Oral Health

• Information for Families
• Information for Providers
• Web sites/Organizations

The American Academy of Pediatrics states that the medical care of infants, children, and adolescents ideally should be accessible, continuous, comprehensive, family centered, coordinated, compassionate, and culturally effective. It should be delivered or directed by well-trained physicians who provide primary care and help to manage and facilitate essentially all aspects of pediatric care.¹

Pediatric primary dental care needs to be delivered in a similar manner. The dental home is a specialized primary dental care provider within the philosophical complex of the medical home. Referring a child for an oral health examination by a dentist who provides care for infants and young children 6 months after the first tooth erupts or by 12 months of age establishes the child’s dental home and provides an opportunity to implement preventive dental health habits that meet each child’s unique needs and keep the child free from dental or oral disease.²

Pediatricians and pediatric health care professionals should develop the knowledge base to perform oral health risk assessments on all patients beginning at 6 months of age. Patients who have been determined to be at risk of development of dental caries or who fall into recognized risk groups should be directed to establish a dental home 6 months after the first tooth erupts or by 1 year of age (whichever comes first).²

For many pediatricians, efforts to promote the health of children have been directed at attending to the needs of particular children in a practice setting, on an individual basis, and providing them with a medical home. Increasingly, however, the major threats to the health of America's children arise from problems that cannot be adequately addressed by the practice model alone. "We must become partners with others, or we will become increasingly irrelevant to the health of children."³

Guides for Families

• Video Resource: "Dental Care for the Special Child"
  The American Academy of Pediatric Dentistry (AAPD) offers a 12-minute videotape targeted toward parents and caregivers of children with special needs. "Dental Care for the Special Child" is intended for screening in dental and medical offices, and includes educational topics such as the value of early dental care, prevention and proper brushing, narrated by three parents of children with disabilities. Developed in collaboration with parent, community and dental organizations, the video answers frequently asked questions, including "How can I prevent dental problems for my special child?," "Will preventive dentistry help my child?," "Are pediatric dentists prepared to care for special-needs children?" and "Will my child need special care during dental treatments?," among others. For more on this resource, click here.
  
  
• Dental Care Every Day: A Caregiver's Guide
  This guide will show you how to help someone brush, floss, and have a healthy mouth. The booklet includes:
  • Getting Started
  • Three Steps to A Healthy Mouth
  • Step 1. Brush Every Day
  • Step 2. Floss Every Day
  • Positioning Your Body: Where To Sit or Stand
  • Step 3. Visit a Dentist Regularly
  • Prepare for Every Dental Visit: Your Role

Guides for Providers

• Association of State and Territorial Dental Directors (ASTDD) Best Practices. ASTDD, through coordinated efforts of its Best Practices Project, is dedicated to cultivating best practices that help:
  • Build infrastructure and capacity in state, territorial and community oral health programs,
  • Meet the Call to Action set by the Surgeon General's Report on Oral Health and A National Call to Action to Promote Oral Health, and
  • Achieve Healthy People 2010 objectives to enhance the oral health of all Americans and reduce health disparities
    
  
  For the purposes of the ASTDD Best Practices Project, a Best Practice Approach is defined as: a public health strategy that is supported by evidence for its impact and effectiveness. Evidence includes research, expert opinion, field lessons, and theoretical rationale. For each Best Practice Approach analyzed and reported on this web site, varying strength of evidence is observed. Best Practice Approaches are available at: www.astdd.org/?template=bp_home.html&shell=best
  
• The National Maternal and Child Oral Health Resource Center (OHRC) has
  produced three new resources -- a fact sheet, a tip sheet, and a resource
  guide -- to assist professionals working to improve oral health services
  for children and adolescents with special health care needs.
  • The fact sheet: Oral Health for Children and Adolescents with Special Health Care Needs: Challenges and Opportunities, presents information on unmet oral health care needs, oral health and general health and well-being, barriers to care such as lack of insurance or qualified oral health professionals, and how Medicaid and other publicly financed reimbursement methods offer opportunities for care.
  • The tip sheet: Strategies for Improving the Oral Health System of Care for Children and Adolescents with Special Health Care Needs, outlines approaches for health professionals who are planning, developing, and implementing state and local efforts to ensure access to care.
  • The resource guide: The Oral Health Services for Children and Adolescents with Special Health Care Needs: Resource Guide provides a list of journal articles, materials, and federal agencies and national organizations that may serve as resources for ensuring optimal care.
    
    
• Bright Futures in Practice: Oral Health
  This guide is designed to help health professionals implement specific oral health guidelines during pregnancy and postpartum, infancy, early childhood, middle childhood, and adolescence. It addresses risk assessment for dental caries, periodontal disease, malocclusion, and injury.
  
