THE REFERENCE MANUAL OF PEDIATRIC DENTISTRY 35
ORAL HEALTH POLICIES: DENTAL HOME
Purpose
e American Academy of Pediatric Dentistry (AAPD) supports
the concept of a dental home
1
for all infants, children,
adolescents, and persons with special health care needs (SHCN).
A dental home is fundamental to helping patients achieve
optimal oral health.
Methods
is policy was developed by the Council on Clinical Aairs,
adopted in 2001
2
, and last revised in 2018
3
. For this revision,
literature searches of PubMed
®
/MEDLINE and Google
Scholar databases were conducted using the terms: dental
home, medical home in pediatrics, and infant oral health care;
elds: all; limits: within the last 10 years, human, English,
meta-analysis, and systematic reviews. e search returned 774
articles that matched the criteria. e articles were evaluated
by title and/or abstract and relevance to the establishment of
a dental home. Expert opinions and best current practices
were relied upon when clinical evidence was not available.
Background
A dental home is “the ongoing relationship between the dentist
and the patient, inclusive of all aspects of oral health care
delivered in a safe, culturally-sensitive, individualized, compre-
hensive, continuous, accessible, coordinated, compassionate, and
patient- and family-centered way regardless of race, ethnicity,
religion, sexual or gender identity, medical status, family struc-
ture, or nancial circumstances. e dental home should be
established no later than 12 months of age to help children and
their families institute a lifetime of optimal oral health.”
1
Estab-
lishment of the dental home is initiated by the identication
and interaction of these individuals, resulting in a heightened
awareness of all issues impacting the patient’s oral health.
Interaction of the dental team with early intervention programs,
early childhood education and child-care programs, schools,
members of the medical and dental communities, and other
public and private community agencies can help ensure
awareness of age-specic oral health issues and establishment
and maintenance of a dental home for all infants, children,
adolescents, and persons with special health care needs.
The dental home concept is derived from the American
Academy of Pediatrics’ (AAP) 1992 policy statement dening
the medical home.
4
Health care provided in a patient-centered
medical home environment has been shown more eective and
less costly in comparison to emergency care facilities or hos-
pitals.
5,6
Family-centered care has been identied by the AAP
as an important characteristic of an eective medical home as
the family is the primary source of strength and support for the
child.
7
Patient- and family-centered approaches promote more
positive health outcomes.
7
Strong clinical evidence exists for
the efficacy of early professional dental care
8
complemented
with caries-risk and periodontal-risk assessments, anticipa-
tory guidance, and periodic supervision
9
. e establishment
of a dental home follows the medical home model as a cost-
eective measure to reduce the nancial burden and decrease
the number of dental treatment procedures experienced by
young children
10-12
and serves as a higher quality health care
alternative in orofacial emergency care situations.
13
Children who have a dental home are more likely to receive
individualized preventive and routine oral health care thereby
improving families’ oral health knowledge and practices, espe-
cially in children at high risk for early childhood caries.
8
Refer-
ral by the primary care physician or health provider has been
recommended, based on risk assessment, as early as six months
of age and no later than 12 months of age.
14-16
is provides
time-critical opportunities to implement preventive health
practices and reduce the child’s risk of preventable dental/oral
disease.
16
Periodicity of reappointment also is based upon risk
assessment.
9
Central to the dental home model is dentist-directed care.
e dentist performs the examination, diagnoses oral condi-
tions, and establishes a treatment plan that includes individual-
ized preventive services, and all services are delivered under the
dentist’s supervision. e dental home delivery model implies
direct supervision (i.e., physical presence during the provision
of care) of allied dental personnel by the dentist. The allied
dental personnel (e.g., dental hygienist, expanded function
dental assistant/auxiliary, dental assistant) work under direct
supervision of the dentist to increase productivity and eciency
while preserving quality of care. Depending on state regula-
tions, this model may also allow for provision of preventive
oral health education and preventive oral health services by
allied dental personnel under general supervision (i.e., without
the presence of the supervising dentist in the treatment facil-
ity) following the examination, diagnosis, and treatment plan
by the licensed, supervising dentist. Furthermore, the dental
team can be expanded to include auxiliaries who go into the
community to provide education and coordination of oral
health services. Utilizing allied personnel to improve oral health
ABBREVIATIONS
AAP: American Academy of Pediatrics. AAPD: American Academy
of Pediatric Dentistry. SHCN: Special health care needs.
