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Question

When should older pediatric dental patients transition to general dental practices?

Answer

Pediatric dentists sometimes find that they’re treating older pediatric patients who have become young adults and who have no desire to leave the practice. Although this loyalty is often a sign of a positive doctor–patient relationship, the scope of care that pediatric dentists provide does not include many of the adult dental care services that general dentists provide. A general dentist is better suited both atmospherically and medically to deal with adult dental issues and thus provide optimum care.1

The American Academy of Pediatric Dentistry does not indicate a specific age for pediatric patients to leave the practice, and the decision should be made on a case-by-case basis. Some patients have complex health needs, and their situations should be carefully considered to make the transition flexible to accommodate patient and family needs.

Because of ongoing personal changes, a desire for greater independence, busy schedules, and shifting priorities, oIder pediatric dental patients may present challenges for pediatric dentists. So, it can be advantageous for pediatric dentists to develop a timeframe for older patients to leave their practices. If a timeframe isn’t established, older pediatric patients may not complete their treatment plan in a timely manner or at all—leaving the doctor with crowns, models, or orthodontic appliances that were designed for a particular patient and cannot be reused.

Once a pediatric patient turns 16, the dentist might consider having a 2-year planning consultation with the patient and his/her parents. Looking toward the future, the dentist can advise the family how best to complete necessary dental work within that timeframe before moving on to a general dentist. If the patient is also going through orthodontia, the dentist and orthodontist can work cooperatively to complete all ongoing work in that remaining time period.

These discussions benefit patients because the collaboration helps establish a working plan for ongoing dental work before the transition to adult dentistry. The dentist can ask important questions related to the patient’s ongoing care at this time. By establishing a general age for older pediatric patients to leave the practice, pediatric dentists also can give them time to look for and assistance to find a general dentist.

A patient’s 18th birthday or high school graduation (whichever comes first) may be a good age for leaving the pediatric dental practice. If this is the case, the practice brochure as well as information on the practice’s website should explain this policy. Staff members should remind parents of the policy when patients turn 16. The practice can then work with patients and their parents to establish a completion goal and to ensure the patients’ teeth are in good shape when they leave the practice.

Some dentists might consider discharging certain older pediatric patients while continuing to treat others. When this is the case, it is prudent to have a clinical rationale for continuing to treat a particular patient. Extending the dates of service should be reserved for the need to complete a particular treatment plan.

Planning for the transition of young adult patients is beneficial for dentists and their patients. It helps provide for continuity of care, even if a patient is no longer in the immediate vicinity. Also, it encourages communication among dentists who treat, refer, and cooperate in the ongoing dental care of young adults.

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Resources

  • How to Transition Pediatric Patients to Adult Treatment (Dentistry Today)
  • Policy on Transitioning from a Pediatric-Centered to an Adult-Centered Dental Home for Individuals with Special Health Care Needs (American Academy of Pediatric Dentistry)

1Chavis, S., & Canares, G. (2020). The transition of patients with special health care needs from pediatric to adult- based dental care: A scoping review. Pediatric Dentistry, 42(2):101-109.