Figure 1. Analytic Framework for the Physician's Role in Caries Prevention in Preschool Children (Text Description)

Figure 1 provides a diagram of the analytic framework, which outlines general types of interventions provided by primary care clinicians that are appropriate to children between birth and 5 years of age. It begins on the left with "physician office visit for child 0 to 5 years of age" and ends on the right with "dental caries outcomes."

The physician performs an oral screening for suspected disease and risk assessment. (Key question [KQ] 1 a and b: How accurate is screening by the primary care clinician in identifying children aged from birth to 5 years who a) have dental caries requiring referral to a dentist? or b) are at elevated risk for future dental caries?)

A footnote describes screening for suspected disease as visually identifying one or more cavitated lesions or suspecting that such a condition is present. A second footnote defines "elevated risk" as "inadequate fluoride exposure, caries in siblings or parents, irregular brushing/plaque retention, white spots on smooth tooth surfaces, frequent/prolonged carbohydrate exposure, special needs/medical conditions that increase risk, or lower socioeconomic status."

On the basis of the results of the screening, the physician may refer a child with "suspected disease" to a dentist. (KQ 2: How effective is referral by the primary care clinician of children aged from birth to 5 years to dentists in terms of the proportion of referred children making a dental visit?)

If a child has inadequate exposure to fluoride, a supplemental fluoride prescription is a possible intervention. (KQ 3 a, b, c: How effective is the prescription of dietary supplemental fluoride by the primary care clinician in terms of a) appropriateness of supplementation decision? b) parental adherence to the dosage regimen? c) prevention of dental caries?)

The physician may also apply a topical fluoride. (KQ 4 a, b, c: How effective is application of fluoride by the primary care clinician in terms of a) appropriateness of application decision? b) achieving parental agreement for the application? and c) prevention of dental caries?

Or the physician may undertake parental counseling for caries preventive behaviors. (KQ 5 a, b: How effective is counseling by the primary care clinician for caries preventive barriers as measured by a) adherence to the desired behavior and b) prevention of dental caries.

If no disease or risk factors are identified, the physician may counsel parents for reasons that include health promotion and parental education This arm and the outcomes of treatment by dental professionals are shown in Figure 1 by dotted lines, indicating that they are not evaluated in this review.

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