Caries Risk Assessment and Dental Referral by Paediatric Primary Care Physicians in Sichuan Province, China: A Cross-Sectional Study

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Abstract

Background

Limited information is known about dental implementation by pediatric primary care physicians (PCPs) at the primary care level in China. This study aimed to explore the current status of primary oral care implementation and related influencing factors.

Methods

A cross-sectional survey was conducted among PCPs in Sichuan Province, China. Multivariable logistic regression was used to analyse factors associated with CRA and dental referral for high caries-risk children.

Results

A total of 504 out of 524 questionnaires remained for analysis. In all, 93.8% of PCPs reported that they usually or sometimes performed dental screening for children, 31.3% performed CRA, and 49.0% referred high caries-risk children to dentists. More CRA activities were associated with PCPs who encountered a greater number of children with caries during systematic care (adjusted OR: 2.37, 95% CI:[1.08,5.18], had dental knowledge training by pediatric dentists (aOR: 2.26, 95% CI:[1.36, 3.75], and learned pediatric dental knowledge on their own (aOR: 2.87, 95% CI: [1.51, 5.45]). In addition to the above associators, a higher rate of dental referrals for high caries-risk children was associated with having a dental department in the same work institute (aOR: 1.72, 95% CI: [1.09, 2.70] and having more confidence in their dental knowledge (aOR: 1.29, 95% CI: [1.04, 1.61]).

Conclusion

Paediatric PCPs commonly implement dental screening but perform fewer CRAs and dental referrals for high caries-risk children during systematic health management in western China. To increase CRA activities and dental referral by paediatric PCPs, health policymakers could encourage interdisciplinary cooperation between dental professionals and paediatric PCPs.

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Most cited references 37

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Oral diseases: a global public health challenge

Marco A. Peres, Lorna M D Macpherson, Robert J. Weyant … (2019)

Oral diseases are among the most prevalent diseases globally and have serious health and economic burdens, greatly reducing quality of life for those affected. The most prevalent and consequential oral diseases globally are dental caries (tooth decay), periodontal disease, tooth loss, and cancers of the lips and oral cavity. In this first of two papers in a Series on oral health, we describe the scope of the global oral disease epidemic, its origins in terms of social and commercial determinants, and its costs in terms of population wellbeing and societal impact. Although oral diseases are largely preventable, they persist with high prevalence, reflecting widespread social and economic inequalities and inadequate funding for prevention and treatment, particularly in low-income and middle-income countries (LMICs). As with most non-communicable diseases (NCDs), oral conditions are chronic and strongly socially patterned. Children living in poverty, socially marginalised groups, and older people are the most affected by oral diseases, and have poor access to dental care. In many LMICs, oral diseases remain largely untreated because the treatment costs exceed available resources. The personal consequences of chronic untreated oral diseases are often severe and can include unremitting pain, sepsis, reduced quality of life, lost school days, disruption to family life, and decreased work productivity. The costs of treating oral diseases impose large economic burdens to families and health-care systems. Oral diseases are undoubtedly a global public health problem, with particular concern over their rising prevalence in many LMICs linked to wider social, economic, and commercial changes. By describing the extent and consequences of oral diseases, their social and commercial determinants, and their ongoing neglect in global health policy, we aim to highlight the urgent need to address oral diseases among other NCDs as a global health priority.

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Early Childhood Caries: Prevalence, Risk Factors, and Prevention

Sukumaran Anil, Pradeep Anand (2017)

Early childhood caries (ECC) is major oral health problem, mainly in socially disadvantaged populations. ECC affects infants and preschool children worldwide. The prevalence of ECC differs according to the group examined, and a prevalence of up to 85% has been reported for disadvantaged groups. ECC is the presence of one or more decayed, missing, or filled primary teeth in children aged 71 months (5 years) or younger. It begins with white-spot lesions in the upper primary incisors along the margin of the gingiva. If the disease continues, caries can progress, leading to complete destruction of the crown. The main risk factors in the development of ECC can be categorized as microbiological, dietary, and environmental risk factors. Even though it is largely a preventable condition, ECC remains one of the most common childhood diseases. The major contributing factors for the for the high prevalence of ECC are improper feeding practices, familial socioeconomic background, lack of parental education, and lack of access to dental care. Oral health plays an important role in children to maintain the oral functions and is required for eating, speech development, and a positive self-image. The review will focus on the prevalence, risk factors, and preventive strategies and the management of ECC.

