Preventive oral health services and caries risk assessment of young children by non-dental healthcare providers: a scoping review
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Background
Early childhood caries (ECC) remains a significant global public health concern, disproportionately affecting vulnerable and underserved populations. Integrating oral health services into primary care particularly through non-dental primary care providers (NDPCPs) offers a promising strategy for early identification and prevention. However, the extent and characteristics of such integration across global health systems remain unclear.
Objectives
This scoping review aimed to map the available evidence on preventive oral health services (POHS) and caries risk assessment (CRA) delivered to children under six years of age by NDPCPs. Specifically, it addressed (1) the types and characteristics of POHS and CRA provided, and (2) how commonly these services are implemented in pediatric primary care settings.
Methods
The review followed the Joanna Briggs Institute (JBI) Scoping Review Framework. A comprehensive search of four databases, MEDLINE, EMBASE, CINAHL, and Web of Science was conducted for English-language studies published between 2009 and 2024. Eligible studies included primary research on CRA, fluoride varnish application, dental referrals, or oral health promotion delivered by NDPCPs (e.g., physicians, nurses, dietitians) to children under six. A total of 54 studies met the inclusion criteria and were charted, summarized, and analyzed narratively.
Results
Most studies (83%) were conducted in the United States, with additional representation from Australia, the United Kingdom, Europe, and limited low– and middle-income countries (LMIC) settings. Interventions were delivered by a wide range of NDPCPs including physicians, nurse practitioners, and health visitors, often during well-child visits. Common interventions included oral health education, CRA using structured tools, fluoride varnish application, and dental referrals. Several studies reported improved service uptake following provider training, electronic medical record (EMR) integration, or Medicaid reimbursement policies. Despite evidence of effectiveness and feasibility, no eligible studies were identified from e.g. Canada, highlighting a critical implementation gap.
Conclusions
NDPCPs play an important and increasingly well-supported role in the delivery of POHS to young children. This review underscores the need for policy frameworks such as reimbursement mechanisms and interprofessional training to support oral health integration into primary care. Canada may benefit from adopting system-level policies to enable and evaluate CRA and POHS in primary care, especially for underserved and Indigenous populations.
