Knowledge, attitude, willingness and readiness of primary health care providers to provide oral health services to children in Niagara, Ontario: a cross-sectional survey

Sonica Singhal; Rafael Figueiredo; Sandy Dupuis; Rachel Skellet; Tara Wincott; Carolyn Dyer; Andrea Feller; Carlos Quiñonez

doi:10.9778/cmajo.20160012

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Table 1: Participant characteristics

Practice characteristics	Family physicians, no. (%) n = 164	Pediatricians, no. (%) n = 17
Years of practice
< 10	34 (20.8)	3 (17.6)
10-19	37 (22.5)	4 (23.5)
≥ 20	93 (56.7)	10 (58.8)
Type of practice
Solo	45 (27.6)	16 (94.1)
Group	118 (72.4)	1 (5.9)
Model of primary practice (can be more than 1)*
Comprehensive care model	5 (3.0)	7 (41.2)
Community health centre	4 (2.4)	0 (0.0)
Family health group	46 (28.0)	1 (5.9)
Family health organization	57 (34.8)	0 (0.0)
Family health network	9 (5.5)	0 (0.0)
Family health team	43 (26.2)	0 (0.0)
Other	15 (9.1)	8 (47.1)
Type of staff in office*
Nurse	94 (58.0)	4 (25.0)
Nurse practitioner	53 (32.7)	1 (6.3)
Physician assistant	11 (6.8)	0 (0.0)
Office manager	99 (61.1)	5 (31.3)
Administrative staff	153 (94.4)	13 (81.3)
Other	54 (33.3)	3 (18.8)

*Number may add to more than total and percentages may add up to more than 100 because participants were allowed to select more than 1 response.

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Table 2: Knowledge about early childhood caries*, community water fluoridation, and topical fluorides

Knowledge item	Family physicians agree or strongly agree, no. (%)† n = 164	Pediatricians agree or strongly agree, no. (%)† n = 17
Knowledge about early childhood caries
Untreated tooth decay could affect the general health of a child	163/163 (100.0)	15/16 (93.8)
Parents should brush their young children's teeth twice a day	161/164 (98.2)	16/16 (100.0)
The first signs of tooth decay are white spots or lines on the tooth surfaces	54/161 (33.5)	8/16 (50.0)
Baby teeth are important even though they fall out	155/161 (96.3)	16/16 (100.0)
Children should have 3 meals and 2-3 snacks per day	149/162 (92.0)	14/16 (87.5)
Parents should limit juice to 4-6 oz/d	143/162 (88.3)	14/16 (87.5)
I feel confident enough to identify tooth decay in children	95/164 (57.9)	13/16 (81.3)
I feel knowledgeable enough to discuss and counsel parents and caregivers regarding their children's dental hygiene	115 /161 (71.4)	13/16 (81.3)
Knowledge about community water fluoridation and topical fluorides
Community water fluoridation is important for preventing tooth decay	145/164 (88.4)	15/16 (93.8)
Topical fluoride therapies are important for preventing tooth decay	125/161 (77.6)	15/16 (93.8)
Awareness of community water fluoridation
Water supplies in the Niagara region are not fluoridated	76/161 (47.2)	11/17 (64.7)

*Defined as the presence of 1 or more decayed, missing (due to caries) or filled tooth surfaces in any primary tooth in a child between birth and 71 months of age.

†Nonrespondents are not included in denominator when calculating percentages.

‡For each question, number of nonrespondents (physicians and pediatricians) vary.

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Table 3: Preventive oral health care practices in medical settings

As part of your well child visits for children 5 years of age or younger, do you:	No. (%)*
	Never	1%-50% patients	> 50% patients
Family physicians
Visually examine the oral cavity? (n = 158)	5 (3.2)	26 (16.5)	127 (80.3)
Visually examine the teeth? (n = 159)	9 (5.7)	51 (32.1)	99 (62.3)
Determine the child's risk for developing tooth decay? (n = 156)	37 (23.7)	63 (40.3)	56 (35.9)
Advise parents or caregivers on tooth cleaning methods? (n = 156)	32 (20.5)	62 (39.8)	62 (39.8)
Advise parents or caregivers on the use of bottles or sippy cups? (n = 158)	15 (9.5)	38 (24.1)	105 (66.5)
Advise parents or caregivers on the use of fluoride toothpaste? (n = 157)	41 (26.1)	37 (23.6)	79 (50.3)
Prescribe fluoride supplements? (n = 156)	121 (77.6)	25 (16.0)	10 (6.4)
Pediatricians
Visually examine the oral cavity? (n = 16)	2 (12.5)	1 (6.3)	13 (81.3)
Visually examine the teeth? (n = 16)	3 (18.8)	2 (12.5)	11 (68.8)
Determine the child's risk for developing tooth decay? (n = 16)	4 (25.0)	0 (0.0)	12 (75.0)
Advise parents or caregivers on tooth cleaning methods? (n = 16)	3 (18.8)	7 (43.7)	6 (37.5)
Advise parents or caregivers on the use of bottles or sippy cups? (n = 16)	3 (18.8)	1 (6.3)	12 (75.0)
Advise parents or caregivers on the use of fluoride toothpaste? (n = 16)	3 (18.8)	5 (31.2)	8 (50.0)
Prescribe fluoride supplements? (n = 16)	11 (68.8)	4 (25.0)	1 (6.2)

