Edelstein Burton L, Basch Charles E, Zybert Patricia, Wolf Randi L, Custodio-Lumsden Christie L, Levine June, Trent Raynika, Estrada Ivette, Koch Pamela A, Andrews Howard F, Kunzel Carol
Columbia University Irving Medical Center, New York, New York.
20 E Beach Rd, Richmond, MA 01201-8730 (
Prev Chronic Dis. 2025 Jan 2;22:E01. doi: 10.5888/pcd22.240151.
Early childhood caries (ECC), dental cavities in children younger than 6 years, is common, consequential, and inequitably concentrated among socially disadvantaged children. The World Health Organization and authoritative clinical and public health agencies promote 4 chronic disease management (CDM) approaches that are low-cost and can be delivered in home and community sites: pharmacologic, behavioral, monitoring, and minimally invasive dentistry (MID). The extent of adoption of these approaches among US pediatric dentists is unknown.
From November 2021 through July 2023, trained research staff members administered and videorecorded via Zoom a semistructured survey on ECC management to 1,639 clinically active pediatric dentists in the US, including 170 thought leaders (organizational and academic leaders). Data collected included treatment approaches, time allocated to counseling, and personal, practice, and patient population characteristics.
The survey response rate was 27.7%. Among CDM approaches, 88.7% cited pharmacologic approaches, 43.4% behavioral, 41.1% monitoring, and 39.3% MID approaches. MID was significantly associated with thought leaders and with more recent graduates engaged as associates in larger practices or in safety-net settings serving high volumes of low-income children and children with a history of caries. We noted fewer significant associations between other CDM approaches and the characteristics of dentists, practices, and populations served. CDM was not associated with the race or ethnicity of dentists or patients, the numbers of ancillary personnel in practice, or dental management organizations. One-third (32.4%) of respondents reported scheduling 5 or fewer minutes for counseling on caries.
Except for pharmacologic treatments and despite professional guidelines, CDM approaches are underused. We posit that CDM approaches hold strong promise to enhance oral health equity as value-based care arrangements expand in dentistry.
幼儿龋齿（ECC）是指6岁以下儿童出现的龋齿，这种情况很常见，会产生不良后果，并且不公平地集中在社会经济弱势儿童中。世界卫生组织以及权威的临床和公共卫生机构推广了4种低成本的慢性病管理（CDM）方法，这些方法可以在家庭和社区场所实施：药物治疗、行为干预、监测以及微创牙科（MID）。美国儿科牙医采用这些方法的程度尚不清楚。
从2021年11月到2023年7月，经过培训的研究人员通过Zoom对美国1639名临床执业的儿科牙医进行了关于ECC管理的半结构化调查并录像，其中包括170名思想领袖（组织和学术领袖）。收集的数据包括治疗方法、用于咨询的时间以及个人、执业情况和患者群体特征。
调查回复率为27.7%。在CDM方法中，88.7%的人提到药物治疗方法，43.4%提到行为干预，41.1%提到监测，39.3%提到MID方法。MID与思想领袖以及在大型诊所或为大量低收入儿童和有龋齿病史儿童服务的安全网机构担任助理的应届毕业生显著相关。我们注意到其他CDM方法与牙医、诊所和服务人群的特征之间的显著关联较少。CDM与牙医或患者的种族或民族、诊所辅助人员数量或牙科管理组织无关。三分之一（32.4%）的受访者报告说安排了5分钟或更少时间用于龋齿咨询。
除了药物治疗外，尽管有专业指南，但CDM方法的使用不足。我们认为，随着牙科领域基于价值的护理安排不断扩大，CDM方法有望大力促进口腔健康公平。
