Dental home Pediatrics

Early childhood dental caries occurs in all racial and socioeconomic groups; however, it tends to be more prevalent in children in families belonging to the low-income group, where it is seen in epidemic proportions. Dental caries results from an overgrowth of specific organisms that are a part of normally occurring human flora. Human dental flora is site specific, and an infant is not colonized until the eruption of the primary dentition at approximately 6 to 30 months of age. The most likely source of inoculation of an infant's dental flora is the mother, or another intimate care provider, shared utensils, etc. Decreasing the level of cariogenic organisms in the mother's dental flora at the time of colonization can significantly impact the child's redisposition to caries. To prevent caries in children, high-risk individuals must be identified at an early age (preferably high-risk mothers during prenatal care), and aggressive strategies should be adopted, including anticipatory guidance, behavior modifications (oral hygiene and feeding practices), and establishment of a dental home by 1 year of age for children deemed at risk.

1. SUBMITTED BY :- Akshdeep singh Roll no. 07 BDS 3 rd Year SUBMITTED TO :- PROF. &HEAD – Dr. Virinder Goyal PROFESSOR – Dr. Kanika Gupta Verma Reader – Dr. Suruchi Juneja Sukhija Sr. Lecturer - Dr. Sohajpreet singh Dr. Sakshi Bambha Dr. Lovejeet Ahuja

2. CONTENT OBJECTIVES HISTORY DEFINITION CHARACTERISTIC ADVANTAGES KEY COMPONENTS MODELS CONCEPTUALISING DENTAL HOMES SPECIALISED CARE REFERRAL

3. OBJECTIVES To enhance the dentists ability to assist children and their parents for oral health care. To schedule early oral health examinations for cost effectiveness. Individual child risk assessment for dental diseases. Monitoring the growth and development. To make the parents aware of when and how frequently should they visit a dental home for their child.

4. history The concept of a dental home is too new to have been studied as a predictor of oral health. In 1999,Nowak described the term in relation to desired recurrence of preventive oral health supervisory service as propagated by the American Academy of Paediatric Dentistry.

5. Doykos suggested that early association with a dentist has benefit of reduced cost of care, with the difference being attributed to an increased need for treatment services for those who delay the first dental visit.

6. In recent analysis Grembowski and Milgrom arranged a dental home like program and compared results with the children who didn’t attend the program and results were in favour of the children who attended the program. This lead to concept of Dental and Medical home.

7. DEfinition According to American Academy of Paediatric Dentistry (AAPD) can be defined as ‘The dental home’ is the ongoing relationship between the dentist and the patient , inclusive of all aspects of oral health delivered in a comprehensive, continuously accessible, coordinated, and family-centred way. Establishment of dental home begins no later than 12 months of age and includes referral to dental specialists when appropriate.

8. ADVANTAGES Embrace the importance of early intervention with optimal preventive strategies chosen based on the risk of the patient. Encourage the first dental visit by approx. 1 year of age. Practitioners can provide personalised preventive approaches for children based on their families histories which includes medical history, dietary habits, medications, fluoride availability and parental attitudes.

9. CONTINUATION An important feature is to provide anticipatory guidance to the parents so that they are aware of their children’s growth and development , as well as possible risk factors that occur as children age. Preventive intervention can be personalised to the needs of the child.

10. Key Components of Dental Homes Access to Care - Dental homes must be attuned to the impact that family education level, income, and health insurance status have on access to care. Inability to pay for oral health care is a major drawback for families attempting to establish a dental home.

11. Quality of Care- The notion that oral health professionals choose to make care available is not necessarily means that quality care will be provided. So, it is important to distinguish between “one-star” and “ fivestar ” dental homes. Coordination of Care- Care coordination connects children and their families to comprehensive care and community resources. A key element of care coordination is the identification of a lead coordinator, who might be a dentist, a mid-level oral health provider (e.g., dental hygienist, dental therapist), primary care health professional, or a family member. In all cases, a coordinator must be able to navigate the health care system.

12. Preventive Care- It is important to remove treatment-only concept of the dental home and to instead create a concept of the dental home as also providing preventive care. Under such a model, dental homes would provide risk assessment, preventive care, and education, among other services.

13. MODELS There was a expressed frustration that the most commonly used dental home definition still does not include key components of care (i.e., access to care, quality care, coordination of care) or follow prevention-oriented disease management. Due to all drawbacks and frustration there have been several models proposed which we’ll discuss now.

14. Vertical Model In this model, the highest-level, most complicated care would be provided by a dentist, and lower levels of care would be provided by a dental hygienist. It is also called as high rise as the highest level or most complicated care will be provided

15. Dispersion Model Also called as Low-Rise Model In this model, the entire community serves as the dental home, and community resources are integrated to serve the population’s oral health needs. For example, children receive preventive care (dental sealants and fluoride varnish) at school, risk assessment and education from their primary care health professional, and needed restorative treatment at a private dental practice or safety net dental clinic. A number of participants believed that the dispersion model was the optimal dental home model

16. Two-Tiered Model It is a combination of vertical model and dispersion model. As both the vertical and dispersion models seek to deliver better oral health services in an integrated way, participants agreed to combine the models into a flexible two-tiered structure. Participants also agreed that this will be a more better, efficient and flexible model.

17. CONCEPTUALISING Dental Homes We will now discuss how the roles of dental hygienists, primary care health professionals, community-based health providers, and families—as well as the key role played by the dentist—related to the concept of the dental home.

18. Primary Care Health Professionals Using primary care health professionals (e.g., physicians, nurse practitioners) to provide oral health preventive care and education on oral disease prevention is an excellent way to take advantage of resources to widen the reach of the oral health delivery system by linking medical homes and dental homes.

19. Community-Based Health Providers Community-based health providers can play a crucial role in providing education on oral disease prevention. FAMILIES Families serve as the focal point of medical homes and dental homes. A child’s ability to enter a system of care is dependent to a large extent on the family, and family ahs the most important role to care to fit a child’s needs.

20. SPECIALISED CARE REFERRAL Another feature of dental home would be coordination of specialized care for child. When a child has been observed over a period , appropriate recommendations can be made for other treatments such as orthodontic referral and observations. Dental home provides a wonderful opportunity for primary dental provider to recognize changes in growth and development that can be discussed with parent and appropriate recommendations to seek further consultation from the child’s physician.

21. Behavioural research supports a child’s increased levels of comfort and reduced level anxiety levels as familiarity increases with dental environment. It can provide a personalised and individualised recall program for a child. The continuous care provided by a dental team also would recognise other developmental milestones that may suggest needed attention.