Primary Care

Thank you for being part of the effort to improve children's oral health in Maine. Start by learning about early childhood caries, then use the navigation menu to explore additional resources available through From the First Tooth.

Problem Statement

Early Childhood Caries, or tooth decay, is the most common chronic infectious disease among children in the United States. The prevalence of Early Childhood Caries in 2-year-old children is 11% and rapidly increases to 44% in 5-year-old children. Consequences of untreated decay include pain and infection, impaired speech, delays in learning, problems with eating, social development, and, potentially, reduced quality of life. Therefore, oral health is not isolated–it is connected to overall health. 

Multiple interrelated social and demographic factors — including income, race, parents’ access to dental care, and educational level — can affect children’s access to preventive dental care. For example, it is well documented that low-income children are only half as likely as middle- and high-income children to access preventive dental services, despite the higher occurrence of dental problems in this population. Low-income children are also two to three times more likely to suffer from untreated dental disease than their more affluent peers.

Adding to this issue, most Maine counties contain federally designated Dental Health Professional Shortage Areas. Unfortunately, U.S. populations with the greatest burden of dental caries are the least likely to have access to dental care.

Without access to regular preventive dental services, dental care for many children is postponed until the disease has to be treated in the operating room or symptoms such as toothaches and facial abscesses become so acute that care is sought in hospital emergency departments. The latter consequence of failed prevention is not only wasteful and costly to the healthcare system, but it also rarely addresses the problem, as few emergency departments deliver comprehensive dental services.

Pediatric primary care providers often see children for well-child visits more than six times in their first year of life, before they ever see a dentist. As a result, these early and frequent visits provide a valuable opportunity to deliver preventive oral health services within the medical home. 

By incorporating oral health services, such as risk assessments and fluoride varnish applications, into your work, you can support children's lifelong oral health and overall well-being.

Provider Guidance

Dental Caries

The Pediatric Specialty Guidelines for Dental Caries describes the management and potential referral for children with dental caries and the timing of the referral. The video presents a dialogue with a pediatrician and pediatric dentists that walks through the referral guidelines for early childhood caries for primary care providers and expands upon a few specific cases.

• Dental Caries: Primary Teeth Referral Guideline – PDF
• Dental Caries: Permanent Teeth Referral Guideline – PDF
• Dental Caries: Permanent Teeth – Video

Dental Trauma

The Pediatric Specialty Guidelines for Dental Trauma discusses the management and referral for children with dental injuries as well as the timing of referrals. The video presents a dialogue with a pediatrician and pediatric dentist that walks through the referral guidelines for primary care providers and expands upon a few specific cases.

• Dental Trauma: Primary Teeth Referral Guideline – PDF
• Dental Trauma: Permanent Teeth Referral Guideline – PDF
• Dental Trauma in Pediatric Care – Video