Pediatric and Adolescent Visits in the General Dentist Office

Objective: Examine communication and procedures in pediatric (P) and adolescent (A) visits to general dentist offices.

Methods: P/A visits (N=559) with either the dentist (251) or hygienist (308) were directly observed in 120 private offices. Using the Dental Davis Observation Code (DOC), 24 standard practitioner behaviors were recorded at 30-second intervals and visit services were documented. We compared the frequency of preventive service delivery by provider, visit services and patient characteristics.

Results: Dentist (DDS) patients were slightly older than hygienist (HYG) patients (11.2 yrs v. 10.3 yrs; p=.02). Restorations (43%), oral exams (37%), cleanings (17%), sealants (8%), and oral hygiene instruction (OHI, 8%) were the most common procedures in the DDS visit; HYG visits included cleanings (96%), fluoride treatments (69%), OHI (51%), and radiographs (39%). Pediatric patients (< 13 years old) received more comfort, feedback on their oral health, and fluoride treatments than teens. Discussions of tobacco use or diet were very infrequent. HYG asked patients to make a behavior change more often than DDS (63% vs. 17%), but there were no differences by patient age. During the HYG visits, dentists' provided oral counseling, health education and behavior change requests; a small percent of patients (28%) received these messages from both providers during their visit. At restorative visits, DDS provided counseling, behavior change requests or OHI to 16%, 13% and 1% of patients.

Conclusions: Approximately 18% of visits to private general dentists are with P/A patients. HYG provide the majority of preventive counseling during prophylaxis visits; DDS may miss opportunities to briefly counsel about self-care during restorative visits. Preventive messages are reinforced or supplemented by the dentist during some HYG visits, so that patients and/or parents receive an enhanced message. Joint HYG-DDS messages may have an untapped synergistic effect in promoting self-care. Supported by NIDCR 1R01DE15171.