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Policy on the Dental Home

Latest Revision
2023

Abbreviations
AAP: American Academy of Pediatrics. AAPD: American Academy of Pediatric Dentistry. SHCN:
Special health care needs.

Purpose
The American Academy of Pediatric Dentistry (AAPD) supports the concept of a dental home1 for all
infants, children, adolescents, and persons with special health care needs. A dental home is fundamental
to helping patients achieve optimal oral health.

Methods
This policy was developed by the Council on Clinical Affairs, adopted in 20012, and last revised in 20183.
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; fields:
all; limits: within the last 10 years, human, English, meta-analysis, and systematic reviews. The search
returned 774 articles that matched the criteria. The 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, comprehensive, continuous,
accessible, coordinated, compassionate, and patient- and family-centered way regardless of race,
ethnicity, religion, sexual or gender identity, medical status, family structure, or financial circumstances.
The 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 Establishment of the dental home is initiated by the
identification 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-specific 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 defining the medical home.4 Health care provided in a patient-centered medical home
environment has been shown more effective and less costly in comparison to emergency care facilities or
hospitals.5,6 Family-centered care has been identified by the AAP as an important characteristic of an
effective medical home as the family is the primary source of strength and support to 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 care8 complemented with caries-risk and periodontal-risk
assessments, anticipatory guidance, and periodic supervision9. The establishment of a dental home
follows the medical home model as a cost-effective measure to reduce the financial burden and decrease
the number of dental treatment procedures experienced by young children10-12 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, especially in children at
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high risk for early childhood caries.8 Referral 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 This 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. The dentist performs the examination,
diagnoses oral conditions, and establishes a treatment plan that includes individualized preventive
services, and all services are delivered under the dentist’s supervision. The 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 efficiency while preserving quality of care. Depending on state regulations, 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
facility) 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 literacy could decrease individuals’ risk for oral diseases and mitigate a later need for more
extensive and expensive therapeutic services.17
Although teledentistry complements and does not serve as a substitute for the establishment of a
dental home18, it can expand the reach of a dental home for time-sensitive traumatic injuries19,20, oral
health screening21, consultations20-22, caries triage and detection20-22, treatment planning20,21,23, patient
education20,21, dental referrals20,21,23, and dental treatment monitoring23 with populations who face barriers
to oral health services22-24. Access to oral health care providers may be limited due to financial barriers,
special health care needs, workforce shortages, transportation issues, and residing in rural or remote
areas22-24, as well as during times when dental clinics are closed due to local unforeseen circumstances
(e.g., fire, natural disaster) or a pandemic18,25.
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. This transitioning period is
potentially stressful for parents and adolescents and for young adults with special health care needs
(SHCN) as resources for acquiring adulthood healthcare are insufficient for this population26,27. 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 practice28.

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 financial circumstances.1,7,29-31
• comprehensive assessment for oral diseases and conditions.
• comprehensive evidence-base oral health care including acute care and preventive services in
accordance with AAPD periodicity schedules.9
• individualized preventive dental health program based upon a caries-risk assessment32 and a
periodontal disease risk assessment14.
• anticipatory guidance regarding hygiene practices, oral/dental development and growth,
speech/language development, nonnutritive habits, diet and nutrition, injury prevention,
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tobacco/nicotine product use, substance 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, gingivae, and other oral structures. This 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