Latest Revision
2023
Policy on the Dental Home
How to Cite: American Academy of Pediatric Dentistry. Policy on the
dental home. The Reference Manual of Pediatric Dentistry. Chicago, Ill.:
American Academy of Pediatric Dentistry; 2023:35-7.
36 THE REFERENCE MANUAL OF PEDIATRIC DENTISTRY
ORAL HEALTH POLICIES: DENTAL HOME
literacy could decrease individuals’ risk for oral diseases and
mitigate a later need for more extensive and expensive thera-
peutic services.
17
Although teledentistry complements and does not serve as
a substitute for the establishment of a dental home
18
, it can ex-
pand the reach of a dental home for time-sensitive traumatic
injuries
19,20
, oral health screening
21
, consultations
20-22
, caries
triage and detection
20-22
, treatment planning
20,21,23
, patient
education
20,21
, dental referrals
20,21,23
, and dental treatment
monitoring
23
with populations who face barriers to oral health
services
22-24
Access to oral health care providers may be limited
due to nancial barriers, special health care needs, workforce
shortages, transportation issues, and residing in rural or remote
areas
22-24
, as well as during times when dental clinics are
closed due to local unforeseen circumstances (e.g., re, natural
disaster) or a pandemic
18,25
.
A coordinated transition from a pediatric to an adult dental
home is critical for extending the level of oral health and the
health trajectory established during childhood. is transition-
ing period is potentially stressful for parents and adolescents
and for young adults with SHCN as resources for acquiring
adulthood healthcare are insucient for this population
26,27
.
Education and preparation before transitioning to a dentist
who is knowledgeable and comfortable in both adult oral
health needs and managing SHCN are important. Until the
new dental home is established, the patient can maintain a
relationship with the current care provider and have access to
emergency services. In cases in which transitioning is not
possible, the dental home can remain with the pediatric
dentist who is ethically obligated to recommend referrals for
specialized dental care when the needed treatment exceeds the
practitioner’s scope of practice
28
.
Policy statement
The AAPD encourages parents and other care providers to
help every child establish a dental home no later than 12
months of age. The AAPD recognizes a dental home for
pediatric patients should provide:
• safe, culturally-sensitive, individualized, comprehensive,
continuous, accessible, coordinated, compassionate,
patient- and family-centered care regardless of race,
ethnicity, religion, sexual or gender identity, medical
status, family structure, or nancial circumstances.
1,7,29-31
• comprehensive assessment for oral diseases and conditions.
• comprehensive evidence-based oral health care including
acute care and preventive services in accordance with
AAPD periodicity schedules.
9
• individualized preventive oral health program based upon
a caries-risk assessment
32
and a periodontal disease risk
assessment
14
.
• anticipatory guidance regarding oral hygiene practices,
oral/dental development and growth, speech/language
development, nonnutritive habits, diet and nutrition,
injury prevention, tobacco/nicotine product use, sub-
stance misuse, human papilloma virus vaccinations, and
intraoral/perioral piercing and oral jewelry/accessories.
9
• management of acute/chronic oral pain and infection.
33,34
• management of and long-term follow-up for acute dental
trauma.
35-37
• information about proper care of the child’s teeth, gin-
givae, and other oral structures. is would include the
prevention, diagnosis, and treatment of disease of the
supporting and surrounding tissues and the maintenance
of health, function, and esthetics of those structures and
tissues.
38
• dietary counseling.
39
• referrals to dental specialists when care cannot directly be
provided within the dental home.
28
• effective transition from a pediatric to an adult dental
home including early recommendations to caregivers and
collaboration, communication, and coordination between
the pediatric and adult oral health care teams to ensure
uninterrupted comprehensive care.
40,41
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