title: Barriers to pediatricians' adherence to American Academy of Pediatrics oral health referral guidelines: North Carolina general dentists' opinions.
abstract: OBJECTIVE
  The purposes of this study were to: (1) assess knowledge, attitudes, and behaviors of North Carolina general dentists (GDs) regarding American Academy of Pediatrics (AAP) dental referral guidelines; and (2) determine factors that influence pediatricians' ability to comply with AAP guidelines.
  
  
  METHODS
  One thousand GDs were surveyed to determine barriers toward acceptance of physician referrals of infants and toddlers. The primary outcome using ordered logistic regression was GDs' acceptance of children described in five case scenarios, with different levels of risk and oral health status.
  
  
  RESULTS
  GDs believed pediatricians should refer patients at risk for caries to a dentist. While 61 to 75 percent of GDs were willing to accept low caries risk referrals of infants and toddlers, only 35 percent would accept referrals when caries was present. Predictors of referral acceptance were correct knowledge about AAP guidelines (OR=2.0, 95%CI=1.2-3.3), confidence in providing preventive care to infants and toddlers (OR=2.6, 95%CI=1.3-4.9), and agreement that parents see importance in dental referrals (OR=2.1, 95% CI=1.2-3.6).
  
  
  CONCLUSIONS
  This study identified factors influencing acceptance of pediatrician referrals for the age one dental visit among North Carolina GDs and highlighted challenges pediatricians face in referring young children for dental care.
authors.affiliation: Pediatric dentist in Charlotte, N.C., USA. mlong819@gmail.com.
authors.forename: C Marshall
authors.initials: CM
authors.lastname: Long
authors.affiliation: University of North Carolina at Chapel Hill, Chapel Hill, N.C., USA.
authors.forename: Rocio B
authors.initials: RB
authors.lastname: Quinonez
authors.affiliation: Department of Pediatric Dentistry, School of Dentistry; at the University of North Carolina at Chapel Hill, Chapel Hill, N.C., USA.
authors.forename: R Gary
authors.initials: RG
authors.lastname: Rozier
authors.affiliation: Department of Health Policy and Management, Gillings School of Global Public Health; at the University of North Carolina at Chapel Hill, Chapel Hill, N.C., USA.
authors.forename: Ashley M
authors.initials: AM
authors.lastname: Kranz
authors.affiliation: Department of Dental Research; at the University of North Carolina at Chapel Hill, Chapel Hill, N.C., USA.
authors.forename: Jessica Y
authors.initials: JY
authors.lastname: Lee
mesh_terms: D001291:Attitude of Health Personnel; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D019140:Dental Care for Children / Q000523:psychology; D003731:Dental Caries / Q000628:therapy; D003733:Dental Caries Susceptibility; D003815:Dentists / Q000523:psychology*; D005260:Female; D005792:General Practice, Dental; D019983:Guideline Adherence; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006304:Health Status; D006801:Humans; D007223:Infant; D007400:Interprofessional Relations; D008297:Male; D009909:Oral Health; D010348:Patient Care Team; D010372:Pediatrics; D017410:Practice Guidelines as Topic; D012017:Referral and Consultation; D018570:Risk Assessment; D013022:South Carolina