References
1. American Academy of Pediatric Dentistry. Definition of dental home. The Reference Manual of
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3. American Academy of Pediatric Dentistry. Policy on the dental home. Pediatr Dent 2018;40(6):29-
30.
4. American Academy of Pediatrics Ad Hoc Task Force on the Definition of the Medical Home. The
medical home. Pediatrics 1992;90(5):774.
5. Peikes D, Dale S, Ghosh A, et al. The Comprehensive Primary Care Initiative: Effects on spending,
quality, patients, and physicians. Health Aff (Millwood) 2018;37(6):890-9.
6. Fu N, Singh P, Dale S, et al. Long-term effects of the Comprehensive Primary Care Model on health
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7. American Academy of Pediatrics Committee on Hospital Care and Institute for Patient- and Family-
Centered Care. Policy statement on patient- and family-centered care and the pediatrician's role.
Pediatrics 2012;129(2):394-404.
8. Thompson CL, McCann AL, Schneiderman ED. Does the Texas First Dental Home program improve
parental oral care knowledge and practices? Pediatr Dent 2017;39(2):124-9.
9. American Academy of Pediatric Dentistry. Periodicity of examination, preventive dental services,
anticipatory guidance/counseling, and oral treatment for infants, children, and adolescents. The
Reference Manual of Pediatric Dentistry. Chicago, Ill.: American Academy of Pediatric Dentistry;
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10. Hung M, Licari FW, Lipsky MS, et al. Early preventive dental visits: Do they reduce future operative
treatments? Dent J (Basel) 2022;10(4):53.
11. Kolstad C, Zavras A, Yoon R. Cost-benefit analysis of the age one dental visit for the privately
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12. Nowak AJ, Casamassimo PS, Scott J, Moulton R. Do early dental visits reduce treatment and
treatment costs for children? Pediatr Dent 2014;36(7):489-93.
13. Owens PL, Manski RJ, Weiss AJ. Emergency Department Visits Involving Dental Conditions, 2018.
Healthcare Cost and Utilization Project (HCUP) Statistical Brief #280. August 2021. Agency for
Healthcare Research and Quality, Rockville, MD. Available at: “www.hcup-
us.ahrq.gov/reports/statbriefs/sb280-Dental-ED-Visits2018.pdf”. Accessed January 13, 2023.
14. American Academy of Pediatric Dentistry. Risk assessment and management of periodontal diseases
and pathologies in pediatric dental patients. The Reference Manual of Pediatric Dentistry. Chicago,
Ill.: American Academy of Pediatric Dentistry; 2023:PENDING.
15. American Academy of Pediatrics. Policy on maintaining and improving the oral health of young
children. Pediatrics 2014;134(6):1224-9.
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16. Casamassimo P, Holt K, eds. Components of oral health supervision. In: Bright Futures in Practice:
Oral Health. Pocket Guide, 3rd ed. Washington, D.C.: National Maternal and Child Oral Health
Resource Center; 2016:10.
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care services in a dental home. The Reference Manual of Pediatric Dentistry. Chicago, Ill.: American
Academy of Pediatric Dentistry; 2023:PENDING.
18. American Academy of Pediatric Dentistry. Policy on teledentistry. The Reference Manual of
Pediatric Dentistry. Chicago, Ill.: American Academy of Pediatric Dentistry; 2023:PENDING.
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personnel to dentists via teledentistry in a children's hospital system: A pilot study. Front Oral Health
2021;2:769988.
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pediatric dental practice during the COVID-19 pandemic. Pediatr Dent 2021;43(6):463-7.
21. Irving M, Stewart R, Spallek H, Blinkhorn A. Using teledentistry in clinical practice as an enabler to
improve access to clinical care: A qualitative systematic review. J Telemed Telecare 2018;24(3):129-
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22. Estai M, Kanagasingam Y, Tennant M, Bunt S. A systematic review of the research evidence for the
benefits of teledentistry. J Telemed Telecare 2018;24(3):147-56.
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systematic review of systematic reviews. Evid Based Dent 2022;8:1-8.
24. Johnson V, Brondani M, von Bergmann H, Grossman S, Donnelly L. Dental service and resource
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28. American Academy of Pediatric Dentistry. Policy on ethical responsibilities in the oral health care
management of infants, children, adolescents, and individuals with special health care needs. The
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29. American Academy of Pediatrics. Preamble to patient-centered medical home joint principles 2007.
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Accessed April 28, 2023.
30. American Academy of Pediatric Dentistry. Policy on care for vulnerable populations in a dental
setting. The Reference Manual of Pediatric Dentistry. Chicago, Ill.: American Academy of Pediatric
Dentistry; 2023:PENDING.
31. American Academy of Pediatric Dentistry. Policy on social determinants of children’s oral health and
health disparities. The Reference Manual of Pediatric Dentistry. Chicago, Ill.: American Academy of
Pediatric Dentistry; 2023:PENDING.
32. American Academy of Pediatric Dentistry. Caries-risk assessment and management for infants,
children, and adolescents. The Reference Manual of Pediatric Dentistry. Chicago, Ill.: American
Academy of Pediatric Dentistry; 2023:PENDING.
33. American Academy of Pediatric Dentistry. Pain management in infants, children, adolescents, and
individuals with special health care needs. The Reference Manual of Pediatric Dentistry. Chicago, Ill.:
American Academy of Pediatric Dentistry; 2023:PENDING.
34. American Academy of Pediatric Dentistry. Use of antibiotic therapy for pediatric dental patients. The
Reference Manual of Pediatric Dentistry. Chicago, Ill.: American Academy of Pediatric Dentistry;
2023:PENDING.
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35. Bourguignon C, Cohenca N, Lauridsen E, et al. International Association of Dental Traumatology

guidelines for the management of traumatic dental injuries: 1. Fractures and luxations. Dent
Traumatol 2020;36(4):314-30.
36. Fouad AF, Abbott PV, Tsilingaridis G, et al. International Association of Dental Traumatology
guidelines for the management of traumatic dental injuries: 2. Avulsion of permanent teeth. Dent
Traumatol 2020;36(4):331-42.
37. Day PF, Flores MT, O’Connell AC, et al. International Association of Dental Traumatology
guidelines for the management of traumatic dental injuries: 3. Injuries in the primary dentition. Dent
Traumatol 2020;36(4):343-59.
38. American Academy of Pediatric Dentistry. Policy on early childhood caries: Consequences and
preventive strategies. The Reference Manual of Pediatric Dentistry. Chicago, Ill.: American Academy
of Pediatric Dentistry; 2023:PENDING.
39. American Academy of Pediatric Dentistry. Policy on dietary recommendations for infants, children,
and adolescents. The Reference Manual of Pediatric Dentistry. Chicago, Ill.: American Academy of
Pediatric Dentistry; 2023:PENDING.
40. American Academy of Pediatric Dentistry. Policy on transitioning from a pediatric to an adult dental
home for individuals with special health care needs. The Reference Manual of Pediatric Dentistry.
Chicago, Ill.: American Academy of Pediatric Dentistry; 2023:PENDING.
41. White PH, Cooley WC. Supporting the health care transition from adolescence to adulthood in the
medical home. Pediatrics 2018;142(5):e20182587.