Chronic Disease Management of Early Childhood Dental Caries: Practices of US Pediatric Dentists.

Introduction: Early childhood caries (ECC), dental cavities in children younger than 6 years, is common, consequential, and inequitably concentrated among socially disadvantaged children. The World Health Organization and authoritative clinical and public health agencies promote 4 chronic disease management (CDM) approaches that are low-cost and can be delivered in home and community sites: pharmacologic, behavioral, monitoring, and minimally invasive dentistry (MID). The extent of adoption of these approaches among US pediatric dentists is unknown. Methods: From November 2021 through July 2023, trained research staff members administered and videorecorded via Zoom a semistructured survey on ECC management to 1,639 clinically active pediatric dentists in the US, including 170 thought leaders (organizational and academic leaders). Data collected included treatment approaches, time allocated to counseling, and personal, practice, and patient population characteristics. Results: The survey response rate was 27.7%. Among CDM approaches, 88.7% cited pharmacologic approaches, 43.4% behavioral, 41.1% monitoring, and 39.3% MID approaches. MID was significantly associated with thought leaders and with more recent graduates engaged as associates in larger practices or in safety-net settings serving high volumes of low-income children and children with a history of caries. We noted fewer significant associations between other CDM approaches and the characteristics of dentists, practices, and populations served. CDM was not associated with the race or ethnicity of dentists or patients, the numbers of ancillary personnel in practice, or dental management organizations. One-third (32.4%) of respondents reported scheduling 5 or fewer minutes for counseling on caries. Conclusion: Except for pharmacologic treatments and despite professional guidelines, CDM approaches are underused. We posit that CDM approaches hold strong promise to enhance oral health equity as value-based care arrangements expand in dentistry.