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Integrating the common risk factor approach into a social determinants framework.

Richard G. Watt, Aubrey Sheiham (2012)

The common risk factor approach (CRFA) has been highly influential in integrating oral health into general health improvement strategies. However, dental policy makers and oral health promoters have interpreted the CRFA too narrowly. They have focussed too heavily on the common behavioural risks, rather than on the broader shared social determinants of chronic diseases. A behavioural preventive approach alone will have minimal impact in tackling oral health inequalities and indeed may widen inequalities across the population. Based on recent WHO policy recommendations, this study presents the case for updating the CRFA in accordance with the social determinants agenda. The theoretical basis for a social determinants framework for oral health inequalities is presented, and implications for oral health improvement strategies are highlighted. Future action to address oral health inequalities in middle- and high-income countries requires a radical policy reorientation towards tackling the structural and environmental determinants of chronic diseases. In more equal and fairer societies, all sections of the social hierarchy experience better health and social well-being. © 2012 John Wiley & Sons A/S.

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Author and article information

Journal

Journal ID (nlm-ta): Risk Manag Healthc Policy

Journal ID (iso-abbrev): Risk Manag Healthc Policy

Journal ID (publisher-id): rmhp

Title: Risk Management and Healthcare Policy

Publisher: Dove

ISSN (Electronic): 1179-1594

Publication date (Electronic): 03 September 2022

Publication date Collection: 2022

Volume: 15

Pages: 1641-1650

Affiliations

[1 ]West China School of Public Health and West China Fourth Hospital, Sichuan University , Chengdu, People’s Republic of China

[2 ]HEOA Group, Institute for Healthy Cities and West China Research Center for Rural Health Development, Sichuan University , Chengdu, People’s Republic of China

[3 ]Institute of Hospital Management, West China Hospital, Sichuan University , Chengdu, People’s Republic of China

[4 ]Department of Health Services Administration, the University of Alabama at Birmingham , Birmingham, AL, USA

[5 ]Department of Maternity and Child Health Management, Sichuan Provincial Maternity and Child Health Care Hospital , Chengdu, People’s Republic of China

[6 ]Department of Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University , Chengdu, People’s Republic of China

[7 ]State Key Laboratory of Oral Diseases & National Clinical Research, Sichuan University , Chengdu, People’s Republic of China

Author notes

Correspondence: Xing Qu, Institute of Hospital Management, West China Hospital, Sichuan University , No. 37 Guoxue Lane, Chengdu, 610041, People’s Republic of China, +86 13880713452, Email qvxing@163.com

Author information

Xing Qu http://orcid.org/0000-0002-7696-7192

Article

Publisher ID: 362004

DOI: 10.2147/RMHP.S362004

PMC ID: 9450904

PubMed ID: 36092548

SO-VID: 5c0783c2-70af-4351-aa34-60aa940df717

License:

This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

History

Date received : 17 February 2022

Date accepted : 08 August 2022

Page count

Figures: 0, Tables: 6, References: 45, Pages: 10

Funding

Funded by: the National Natural Science Foundation of China;

Funded by: the National Social Science Fund of China;

This study was supported by the National Natural Science Foundation of China (No. 71904136) and the National Social Science Fund of China (Grant No. 21ZDA104). The funding organizations had no role in the study design, implementation, analysis or interpretation of the data.

Caries Risk Assessment and Dental Referral by Paediatric Primary Care Physicians in Sichuan Province, China: A Cross-Sectional Study

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Most cited references 37

Oral diseases: a global public health challenge

Early Childhood Caries: Prevalence, Risk Factors, and Prevention

Integrating the common risk factor approach into a social determinants framework.

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