*Nonrespondents are not included in denominator when calculating percentages.

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Table 4: Willingness to preform preventive oral health care activities

Health measure	Willingness to preform, no. (%)
Health measure	1 (most willing)	2	3	4	5 (least willing)
Physicians
Lift the child's top lip to check for tooth decay (n =162)	112 (69.1)	27 (16.7)	16 (9.9)	6 (3.7)	1 (0.6)
Advise parents or caregivers regarding prevention measures for tooth decay (e.g. tooth brushing) (n = 162)	120 (74.1)	23 (14.2)	14 (8.6)	4 (2.5)	1 (0.6)
Formally refer suspected cases of tooth decay to dental professionals (n = 156)	72 (46.2)	35 (22.4)	30 (19.2)	10 (6.4)	9 (5.8)
Obtain more education about prevention measures for tooth decay (e.g. fluoride varnish) (n = 160)	66 (41.3)	43 (26.9)	27 (16.9)	11 (6.9)	13 (8.1)
Implement prevention measures for tooth decay (e.g., fluoride varnish) (n = 160)	48 (30.0)	26 (16.3)	30 (18.8)	23 (14.4)	33 (20.6)
Pediatricians
Lift the child's top lip to check for tooth decay (n = 15)	13 (81.3)	1 (6.3)	0 (0.0)	0 (0.0)	1 (12.5)
Advise parents or caregivers regarding prevention measures for tooth decay (e.g. tooth brushing) (n = 16)	14 (87.5)	0 (0.0)	0 (0.0)	0 (0.0)	2 (12.5)
Formally refer suspected cases of tooth decay to dental professionals (n = 16)	9 (56.3)	1 (6.3)	2 (12.5)	0 (0.0)	4 (25.0)
Obtain more education about prevention measures for tooth decay (e.g., fluoride varnish) (n = 16)	6 (37.5)	5 (31.3)	1 (6.3)	2 (12.5)	2 (12.5)
Implement prevention measures for tooth decay (e.g., fluoride varnish) (n = 16)	3 (18.8)	2 (12.5)	3 (18.8)	1 (6.3)	7 (43.8)

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Table 5: Steps family physicians and pediatricians take if they suspect a child has tooth decay

Steps taken (can be more than 1)*	Family physicians, no. (%) n = 163	Pediatricians, no. (%) n = 16
Advise the parent or caregiver to take the child to a dentist	145 (89.0)	16 (100.0)
Make a note in the medical chart	73 (44.8)	11 (68.8)
Give the parent or caregiver the name(s) of a dentist	39 (23.9)	8 (50.0)
Do not formally refer children to dentists	14 (8.6)	2 (12.5)
Have never seen a child with tooth decay	10 (6.1)	1 (6.3)
Make a formal referral to a dentist	10 (6.1)	0 (0.0)
Other	9 (5.5)	3 (18.8)

*Number for each category may add to more than total and percentages may add up to more than 100 because participants were allowed to select more than 1 response.

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Table 6: Reasons for not performing prevention measures aimed at dental problems

Perceived barriers to carry prevention measures (can be more than 1)*	Family physicians, no. (%) n = 161	Pediatricians, no. (%) n = 16
Lack of clinical time	106 (65.8)	10 (62.5)
Dentists should perform these activities	68 (42.2)	8 (50.0)
Lack of knowledge in identifying dental problems	84 (52.2)	4 (25.0)
Lack of office staff to assist in prevention measures	60 (37.3)	7 (43.8)
Lack of reimbursement	59 (36.6)	6 (37.5)
Lack of parent's or caregiver's perceived need for dental care	61 (37.9)	5 (31.3)
Infants and toddlers are too young and uncooperative for oral examinations	37 (23.0)	2 (12.5)
Other	16 (9.9)	2 (12.5)

*Number for each category may add to more than total and percentages may add up to more than 100 because participants were allowed to select more than 1 response.