A new study has found that preventive dental visits can be an opportunity for dental care professionals to provide healthy weight intervention (HWI) to children (Journal of the American Dental Association, March 2009, Vol. 140:3, pp. 313-316).
"The dental setting already promotes the healthy eating message for the prevention of dental decay," said Mary Tavares, D.M.D., M.P.H., a senior clinical investigator at the Forsyth Institute and one of the study authors, in an interview with DrBicuspid.com. "In addition, the dental care delivery model calls for twice yearly visits as opposed to the medical model of once a year."
“It is becoming more important for the dental profession to consider the entire patient and his well-being.”
— Mary Tavares, D.M.D., M.P.H.
The study cites a 2003-2004 National Health and Nutrition Examination Survey that found that 18.8% of U.S. children ages 6 to 11 years were overweight and 37.2% were at risk of becoming overweight -- double the number 20 years ago.
These children have an increased risk of developing type 2 diabetes, sleep apnea, orthopedic complications, hypertension, and other cardiovascular risk factors, as well as negative psychological effects resulting from teasing and discrimination, the study authors note.
"It is becoming more important for the dental profession to consider the entire patient and his well-being," Dr. Tavares said. "The benefits have less to do with financial matters than with a positive perception by patients that the practice cares about more than its patients' teeth."
Dr. Tavares and her co-author, Virginia Chomitz, Ph.D., conducted a pilot study in Massachusetts to assess whether it would be feasible to introduce an intervention program promoting awareness of pediatric obesity risk and providing recommendations, goal-setting frameworks, and referrals as part of dental care visits.
They looked at 139 children ages 6 to 13 from two community dental clinics in Cambridge and Somerville. The children came in for two or three preventive visits over a period of 18 months. At each visit, a hygienist collected information about risk factors that could lead to obesity, including food, physical activity, screen time, and meal habits. Each child's height and weight were measured, and their body mass index (BMI) for-age percentile was calculated.
The information was put into a health report card with recommendations for healthy behavior modifications. The child then selected healthy living goals for the next six months. The hygienist recorded the length of the visit to calculate whether this process could easily be included into a typical preventive dental visit.
The researchers collected feedback about this program from the children's caregivers and the dental care providers. The caregivers were asked to fill out a questionnaire, while the dental team participated in a focus group.
After reviewing answers from the caregiver questionnaires, the researchers said the results were "encouraging." Nearly 95% of caregivers reported that they made better food choices for their children, nearly 80% said they had reduced television and video game time, and 71% said their child got more exercise.
The focus groups revealed that dentists and hygienists would be more likely to incorporate a healthy weight intervention if parents and families liked it, if a positive effect was seen on dental health and weight, and if it was cost-neutral.
"Overall, clinicians were enthusiastic about the HWI; most thought that it would be possible to implement and that their offices would consider it," the authors wrote.
Important considerations for any office are the time commitment involved and the equipment needs.
It will take approximately two to four months -- depending on the how often they do the healthy weight intervention -- for most hygienists to fit this protocol into their routine, Dr. Tavares said.
"So within a few months, no additional time will be needed," she said. "In fact, hygienists welcome the expansion of their roles." The focus groups with hygienists revealed that they were eager to take on the healthy weight intervention program, she added.
"We found that, by the six-month visit, the hygienists were able to perform all of their duties for the dental office visits, including the HWI, in less than 40 minutes," the authors wrote. "The dental staff members and providers who participated in the study thought that the HWI was important, and they were willing to make minor scheduling adjustments to accommodate it."
The only other requirements are a scale, something to measure height (such as a simple measuring strip tacked to the wall), and the cost to photocopy or print the forms, Dr. Tavares said.
"Our preliminary findings show that an HWI is feasible and is acceptable in pediatric dental care settings," the authors concluded. "Caregivers and dental care providers considered it to be useful, and it was well-accepted by the subjects."
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