Early Childhood Caries and the Pediatric NP
Early Childhood Caries and the Pediatric NP
The lack of dentists in the US contributes to the gap in oral health disparities. Poor children who live in urban and rural areas have severe unmet needs and require access to qualified individuals who can provide dental assessment and preventive treatment. PNPs who provide primary care services to children can play a key role in oral health promotion. The ADA has stated that education and prevention are necessary to eliminate or minimize the burden of dental disease and offer a caries risk assessment tool on their Web site (http://www.ADA.org). PNPs should use the tool to assess oral health risk of children and prevent dental caries. Educating families on techniques of brushing teeth, providing fluoride, limiting sugary snacks/foods at school and home, and promoting oral health during pregnancy all have an effect on the overall dental health of children and their families. Following AAPD guidelines, PNPs should advise parents to clean infants' teeth as soon as they erupt with a soft toothbrush. Because proper technique of cleaning teeth is important, parents or adults should supervise their children's toothbrushing and flossing. PNPs should also determine the existing fluoride content in the primary source of water before prescribing or recommending a fluoride supplement to the child.
Knowledge regarding the etiology and transmission of infection is also important. With this understanding, PNPs can provide a comprehensive approach toward the prevention of caries. Caregivers should be informed that carious pathogens can be transmitted from mouth to mouth, so they should avoid activities such as allowing the infant to play in the caregiver's mouth and sucking the infant's pacifier or bottle nipple. Nighttime bottle feeding with milk or juice should be discouraged because it contributes to ECC.
PNPs should incorporate oral health assessment, education, and prevention activities such as the application of fluoride varnish as part of the routine health surveillance visit. Prescribing fluoride supplementation and application of fluoride varnish are within the scope of practice of the PNP. PNPs should receive training prior to topical fluoride application and once trained; application is quick, painless, and highly effective and can be done in an office or community setting. The topical application of fluoride treatment is based on caries risk assessment. The application of 5% sodium fluoride varnish to children's teeth safely delivers fluoride and a protective coating to the tooth surfaces. To obtain the maximum benefit, parents and children should be instructed not to brush or floss for at least 4–6 hours, wait until next morning to resume brushing and flossing, and avoid hot drinks on the day of varnish application. For those children who need dental treatment beyond the scope of the PNP, referrals to appropriate dentists and assistance to parents in establishing a dental home for their child should be initiated.
Prevention strategies mentioned need to begin with the implementation of PNP education and training. The literature illuminates the paucity of oral health education in undergraduate and graduate nursing programs, which likely perpetuates the lack of confidence PNPs have at performing a thorough pediatric oral examination. Similarly, within the medical profession, studies regarding the role of pediatricians in the oral health of children reported having no previous training in dental health issues during medical school or residency and had a similar lack of confidence.
In order for PNPs to be successful at promoting pediatric oral health, there is a need for adequate training, and curriculum should be developed to incorporate oral health assessment as part of the routine well-child visit. New York University College of Nursing has taken the lead in terms of PNP oral health education. They collaborated with the school of dental medicine to develop an interprofessional curriculum that "allows the pediatric nurse practitioner students to learn about caries risk assessment and how to apply fluoride varnish while the dental students can become more familiar with the role of the advanced practice nurse in oral health." Similarly, the Society of Teachers of Family Medicine has developed an oral health curriculum (Smiles for Life) for primary care providers.
PNPs should remain abreast of local, state, and national policy issues and advocate at all levels for improved access to oral health care for children. Advocacy is needed at the local level to support education and screening programs outside of the usual brick and mortar settings. PNPs should support and participate in community-based prevention programs such as those provided in school-based and homeless shelters. Including daycare and preschool sites in community oral health initiatives might help to alter the trend of ECC. PNPs should take initiative to improve school nutrition and the elimination of food insecurity by supporting weekend and summer nutrition programs for children.
State and national efforts should focus on reimbursement for dental and nondental providers because poor reimbursement remains a major obstacle to providing preventive care. Reimbursement for nondental providers for preventive screening such as oral health has been a barrier and hindrance for health care providers. Currently, 40 states allow Medicaid programs to provide coverage under the early and periodic screening and diagnostic treatment benefit for children and adolescents receiving routine oral health care. These services include oral examination, screening, risk assessment, anticipatory guidance, caregiver education, and application of fluoride varnish. The Centers for Medicare and Medicaid Services is working with national dental provider organizations including those representing nurse practitioners and nondental (medical) providers involved in providing oral health services. Furthermore, PNPs should also support the need for dentists who accept Medicaid to be reimbursed appropriately for the services they provide. Although PNPs may alleviate some access issues by providing screening, education, and preventive care, pediatric and general dentists need to be available for patients who need restorative care. PNPs and primary care providers should use dental hygienists and dentists when appropriate.
