Research has indicated that access to early oral health care is critical in the early identification and prevention of the disease. Because pediatricians and other child health professionals are most likely to encounter new mothers and infants, it is essential that they are aware of the infectious pathophysiology and associated risk factors of Early Childhood Caries (ECC) to make appropriate decisions regarding timely and effective intervention.
If pediatricians and other health care professionals could examine young children and facilitate the referral of children who most need treatment by a dental health professional, it is likely that the effects of ECC would decrease, resulting in improved general health for children. But as was found recently in a periodic survey conducted by the AAP, most pediatricians believe they should perform oral health assessments and counseling, yet few are confident in their ability to perform the more difficult screening tasks. Many pediatricians identified their lack of professional education as a barrier to oral health screening; they also identified payment issues and parent misinformation regarding the need for dental visits as barriers to very young children receiving care. More education and training are needed for pediatricians and other child health professionals to routinely conduct oral health risk assessments. In addition, it is important to introduce oral health training earlier in the educational pathway e.g., medical school and residency programs are the optimal times to present new educational content, that will be implemented when graduates enter practice.
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AAP promotes improved maternal and child health status by offering pediatricians the tools and support they need to provide community-based, collaborative care within a medical home. Oral health is one of the focus areas in which collaborative care can make a significant difference. AAP's Oral Health Initiative (OHI) aims to educate pediatricians and other health care professionals about oral health, determine promising practice models for decreasing oral health disparities at the community level, increase public awareness about the infectious nature of dental caries and the importance of good oral hygiene, and provide a framework for the AAP to address disparities related to other health conditions.
Oral Health Risk Assessment Training for Pediatricians and Other Child Health Professionals
Family Oral Health Education - A Family Oral Health Education session can be billed twice per year by the dental office. This education may be delivered by the dentist and/or auxiliary staff. The session should include:
o Risk Assessment
o "Lift the Lip" Training (a videotape and flipchart teaching the parent/guardian how to examine the child's mouth)
o Training in teeth cleaning
o Nutritional counseling and use of a cup for drinking
o Discussion and prescription of fluoride supplements
o Follow-up (contact within three months as a reminder about teeth cleaning, lift the
OPEN WIDE is an oral health-training program for non-dental health and human services providers throughout Connecticut, including physicians, nurses, nutritionists, childcare and outreach workers, and others. OPEN WIDE training is designed to:
Educate health and human service providers about the importance of oral health in early childhood development;
Build awareness and integrate oral health into existing health systems;
Enable non-dental providers to recognize and understand oral diseases and conditions;
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Enable non-dental providers to engage in anticipatory guidance and prevention interventions, and make appropriate referral for improved oral health;
Make a positive impact on overall health and well-being through improved oral health.
The Training Curriculum
Currently, the training curriculum focuses on children's oral health. Supplemental modules are being developed on Perinatal Oral Health and Geriatric Dentistry. OPEN WIDE provides the following training components:
A full-color custom binder containing a modular curriculum (with sections on Dental Decay, Early Childhood Caries, Risk Factors for Dental Disease, Prevention, What To Do and How To Do It);
Laminated quick-reference full-color fact sheets and clinical guides;
Extensive appendices with a broad range of resources;
A CD with a 45-minute slide presentation on ECC and over 50 additional slides for customizing presentations;
A trainer's printed slide guide with presentation script in English and Spanish;
Always on Time
Marked to Standard
A continuous-loop DVD in English and Spanish for clients to view in waiting rooms.
Early Childhood Cavities Prevention Program (ECCPP) aims to eliminate early childhood cavities among low-income children up to three years of age by integrating preventive oral health services into Women, Infants and Children (WIC) clinical services. Pregnant women receive home/WIC visits and are assigned to a dental home under a dental managed care program with two Dental Care Organizations (DCOs). Initial care was provided at the Oregon Institute of Technology Dental Hygiene Clinic under contract with the DCOs. Care included emergency, preventive, and restorative services. This community-based collaboration has also successfully provided low-income pregnant women and their young children in Klamath County with essential oral health education and oral health tool kits (including parent education brochures, toothbrushes, floss, sippy cups, and children's fluoride toothpaste). Ninety-three percent of all infants reaching their 2nd birthday in the ECCPP were found to be cavity-free. The community health partnership supporting the ECCPP had established a successful and sustainable model extending dental care to pregnant women and promoting preventive services for both new mothers and their young children.
When low-income pregnant women and mothers with infants have regular dental visits, both mother and child should experience benefits.
The concept of mother-to-child transmission of tooth decay-causing bacteria has been known since the 1970s. Work by Kohler and Andreen in Sweden demonstrated that treating the mother was an effective strategy to prevent early childhood cavities.1 Similarly, recent data from the North Carolina Medicaid program confirmed that children who receive preventive dental care early in life have lower overall treatment costs. Early prevention, such as preventing mother-to-child transmission, is a cost-effective strategy.
The predominant approach for most dental public health programs in the United States is to focus on or give priority to the care of children from low-income families. A model of dental prevention and disease control is needed that conceptualizes dental caries as an infectious process. From this perspective, dental care would aim to reduce pathogens as well as promote oral hygiene and a diet protective against the disease. This means adopting a focus on the mother-child dyad, rather than the child alone, and intervening before the child is born.
A focus on the oral health of new mothers is appropriate, especially for the woman having her first child. Several states are making this effort. Examples include: (1) in 2006 New York State issued a set of comprehensive guidelines on oral health care during pregnancy and early childhood, and (2) Massachusetts extended Medicaid dental benefits to mothers from pregnancy to three years after the birth of the child.