Open Access Open Badges Research article

Pediatricians’ assessments of caries risk and need for a dental evaluation in preschool aged children

C Marshall Long1, Rocio B Quinonez1*, Heather A Beil2, Kelly Close3, Larry P Myers34, William F Vann1 and R Gary Rozier5

Author Affiliations

1 Department of Pediatric Dentistry, School of Dentistry, University of North Carolina, Chapel Hill, NC, USA

2 School of Nursing, University of North Carolina, Chapel Hill, NC, USA

3 North Carolina Department of Health and Human Services, Division of Public Health, Oral Health Section, Raleigh, NC, USA

4 North Carolina Department of Health and Human Services, Division of Medical Assistance, Raleigh, NC, USA

5 Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA

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BMC Pediatrics 2012, 12:49  doi:10.1186/1471-2431-12-49

Published: 4 May 2012



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.


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.


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.


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.