BOSTON — Instituting an interdisciplinary evidence-based risk assessment model for dental caries management improved oral health care in the pediatric primary care setting, according to findings presented at the 2014 National Association of Pediatric Nurse Practitioners Annual Conference.

Among 120 patients seen at a pediatric primary care community health clinic during a 60 calendar day period, 90% of patients were stratified as at high risk for tooth decay using the Caries Management by Risk Assessment (CAMBRA) model, and 48% of these patients were referred for immediate dental interventions, Tatianna T. Ellsworth, RN, BSN, DNP candidate, of the University of San Diego’s Hahn School of Nursing and Health Science, reported during a poster session.

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Among those who received immediate dental recommendations, 60% scheduled a follow-up dental appointment and 32% attended the appointment, Ellsworth found.

Tooth decay is the most common chronic childhood disease, with about 40% of children developing visible caries by kindergarten, according to background information presented during the session. Although only 1.5% of children aged 2 years and younger see a dentist, 89% see a primary care health provider.

“The risk assessment tool was utilized to determine high, moderate and low risk patients at a community clinic in which our population was 83% Hispanic and 100% of our patients were high-risk Medicaid patients,” Ellsworth explained.

Minority children from low income families are at higher risk for poor oral health outcomes, attend fewer dental visits and receive fewer protective sealants, and only about one in five Medicaid patients receive preventive oral health services.

So Ellsworth and colleagues targeted children aged 0 to 3 years seen at the clinic with oral health assessments using the CAMBRA risk assessment tool.

The collaborative model involves pediatric clinicians, dentists and ancillary staff and consists of identifying caries disease indicators with a clinical exam, and weighing pathological versus protective factors to stratify children into one of four risk categories: low, medium, high or extreme.

“It’s like a mini dental session in the pediatric clinic,” Ellsworth said.

Interventions included caregiver counseling, anticipatory guidance, goal setting and age appropriate gum cleansing or tooth brush demonstrations despite a child’s risk classification.

“Low risk patients are those that are brushing their teeth every day, mom isn’t giving them any juice, the number of sweets are reduced and the family has good dental hygiene,” Ellsworth explained. “Moderate risk may be mom has a cavity, but still brushes her children’s teeth. High risk would be if the child still sleeps with a bottle at night.”

A high risk child will always be classified as such until behaviors are modified, she added. This is achieved using a visual goal form. Core goal recommendations include taking a child for a dentist visit by age 1 year, eliminating bottle use at night and encouraging introduction of a sippy cup at by age six months.

“We let parents pick the goals that they feel they can realistically accomplish and then at three months we reassess and determine if we want to pick new goals or continue working on the same ones,” she said. “Interdisciplinary, preventive oral health is an effective means of improving pediatric dental health and complementing existing dental services.”


  1. Ellsworth TT et al. #T19. “An Interdisciplinary Approach to Preventing and Managing Early Childhood Caries.” Presented at: 2014 National Association of Pediatric Nurse Practitioners Annual Conference. March 11-14, 2014; Boston.