Role of the Pediatric Nurse Practitioner
The lack of dentists in the US contributes to the gap in oral health disparities. Poor children who live in urban and rural areas have severe unmet needs and require access to qualified individuals who can provide dental assessment and preventive treatment. PNPs who provide primary care services to children can play a key role in oral health promotion. The ADA has stated that education and prevention are necessary to eliminate or minimize the burden of dental disease and offer a caries risk assessment tool on their Web site (http://www.ADA.org). PNPs should use the tool to assess oral health risk of children and prevent dental caries. Educating families on techniques of brushing teeth, providing fluoride, limiting sugary snacks/foods at school and home, and promoting oral health during pregnancy all have an effect on the overall dental health of children and their families. Following AAPD guidelines, PNPs should advise parents to clean infants' teeth as soon as they erupt with a soft toothbrush. Because proper technique of cleaning teeth is important, parents or adults should supervise their children's toothbrushing and flossing. PNPs should also determine the existing fluoride content in the primary source of water before prescribing or recommending a fluoride supplement to the child.
Knowledge regarding the etiology and transmission of infection is also important. With this understanding, PNPs can provide a comprehensive approach toward the prevention of caries. Caregivers should be informed that carious pathogens can be transmitted from mouth to mouth, so they should avoid activities such as allowing the infant to play in the caregiver's mouth and sucking the infant's pacifier or bottle nipple. Nighttime bottle feeding with milk or juice should be discouraged because it contributes to ECC.
PNPs should incorporate oral health assessment, education, and prevention activities such as the application of fluoride varnish as part of the routine health surveillance visit. Prescribing fluoride supplementation and application of fluoride varnish are within the scope of practice of the PNP. PNPs should receive training prior to topical fluoride application and once trained; application is quick, painless, and highly effective and can be done in an office or community setting. The topical application of fluoride treatment is based on caries risk assessment. The application of 5% sodium fluoride varnish to children's teeth safely delivers fluoride and a protective coating to the tooth surfaces. To obtain the maximum benefit, parents and children should be instructed not to brush or floss for at least 4–6 hours, wait until next morning to resume brushing and flossing, and avoid hot drinks on the day of varnish application. For those children who need dental treatment beyond the scope of the PNP, referrals to appropriate dentists and assistance to parents in establishing a dental home for their child should be initiated.
Prevention strategies mentioned need to begin with the implementation of PNP education and training. The literature illuminates the paucity of oral health education in undergraduate and graduate nursing programs, which likely perpetuates the lack of confidence PNPs have at performing a thorough pediatric oral examination. Similarly, within the medical profession, studies regarding the role of pediatricians in the oral health of children reported having no previous training in dental health issues during medical school or residency and had a similar lack of confidence.
In order for PNPs to be successful at promoting pediatric oral health, there is a need for adequate training, and curriculum should be developed to incorporate oral health assessment as part of the routine well-child visit. New York University College of Nursing has taken the lead in terms of PNP oral health education. They collaborated with the school of dental medicine to develop an interprofessional curriculum that "allows the pediatric nurse practitioner students to learn about caries risk assessment and how to apply fluoride varnish while the dental students can become more familiar with the role of the advanced practice nurse in oral health." Similarly, the Society of Teachers of Family Medicine has developed an oral health curriculum (Smiles for Life) for primary care providers.
PNPs should remain abreast of local, state, and national policy issues and advocate at all levels for improved access to oral health care for children. Advocacy is needed at the local level to support education and screening programs outside of the usual brick and mortar settings. PNPs should support and participate in community-based prevention programs such as those provided in school-based and homeless shelters. Including daycare and preschool sites in community oral health initiatives might help to alter the trend of ECC. PNPs should take initiative to improve school nutrition and the elimination of food insecurity by supporting weekend and summer nutrition programs for children.
State and national efforts should focus on reimbursement for dental and nondental providers because poor reimbursement remains a major obstacle to providing preventive care. Reimbursement for nondental providers for preventive screening such as oral health has been a barrier and hindrance for health care providers. Currently, 40 states allow Medicaid programs to provide coverage under the early and periodic screening and diagnostic treatment benefit for children and adolescents receiving routine oral health care. These services include oral examination, screening, risk assessment, anticipatory guidance, caregiver education, and application of fluoride varnish. The Centers for Medicare and Medicaid Services is working with national dental provider organizations including those representing nurse practitioners and nondental (medical) providers involved in providing oral health services. Furthermore, PNPs should also support the need for dentists who accept Medicaid to be reimbursed appropriately for the services they provide. Although PNPs may alleviate some access issues by providing screening, education, and preventive care, pediatric and general dentists need to be available for patients who need restorative care. PNPs and primary care providers should use dental hygienists and dentists when appropriate.
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