A Resource Guide for Pediatric and General Dentists to Successfully Establish an Infant Oral Health Referral Infrastructure in Your Community and State
The task of successfully establishing an Infant Oral Health referral infrastructure in your community and your state that involves the collaborative interaction of dentists and pediatric medical providers requires that the ‘I’ equation be changed to a ‘We’ equation.
To that end, the following project was designed to assist in changing the practice behavior of involved participants in order to achieve this goal.
"Points of Light" is a project that brings together two operational items in order to overcome multiple, inherent obstacles to having infants presented to a dentist by age one and prior to the emergence of dental decay. The first item is the American Academy of Pediatric Dentistry’s ‘Enhanced Care Through Appropriate Medical Referrals’ program (ECTAMR) and the second item is the American Academy of Pediatrics’ oral health policy ‘Oral Health Risk Assessment Timing & Establishment of the Dental Home’. ECTAMR is a format written for dentists to define and ease the process of interacting with physicians in order to encourage early dental referrals. The AAP oral health policy directs pediatric medical providers to administer oral health risk assessments and refer ‘at risk’ infants to a dentist and establish a ‘Dental Home’ prior to the need for restorative care.
Heretofore, the reluctance of the medical community to make early dental referral has primarily been the result of two areas of concern. First, they perceive that there are too few dentists accepting infants to make effective referrals and second, patients at risk of caries often cannot afford to see a dentist. The third and often unspoken obstacle is that some physicians are unwilling to change their clinical behavior for reasons they do not completely understand and therefore suspect may be more about enhancing one dentist’s patient base rather than enhancing the oral health of the community. ‘Points of Light’ addresses these issues head-on by changing the ‘I’ equation into a ‘We’ equation.
The "Points of Light" project is designed to be implemented in target communities by a five-step process. Ideally, at least four to five communities in the state should be initially operationalized. The five steps are as follows:
- Select a pediatric or general dentist in multiple communities in your state to implement the project and send them a recruitment letter and template packet. (An example recruitment letter is included in your packet). The template packet should include a template of the In-service PowerPoint presentation for general dentists, an example letter to medical providers, a physician information sheet, a copy of the AAP oral health policy, an anticipatory guidance sheet, an example of a list of dentists and a copy of ECTAMR. Attempt to geographically space the pilot communities.
- Have the lead dentist assemble a list of dentists from their community that are willing to see infants in their practices. Their lists should reflect geographic distribution and public assistance program participants. (Letting community dentists know that they will gain an entirely new set of patients and that a list is being compiled to present to medical providers are strong incentives for them to participate).
- Have the lead dentist provide an In-service on Infant Oral Health to participating dentists and their staff. (A template PowerPoint presentation is included in the packet).
- Have the lead dentist mail an informational packet to the pediatric medical providers in their community. This packet should include a cover letter announcing the project, an information sheet, a copy of the AAP oral health policy, an anticipatory guidance sheet and a list of participating dentists. (Examples of all of these items are included in the packet).
- Have the lead dentist contact and schedule In-service sessions with the pediatric medical providers in their community using ECTAMR as a format.
Once the pilot communities are operational and infants are being referred to local area dentists, additional communities should be selected and lead dentists recruited to implement the project as previously described. The underlying goal is to continue creating multiple communities where infant oral health networks are established until all of these communities (Points of Light) merge into continuously expanding areas with operational referral infrastructure. Ultimately, the practice of medical practitioners referring infants to the dentist, parents presenting infants to the dentist and dentists integrating infants into their practices will be accepted practice.
Although "Points of Light" is a Herculean undertaking, it has several advantages that increase the probability of its success:
- First, it steps around the issue of an isolated dentist advocating early referral and substitutes a strong message from one professional collective to another professional collective. By compiling a list of participating dentists, the message to local medical providers is, "We, the dentists of the community are ready and willing to manage these patients prior to the need for restorative dentistry". While they may not completely comprehend the value of early preventive intervention, it is difficult for the medical community to ignore this genre of message.
- Second, this project brings dentists and physicians into participation simultaneously and solves the issue of physicians not knowing who will accept infant patients.
- Lastly "Points of Light" offers a comprehensive vision for changing referral patterns throughout large geographic areas by creating a potentially limitless dental participation infrastructure. It is only through the creation of this infrastructure that parents and medical providers of this country will overcome a generational misconception that children should not go to the dentist until three years of age or until they have a problem.
In the end, everyone who participates in "Points of Light" is a winner. The general dentist gains a new set of patients, the pediatric medical provider delivers more comprehensive and higher quality care, and the pediatric dentist gains those very young patients who already have significant dental decay. Most importantly, by bringing early preventive oral health care to general acceptance, the oral health of children across your state will be significantly improved.
Kevin J. Hale, DDS, FAAPD
AAPD District IV Trustee 2004-07
Sample Points of Light Dentist Contact Letter
Sample Points of Light Physician Contact Letter
Enhanced Care Through Appropriate Medical Referrals Policy
Infant Oral Health Care Handout
Download Infant Oral Health Care PowerPoint Presentation