HJAR Mar/Apr 2024

HEALTHCARE JOURNAL OF ARKANSAS I  MAR / APR 2024 59 Niki Carter, DMD, MPH Dental Director Delta Dental of Arkansas prevalence compared to higher income households. 16 It does not take a great leap to understand that oral health and overall health inequities and inequalities are fac- tors that can increase the risk of caries development. Oral health is vital to children’s overall health. Statistically, young children visit pediatricians or family practitioners more often than dentists, so it is essential these healthcare professionals promote and in- clude oral health in their health assess- ments. 17 Children cannot thrive, have dif- ficulty paying attention in school, and miss school days because of pain due to untreat- ed caries that have become symptomatic. According to the 2023 Annual Report of America’s Health Rankings, Arkansas ranks 48th in the nation, with Mississippi being 49th and Louisiana being the least overall healthy state. The number of dentists per 100,000 resident population for Arkansas is ranked 48th, and number of dental visits ranked 49th nationally. 18 The good news is that there are opportu- nities to improve, and there are many pre- vention tools available. Office opportunities for healthcare pro- viders include: • Incorporate oral health/caries risk as- sessments, whether you are a PCP or dentist. • Refer children to the dentist if they do not have a dental home. • Recommend using fluoridated tooth- paste to your patients. • Apply fluoride varnish in your office. • Recommend OTC fluoride rinse. • Prescribe fluoride supplements when appropriate for children living in non- fluoridated water communities. • Apply silver diamine fluoride when ap- plicable to arrest caries. Silver diamine fluoride (SDF) is a liquid snacking, and special healthcare needs. Research has shown that children with mothers or primary caregivers who have had active decay in the past year have a greater risk to develop caries. 10 Children who drink soda, juice, or other sugary liq- uids have an increased risk of caries. The increased intake of these types of liquids or snacking on sweets or refined carbohy- drates allows the time it takes for acid to be produced if teeth are not cleansed by water, saliva, or proper oral hygiene. Special needs patients are also at an in- creased risk for caries for multiple reasons. 11 These patients often have xerostomia due to medication use, asthma, allergies, or salivary dysfunction. 12 Oral hygiene can be difficult due to cooperation from the patient, or the caregiver cannot perform the proper oral hygiene. Seizures, gastroesophageal reflux disease, vomiting, attention deficit, gingival hyperplasia, and overcrowding teeth can make oral hygiene challenging. Often, the pediatric dentist is required to treat this spe- cial population of patients. In dentistry, there are numerous types of caries risk assessments. Those from the American Dental Association (ADA) and the American Academy of Pediatric Dentistry (AAPD) are the most commonly used by offices and can be downloaded from their websites. 13,14 However, there is not one as- sessment that can be ruled as the best thera- peutic measure for all patients, since the social determinants of health complicate the formula. 15 Social determinants of health have a huge impact on caries risk assessments. Income status, race, ethnicity, transportation, edu- cation level, and zip code have been shown by studies to predict oral health status, in- cluding caries risk. Household income lev- els below the federal poverty level have in- creased risk of poor oral health and caries • A focus on preventive strategies as op- posed to approaches that emphasize treatment of existing disease. • Consideration of workforce models that maximize efficiency. • Development of accurate surveil- lance systems to define the oral dis- ease burden. • The need to evaluate and monitor the concentration of fluoride in drinking water as an effective public health ap- proach to reduce caries in children. 6 Since caries is the most common chronic disease worldwide, it necessitates that there are measurements in place for assessing this disease. 7 In dentistry, a caries risk assess- ment is completed to determine a patient’s risk level for developing tooth decay. It can be compared to other types of health risk assessments. Although in medicine, these vary depending on if it is an overall health or specific health risk assessment, such as cardiovascular disease or diabetes. Health risk assessments ask a series of questions, and a caries risk assessment is no different. Questions for the patient, parent, or caregiver center around risk factors and take into account disease indicators, bio- logical risk factors, socioeconomic factors, and host protective factors. 8 There is also an examination and a recommendation for the action plan or treatment plan. The American Academy of Pediatrics (AAP) has developed their own oral health risk assessment tool to aid in the inclusion of oral health risk assessment during health visits to the pediatric physician. 9 The AAP recommends children receive an oral risk assessment at the 6- and 9-month visits. If the dental home has not been established, the risk assessment should be continued at the 12-, 18-, 24- and 30-month visits. 9 Ma- jor risk factors include maternal oral health, continual bottle or sippy cup use, frequent