Predictors and effectiveness of dental referrals by primary care physicians

Objective: More than 400 pediatric primary care practitioners in North Carolina (NC) currently provide risk assessments for Early Childhood Caries (ECC) and referrals to dentists as part of a preventive dental program known as “Into the Mouths of Babes” (IMB). This study evaluated the predictors of dental referrals by physicians and the effectiveness of referrals in promoting dental use among these children.

Methods: NC Medicaid claims for children who received IMB services during 2001 and 2002 were linked with physician-completed dental risk assessments (Encounter Forms, EFs). The EFs included information on physician-identified ECC and whether the child was referred to a dentist. We examined child- and provider-level predictors of a dental referral using hierarchical logistic regression and time to use of dental care subsequent to an IMB visit using Cox regression.

Results: Of 24,403 children in the study, about 5% had ECC, 2.8% received a dental referral and 3.5% made a dental visit before 42 months of age. Among children with ECC, 32% were referred, and a higher percentage of children with a referral visited a dentist (35.6%) than those not referred (12.0%). In the hierarchical model, children with ECC (vs. No ECC) and those seen in practices in non-metro (vs. metro) counties were more likely to be referred. The number of children in the practice with ECC in the past three months and availability of general dentists in metro counties predicted practice-level likelihood of referral. In the Cox model, the interaction effect of those with ECC and a referral (vs. no ECC and no referral), increasing age of child, availability of a general dentist in the county and having a dental visit prior to the first IMB visit were associated with shorter times to a dental visit.

Conclusion: Physicians' referrals increased access to dentists for children with ECC by almost three-fold, but use for those needing care remained low. Future research needs to examine system- and process-level strategies to improve physicians' referral practices and outcomes. Supported by NIDCR #R03 DE017350.