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Policy on the Dental Home

Purpose

The American Academy of Pediatric Dentistry (AAPD) supports the concept of a dental home for all infants, children, adolescents, and persons with special health care needs. The dental home is inclusive of all aspects of oral health that result from the interaction of the patient, parents, dentists, dental professionals, and nondental professionals. Establishment of the dental home is initiated by the identification and interaction of these individuals, resulting in a heightened awareness of all issues impacting the patient’s oral health.1  This concept is derived from the American Academy of Pediatrics’ (AAP) definition of a medical home which is an approach to providing comprehensive and high quality primary care and not a location or physical structure.2

Methods

This policy was developed by the Council on Clinical Affairs and adopted in 2001. This document is an update from the last revision in 2015. This policy is based on a review of the current dental and medical literature related to the establishment of a dental home. An electronic search was conducted using the terms: dental home, medical home in pediatrics, and infant oral health care; fields: all fields: limits: within the last 10 years, humans, English. Papers for review were chosen from this list and from references within selected articles. Expert opinions and best current practices were relied upon when clinical evidence was not available.

Background

The AAP issued a policy statement defining the medical home in 1992.3  Since that time, it has been shown that health care provided to patients in a medical home environment is more effective and less costly in comparison to emergency care facilities or hospitals.3-5  Strong clinical evidence exists for the efficacy of early professional dental care complemented with caries-risk and periodontal-risk assessment, anticipatory guidance, and periodic supervision.6 The establishment of a dental home follows the medical home model as a costeffective measure to reduce the financial burden and decrease the number of dental treatment procedures experienced by young children.7,8  It also serves as a higher quality health care alternative in orofacial emergency care situations.9

Children who have a dental home are more likely to receive appropriate preventive and routine oral health care, thereby improving families’ oral health knowledge and practices, especially in children at high risk for early childhood caries.6  Referral by the primary care physician or health provider has been recommended, based on risk assessment, as early as six months of age and no later than 12 months of age.10-12  Furthermore, subsequent periodicity of reappointment is based upon risk assessment. This provides time-critical opportunities to implement preventive health practices and reduce the child’s risk of preventable dental/oral disease.13

Policy Statement

The AAPD encourages parents and other care providers to help every child establish a dental home by 12 months of age. The AAPD recognizes a dental home should provide:

  • comprehensive, continuous, accessible, family-centered, coordinated, compassionate, and culturally-effective care for children, as modeled by the AAP.1,14 
  • comprehensive evidence-base oral health care including acute care and preventive services in accordance with AAPD periodicity schedules.1,15
  • comprehensive assessment for oral diseases and conditions.
  • individualized preventive dental health program based upon a caries-risk assessment16 and a periodontal disease risk assessment12.
  • anticipatory guidance regarding growth and dev- elopment.15 
  • management of acute/chronic oral pain and infection. 
  • management of and long-term follow-up for acute dental trauma.17-19 
  • information about proper care of the child’s teeth and gingivae, and other oral structures. This would include the prevention, diagnosis, and treatment of disease of the supporting and surrounding tissues and the maintenance of health, function, and esthetics of those structures and tissues.20
  • dietary counseling.21
  • referrals to dental specialists when care cannot directly be provided within the dental home. 
  •  education regarding future referral to a dentist knowl- edgeable and comfortable with adult oral health issues for continuing oral health care.
  • recommendations and coordination of uninter- rupted comprehensive oral health care during the transition from adolescence to adulthood.14,22
  • referral, at an age determined by patient, parent, and pediatric dentist, to a dentist knowledgeable and comfortable with managing adult oral health care needs.

