Module 4: Anticipatory Guidance, Fluoride Varnish, and Referral

4.6 Referral to a Dentist

A primary medical care provider should refer a child to a dentist immediately if

  • The primary medical care provider observes non-cavitated white spot lesions or cavitated lesions.
  • The child is at moderate or high risk for dental caries.
  • A dental emergency is evident.

The ultimate goal of making a referral to a dentist is to establish a dental home for children at moderate or high risk for dental caries. A dental home is the ongoing relationship between the dentist and the patient, inclusive of all aspects of oral health delivered in a comprehensive, continuously accessible, coordinated, and family-centered way. AAP recommends that children determined to be at risk for development of dental caries or who fall into recognized risk groups be directed to establish a dental home 6 months after the first tooth erupts or by age 1 (whichever comes first).8

AAP has developed an oral health intervention algorithm that could prove helpful to the primary medical care provider who has conducted an oral health assessment and is interested in determining appropriate protocols for preventive treatment and referral to a dentist. Reproduced here, it provides guidance on more intensive fluoride exposure, dietary counseling, and oral hygiene instruction.9

Sometimes it may be difficult to locate a local dental practice, clinic, or federally qualified health center that accepts children enrolled in Medicaid. The Ohio Department of Health, Oral Health Program Web site provides information on finding a dentist. In situations where it is difficult or impossible for Healthchek primary medical care providers to identify a dentist, parents should be referred to the ODJFS county agency directory. The county office may have a list of dentists for parents to contact. If the child is enrolled in a Medicaid managed care plan, the parent or other primary caregiver should call that plan or go to the Medicaid Managed Care Enrollment Center Web site for information on available oral health care.