Dental Home

Board takeaway

Early establishment and rationale

• Primary care referral may begin as early as 6 months, based on risk, and should occur by 12 months.
• Early contact creates an opportunity to prevent disease and improve family knowledge, particularly when early childhood caries risk is high.
• The model derives from the pediatric medical home; family participation supports better outcomes.
• Coordinate with medical providers, early intervention, child-care and education programs, schools, and community agencies to help establish and maintain access.
• Care should be safe, culturally responsive, compassionate, accessible, coordinated, continuous, and tailored to the patient. Identity, medical status, family structure, or finances should not determine eligibility.

What the dental home provides

• Assess oral diseases and conditions comprehensively; provide evidence-based preventive and acute care consistent with AAPD periodicity guidance.
• Build an individualized preventive program from caries and periodontal risk assessments; use risk to determine reappointment timing.
• Teach care of teeth, gingivae, and other oral structures, including prevention, diagnosis, and treatment of supporting-tissue disease and preservation of function and appearance.
• Counsel on diet and nutrition.
• Manage acute and chronic oral pain and infection.
• Treat acute dental trauma and provide long-term follow-up.
• Refer to specialists when needed care cannot be provided within the dental home.

Close the loop after the first visit

The family should leave with an explanation of findings, a prevention/treatment plan, the next visit or referral arrangement, and a way to obtain urgent care.

• When care moves outside the practice, coordinate the referral and continuing care.
• A screening, fluoride application, or teledentistry encounter can contribute to the dental home but does not alone establish its full scope.

Anticipatory guidance

• Oral hygiene; dental and facial growth/development; speech and language development.
• Nonnutritive habits; diet and nutrition; injury prevention.
• Tobacco/nicotine products, substance misuse, human papillomavirus vaccination, and oral/perioral piercings or jewelry.
• Tailor discussion to developmental stage and family needs.

Dentist direction and team supervision

• The dentist examines, diagnoses, and develops the treatment plan, including preventive services; care remains under dentist supervision.
• The model generally uses direct supervision of allied personnel: the dentist is physically present during care.
• Depending on state regulations, allied personnel may provide preventive education and services under general supervision after the supervising dentist's examination, diagnosis, and treatment plan.
• Community auxiliaries can support education and service coordination. Improved oral health literacy may reduce disease and later treatment needs.

Teledentistry and access

• Teledentistry extends a dental home's reach; it does not replace establishing one.
• Uses include time-sensitive trauma support, screening, consultation, caries triage/detection, treatment planning, education, referrals, and treatment monitoring.
• Consider it when finances, SHCN, workforce shortages, transportation, remote residence, or clinic closures impede access.

Transition to adult care

• Prepare early; coordinate communication between pediatric and adult teams to avoid interruption of comprehensive care.
• Select an adult provider comfortable with adult oral health needs and, when relevant, SHCN.
• Until the new home is established, patients may retain the current provider relationship and emergency access.
• If transition is not possible, the pediatric dentist may remain the dental home, with referral when treatment exceeds the practitioner's scope.

Evidence perspective

• The policy describes strong clinical evidence supporting early professional care combined with risk assessment, anticipatory guidance, and periodic supervision; it also cites reduced treatment burden and costs.
• Its literature review included systematic reviews and meta-analyses; expert opinion and current best practices filled evidence gaps. It supplies no formal recommendation grades or numerical effect estimates.

Common board traps

Answer aloud

When should a high-risk infant enter a dental home?

A high-risk infant may be referred as early as six months, and the dental home should be established by 12 months.

• Assess both caries and periodontal risk, provide caregiver counseling and an individualized preventive/treatment plan, and arrange continuing and urgent care.
• The first visit begins the relationship; continuing access and coordination make it a dental home.

How would you transition a young adult with SHCN?

Begin preparation early and identify an adult provider capable of meeting the patient's needs.

• Coordinate medical and dental teams, share relevant information, and maintain existing care and emergency access until the new dental home is established.
• If pediatric care continues because transfer is not feasible, refer treatment needs that exceed the pediatric dentist's scope.