Introduction

Pediatricians are the first medical professionals who will examine the new born and continue to be responsible for general health up to adolescence. Pediatricians need knowledge and skill in addressing children's ^{oral health because of the prevalence of dental disease, which would enable early detection, referral and intervention for the children needing dental care. Early professional intervention can substantially reduce or totally eliminate the effects of oral disease (1). There is a limited amount of oral health subject matter and importance in the medical education ,therefore pediatricians need to be updated about the oral health care needs of the children(2). Pediatricians are in a unique position to contribute to the oral health of their young patients and parents would follow their recommendations (3).}

Early intervention provides the opportunity to educate parents in many areas such as good oral hygiene, establishing proper feeding habits, prevention of nursing caries and dental injuries (4).

The importance of prevention, diagnosis and treatment is necessary to restore and maintain the oral health of infants, children and adolescents and it can never be overemphasized. Comprehensive health care cannot be achieved unless dental care is a strong priority in all health service programs (5). ^{Pediatric visits present crucial opportunities to counsel families, identify high-risk children, initiate timely dental referrals and ensure delivery of preventive interventions. As with immunizations, pediatricians can help construct the first lines of defense against oral disease.}

Considering all these aspects, a study was conducted in New Delhi (India). The aim of the study was to assess pediatricians’ views about oral health care in the capital city of India.

Material and Methods

This study was designed as a telephone survey. Phone numbers were retrieved from the local classified lists. National Capital Territory of Delhi is divided into nine districts namely Central Delhi , North Delhi , South Delhi , East Delhi , North East Delhi , South West Delhi , New Delhi , North West Delhi , West Delhi . Fifteen pediatricians from each district were randomly selected .One week before the telephone survey began, identified practicing pediatricians were called up and study explained and an appointment for the interviews sought. The telephone survey was conducted between September 2010 and December 2010, and calls were made by interviewers who used a standardized questionnaire and simultaneously entered responses. Those who did not respond on the first day were requested to re- schedule the interview. At the end of the 4-month period, 89 of the135 selected physicians (65.92%) were successfully contacted and screened.

Results

Results are presented for the 89 pediatricians panning the National Capital Territory of Delhi who responded to the interview call answering all the questions. All the pediatricians agreed on importance of early prevention of oral disease.

Among the pediatricians interviewed 30 (33.70%)asked the patient to be taken to a dentist for a routine checkup ,whereas 59(66.26%) asked for a dental check up only in case the patient reported any dental problem. 42(47.19%) pediatricians knew about the availability of specialized branch of dentistry dealing with oral health care of children. 58(65.16%) pediatricians referred the patients to their respective family dentist with only 31(34.83%) asking the parents to take the child to a pediatric dentist.

During the interview , 16 (17.9%) of pediatricians recommended to start gum pad cleaning before the teeth appear by wiping the gum pads with a soft cloth, 64 (71.9%) began teeth brushing as soon as a tooth appeared, 2(2.2%) began after a few teeth appeared, and 7 (7.8 %) recommended beginning when a child can hold a tooth brush. 70(78.65%) advised about the quantity and type of dentifrice to be used only if asked where as 19(21.34%)routinely advised on dentifrice use.

All the pediatricians agreed that the parents often consulted them regarding oral habits of their children but only 24(26.96%) would ask such parents to consult the dentist for the same.

Use of pacifier was disapproved by 82(92.13) pediatricians, in fact most of them categorically discouraged their use.

During the interactions some of the pediatricians pointed out that parents are not likely to appreciate unsolicited advice about oral health unless they have come for consultation related with the oral health issues.

Discussion

Pediatricians will see infants and young children during the initial years and they are in a unique position to initiate good oral health practices. This study was undertaken to assess pediatricians’ opinion about oral health care and the usual advice they give for oral hygiene maintenance of the children.

Pediatrician’s consensus on importance of oral health warrants for frequent interaction between them and pediatric dentist .This will ensure dispersal of knowledge about the field of pediatric dentistry.

The trend among pediatricians practicing in National Capital Territory of Delhi is found favoring a dental consultation only when the child reports a dental problem this needs to be changed as the first dental visit should be preferably when there is no dental problem as it allows to reduce the anxiety levels among the children (7,8).

Only about more than half the pediatricians in the national capital knew about the existence of specialist dentist for children, still fewer referred the patients to the specialist. This is not a very positive situation as it is known that a pediatric dentist is better prepared to play an important role in prevention of dental problems in young children through preventive treatments, risk assessment, and anticipatory guidance for parents regarding oral development, caries prevention, and overall oral health.(9).

Most pediatricians (17.9%) gave little emphasis to gum pad cleaning. The gum pads should be cleaned after every feeding with a moist gauze pad or a clean washcloth .This will reduce the number of micro organisms in the mouth capable of converting the lactose milk or other fermentable carbohydrates into acids. The micro organisms already existing in oral cavity before the eruption of primary teeth will predispose them to dental caries.

Parents should start brushing their children's teeth immediately after they appear in the oral cavity. This advise was given only by 71.9% pediatricians and the rest of them advising a later initiation of tooth brushing, with a very few 7.8%postponing it up to the time when child can himself hold the brush. The importance of early initiation of brushing is not only important for good oral hygiene but also for initiating good tooth-brushing habits in later childhood (10,11,12).

78.65% pediatricians advised about the type and quantity of dentifrice only upon being asked .it is very important that pediatrician advise about the type (fluoridated and non fluoridated) and quantity of the paste to be used depending upon the fluoride content of water source.

Pediatricians agreed that they were often consulted for oral habits but about a quarter would refer them for dental opinion. Oral Habits such as thumb sucking, digit sucking, and pacifier usage are common in childhood. Intervention of oral habits is recommended at the age of 4 years (13). Therefore pediatricians should insist that parents have dental consultation if a child is involved in oral habit beyond 4 years.

Pacifiers are known to make Children more prone to otitis media(14), delayed speech development(15) and dental problem (16). Their use was strongly disapproved by majority (92.13%) pediatricians.

Conclusion

The ultimate success of preventive dentistry is very much dependent upon the knowledge and function of the medical group concerned with children. Therefore it is of prime importance that the knowledge of pediatrician regarding preventive dental care be known and if need be enhanced regularly.