Trends in Pediatricians’ Practices and Perceived Barriers Related to Oral Health Assessments; 2008-2018

Sisk, Blake¹; Lewis, Charlotte²; Barone, Lauren¹; Quinonez, Rocio³; Krol, David⁴; Braun, Patricia A.⁵

¹Research, American Academy of Pediatrics, Itasca, IL, United States.

²Pediatrics, University of Washington, Seattle, WA, United States.

³University of North Carolina, Chapel Hill, NC, United States.

⁴Rutgers University, New Brunswick, NJ, United States.

⁵Pediatrics, University of Colorado/ Denver Health, Denver, CO, United States.

Presented at the 2019 Pediatric Academic Societies Annual Meeting.

Background: Recent changes in oral health policies and educational opportunities for pediatricians have encouraged providers to learn about and implement oral health services. However, little is known about the impact of these changes on pediatricians’ practices.

Objective: Evaluate trends in pediatricians’ practices and perceived barriers related to oral health.

Methods: Nationally representative, cross-sectional Periodic Surveys of American Academy of Pediatrics post-residency US pediatrician members in 2008 (n=1104; response rate=69%), 2012 (n=646; RR=48%), and 2018 (n=485; RR=48%). Analytic sample restricted to those that provide health supervision. Surveys collected data on barriers to oral health assessments, frequency of performing oral health tasks, and respondent demographics. Predicted probabilities (PP) from separate multivariable logistic regression models examined the independent effect of survey year, controlling for age, gender, setting, area, hours worked, and time spent in general pediatrics (probabilities generated holding all controls at their means).

Results: Relative to 2008, pediatricians were less likely to report barriers to performing oral health assessments in 2018 (Fig 1). Statistically significant declines in reported barriers were observed for lack of professional training (2008 PP=41.2%, 95% CI 37.3, 45.1; 2018 PP=25.3%, 95% CI 20.3, 30.4%), lack of ability to bill for fluoride varnish (2008 43.2%, 35.5, 50.9; 2018 27.7%, 21.1, 34.3), and inadequate time (2008 34.8%, 31.1, 38.6; 2018 22.3%, 17.6, 27.1). Over the same period, pediatricians were increasingly likely to report performing a variety of oral health assessments (Fig 2). There was a significant increase in the probability of identifying plaque (2008 18.1%, 15.1, 21.0; 2018 26.3%, 21.1, 31.6), and pediatricians were also more likely to report recommending when to use fluoride toothpaste (2012 58.9%, 53.4, 64.3; 2018 70.9%, 64.5, 77.2) and applying fluoride varnish (2008 2.6%, 1.6, 3.7; 2018 16.9%, 12.5, 21.3).

Conclusion: From 2008-2018, pediatricians were less likely to report barriers to performing oral health assessments while also being more likely to report performing a range of oral screening and fluoride related tasks. These results indicate that an ongoing, multifaceted focus on increasing pediatrician involvement in oral health can positively impact pediatricians’ practices and reinforces the importance of pediatrician efforts to continue to reduce oral health disparities among children.