECC prevalence is increasing. 1,7 Children in low-income families have double the caries rate of advantaged children and are less likely to receive dental care. 1,8,9 Untreated ECC can lead to pain, low quality of life, missed school, emergency department visits, hospitalizations, and even death. 10–13 Furthermore, caries are costly to treat. The 2005 Medical Expenditures Survey estimated that $1.55 billion is spent annually to treat dental decay in children younger than 5 years (excluding hospital costs). 13 Nationally, few dental providers participate in public insurance programs, leading publicly insured children to have less access to dental care than do privately insured children. 14 To reduce access barriers, all state Medicaid programs reimburse nondental health care providers for the provision of oral health promotion (OHP) services, 15 specifically fluoride varnish applications (FVAs). The provision of early OHP services has had variable medical provider uptake. 16 Pahel et al. 5 assessed the impact of medical provider FVAs on caries-related treatments as a proxy for ECC. They reported a reduction in caries-related treatments in children insured by Medicaid when 4 or more FVAs were received by age 3 years. Recognizing that low-income families have difficulty obtaining caries-related treatments, we assessed the impact of an OHP intervention (as measured by FVAs) for medical providers on the endpoint outcome, ECC, in children in low-income families.
