title: Pediatricians' assessments of caries risk and need for a dental evaluation in preschool aged children.
abstract: BACKGROUND
  Risk-based prioritization of dental referrals during well-child visits might improve dental access for infants and toddlers. This study identifies pediatrician-assessed risk factors for early childhood caries (ECC) and their association with the need for a dentist's evaluation.
  
  
  METHODS
  A priority oral health risk assessment and referral tool (PORRT) for children < 36 months was developed collaboratively by physicians and dentists and used by 10 pediatricians during well-child visits. PORRT documented behavioral, clinical, and child health risks for ECC. Pediatricians also assessed overall ECC risk on an 11-point scale and determined the need for a dental evaluation. Logistic regression models calculated the odds for evaluation need for each risk factor and according to a 3-level risk classification.
  
  
  RESULTS
  In total 1,288 PORRT forms were completed; 6.8% of children were identified as needing a dentist evaluation. Behavioral risk factors were prevalent but not strong predictors of the need for an evaluation. The child's overall caries risk was the strongest predictor of the need for an evaluation. Cavitated (OR = 17.5; 95% CI = 8.08, 37.97) and non-cavitated (OR = 6.9; 95% CI = 4.47, 10.82) lesions were the strongest predictors when the caries risk scale was excluded from the analysis. Few patients (6.3%) were classified as high risk, but their probability of needing an evaluation was only 0.36.
  
  
  CONCLUSIONS
  Low referral rates for children with disease and prior to disease onset but at elevated risk, indicate interventions are needed to help improve the dental referral rates of physicians.
authors.affiliation: Department of Pediatric Dentistry, School of Dentistry, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: C Marshall
authors.initials: CM
authors.lastname: Long
authors.forename: Rocio B
authors.initials: RB
authors.lastname: Quinonez
authors.forename: Heather A
authors.initials: HA
authors.lastname: Beil
authors.forename: Kelly
authors.initials: K
authors.lastname: Close
authors.forename: Larry P
authors.initials: LP
authors.lastname: Myers
authors.forename: William F
authors.initials: WF
authors.lastname: Vann
authors.forename: R Gary
authors.initials: RG
authors.lastname: Rozier
mesh_terms: D057189:Checklist; D002675:Child, Preschool; D003661:Decision Support Techniques; D019140:Dental Care for Children; D003731:Dental Caries / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D016015:Logistic Models; D015999:Multivariate Analysis; D009657:North Carolina; D010372:Pediatrics; D010818:Practice Patterns, Physicians'; D012017:Referral and Consultation; D018570:Risk Assessment; D012307:Risk Factors