The AAPD advocates interaction with early intervention programs, schools, early childhood education and child care programs, members of the medical and dental communities, and other public and private community agencies to ensure awareness of age-specific oral health issues.23

References

  1. American Academy of Pediatric Dentistry. Definition of dental home. Pediatr Dent 2018;40(6):12.
  2. American Academy of Pediatrics. The medical home. Pediatrics 2002;110(1Pt1):184-6.
  3. American Academy of Pediatrics Ad Hoc Task Force on the Definition of the Medical Home. The medical home. Pediatrics 1992;90(5):774.
  4. American Academy of Pediatrics Council on Children with Disabilities. Care coordination: Integrating health and related systems of care for children with special health care needs. Pediatrics 2005;116(5):1238-44.
  5. Klitzner TS, Rabbitt LA, Chang RK. Benefits of care coordination for children with complex disease: A pilot medical home project in a resident teaching clinic. J Pediatr 2010;156(6):1006-10.
  6. Thompson CL, McCann AL, Schneiderman ED. Does the Texas First Dental Home program improve parental oral care knowledge and practices? Pediatr Dent 2017;39(2):124-9.
  7. Nowak AJ, Casamassimo PS, Scott J, Moulton R. Do early dental visits reduce treatment and treatment costs for children? Pediatr Dent 2014;36(7):489-93.
  8. Kolstad C, Zavras A, Yoon R. Cost-benefit analysis of the age one dental visit for the privately insured. Pediatr Dent 2015;37(4):376-80.
  9. Allareddy V, Nalliah RP, Haque M, Johnson H, Tech SRB, Lee MK. Hospital-based emergency department visits with dental conditions among children in the United States: Nationwide epidemiological data. Pediatr Dent 2014;36(5):393-9.
  10. Nowak AJ, Casamassimo PS. The dental home: A primary oral health concept. J Am Dent Assoc 2002;133(1):93-8.
  11. Casamassimo P, Holt K, eds. Bright Futures in Practice: Oral Health. Pocket Guide, 2nd ed. Washington, D.C.: National Maternal and Child Oral Health Resource Center; 2014.
  12. American Academy of Periodontology. Periodontal diseases of children and adolescents. J Periodontol 2003;74(11):1696-704.
  13. U.S. Department of Health and Human Services. Healthy People 2020: Oral health of children and adolescents. Available at: “http://www.healthypeople.gov/2020/topics-objectives/topic/oral-health/objectives”. Accessed March 16, 2018.
  14. American Academy of Pediatrics. Preamble to patientcentered medical home joint principles 2007. Available at: “https://www.aap.org/en-us/professional-resources/quality-improvement/_layouts/15/WopiFrame.aspx?sourcedoc=/en-us/professional-resources/
    qualityimprovement/Documents/Preamble-Patient-CenteredPrinciples.doc&action=default”. Accessed March 1, 2018. (Archived by WebCite® at: “http://www.webcitation.org/6uEP86IxA”)
  15. American Academy of Pediatric Dentistry. Periodicity of examination, preventive dental services, anticipatory guidance/counseling, and oral treatment for infants, children, and adolescents. Pediatr Dent 2018;40(6):194-204.
  16. American Academy of Pediatric Dentistry. Caries-risk assessment and management for infants, children, and adolescents. Pediatr Dent 2018;40(6):205-12.
  17. Diangelis AJ, Andreasen JO, Ebeleseder KA, et al. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 1. Fractures and luxations of permanent teeth. Dental Traumatol 2012;28(1):2-12. Erratum. Dental Traumatol 2012;28(6):499.
  18. Andersson L, Andreasen JO, Day P, et al. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 2. Avulsion of permanent teeth. Dental Traumatol 2012;28(2):88-96. 
  19. Malmgren B, Andreasen JO, Flores MT, et al. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 3. Injuries in the primary dentition. Dental Traumatol 2012; 28(3):174-82.
  20. American Academy of Pediatric Dentistry. Policy on early childhood caries: Classifications, consequences and preventive strategies. Pediatr Dent 2018;40(6):60-2.
  21. American Academy of Pediatric Dentistry. Policy on dietary recommendations for infants, children and adolescents. Pediatr Dent 2018;40(6):65-67.
  22. American Academy of Pediatric Dentistry. Policy on transitioning from a pediatric-centered to an adultcentered dental home for individuals with special health care needs. Pediatr Dent 2018;40(6):131-4.
  23. American Academy of Pediatric Dentistry. Dental home resource center. Available at: “http://www.aapd.org/advocacy/dentalhome/”. Accessed March 16, 2018. (Archived by WebCite® at: “http://www.webcitation.org/722MEzKg7”)