Dental care considerations for young children.

Although the majority of America's children enjoy remarkably good oral health, a significant subset of low-income, minority, medically and developmentally compromised, and socially vulnerable children continue to suffer significant and consequential dental and oral disease. Most of this inequitably distributed disease burden is preventable through early and individualized preventive care. Yet the primary-care medical and dental workforce is ill-prepared to manage the oral health needs of young children. Demographic trends suggest that the problem of disparities in both oral health status and access to competent dental services will continue to worsen for young children. Impediments to improving the oral health of young children include barriers between medical and dental systems of care, paucity of private and safety-net facilities and providers in many areas where vulnerable children reside, and dysfunctional Medicaid insurance programs. Barriers are generated by parents, providers, payers, and systems of care as well as by the age-appropriate behaviors of young children. Vulnerable families often do not access the case management services and disease control information needed to effectively address their young children's needs. Approaches to improving the oral health of young children therefore include enhancing public education about oral health, the appropriateness of early and periodic dental care, and primary prevention. Improvements in workforce numbers, distribution, diversity, and competency are needed. Attention to delivery systems and public insurance capacities are also necessary to effectuate improvements. HRSA's Title VII and VIII health professions training programs could potentially address may of these barriers and shortcomings. Training enhancements for predoctoral, postdoctoral, and graduate dentists and hygienists as well as for primary-care medical providers hold the key to marked improvements in the oral health of young children. Enhanced training of health care providers is the necessary if not sufficient condition to children whose daily life experiences are compromised by dental and oral diseases that are overwhelmingly preventable.