  Also available as a pocket guide. This guide provide an overview of the publication Bright Futures in Practice: Oral Health.
  
  
• Children's Dental Health Knowledge Path
  The new edition of Knowledge Path: Oral Health and Children and Adolescents is an electronic guide to recent, high-quality resources that analyze data, describe effective programs, and report on policy and research aimed at improving access to and the quality of oral health for children and adolescents.
  
  Produced by the MCH Library in collaboration with the National Maternal and Child Oral Health Resource Center, the knowledge path includes information on (and links to) Web sites and electronic publications; journal articles; books, reports, and other print publications; databases; and discussion groups and electronic newsletters. It is intended for use by health professionals, policymakers, program administrators, and families who are interested in tracking timely information on this topic.
  
  The knowledge path is available at: www.mchlibrary.info/KnowledgePaths/kp_oralhealth.html
  
  
• Health Professional’s Guide to Pediatric Oral Health Management
  A series of seven self-contained online modules designed to assist health professionals in managing the oral health of infants and young children.
  
  These modules provide health professionals with information to help them prevent oral diseases, which still afflict many U.S. children, especially children from families with low incomes, children in certain minority groups, and children with special health care needs. The modules assist health professionals in performing an oral screening to identify infants and children at increased risk for oral health problems, offering referrals to oral health professionals, and providing parents with anticipatory guidance.
  
  Module 7: Discusses how health professionals can help infants and young children with special health care needs achieve and maintain optimal oral health. The module offers a definition of children with special health care needs and reviews factors that place these infants and young children at increased risk for certain oral conditions. It includes information on oral conditions that may occur in infants and young children with special health care needs. In addition, the module offers guidance on how to perform an oral screening for these infants and young children and presents anticipatory guidance that health professionals can provide to parents.
  
  
• Oral Conditions in Children With Special Needs - A Guide for Health Care Providers
  
  Tips for providers:
  • Take time to talk and listen to parents and caregivers.
  • Tell parents and caregivers to seek a dental consultation no later than a child’s first birthday.
  • Seek advice on behavior management techniques; early intervention and familiarization with the dental team may take several visits.
  • Evaluate and treat orthodontic problems early to minimize risk of more complicated problems later in life.
  • Advise caregivers
    
    
• Planning Guide for Dental Professionals Serving Children with Special Health Care Needs
  This Planning Guide has been developed for dental team members who wish to provide care to children with special health care needs, particularly those with developmental disabilities. Dental professionals will find the guide useful when scheduling appointments, promoting oral health with parents or other caregivers (anticipatory guidance), assessing dental needs, developing a realistic care plan, and providing preventive dental care.
  
  Developed by: USC University Affiliated Program - Children's Hospital Los Angeles California February, 2000

Training for Providers

• Oral Health Risk Assessment Training Speaker's Kit
  www.aap.org/commpeds/dochs/oralhealth/screening.cfm
  This training is designed to support pediatricians and child health providers as they implement oral health risk assessments during well-child visits. The training provides participants with an understanding of:
  • The role of the child health care professional in assessing children’s oral health
  • The pathogenesis of caries
  • Conducting an oral health risk assessment (including oral screening exam)
  • Providing appropriate oral health education to families
  • Developing a management plan with referrals to a dental home
    
• School-Based Dental Sealant Program Manual
  Seal America: The Prevention Invention manual was first developed in 1995 by the American Association of Community Dental Programs in cooperation with the Association of State and Territorial Dental Directors, the Health Resources and Services Administration's Maternal and Child Health Bureau, and the Centers for Disease Control and Prevention's Division of Oral Health.
  
  The electronic version was created by the National Maternal and Child Oral Health Resource Center. Topics include defining the population, gaining community support, staffing, purchasing portable equipment, funding, collecting and analyzing data, preparing to go into the school, implementing the program in the school, understanding the importance of referral and follow-up, and evaluating the program. Appendices include sample forms and resource materials. The manual is intended for use by health professionals, program administrators, and others interested in starting a dental sealant program to help prevent dental caries in children.
  
• Southern Association of Institutional Dentists
  The Southern Association of Institutional Dentists is a benevolent group of dental professionals whose mission is to improve the oral health of people with disabilities through service, education, and advocacy.
  
  Their Web site contains modules to help in treating CSHCN. The modules included on the site are as followed:
  • Mental Retardation - A review for dental professionals
  • Clinical Concerns in the Provisions of Dental Care for Clients with Mental Retardation
  • Down Syndrome - A Review for Dental Professionals
  • Cerebral Palsy - A Review for Dental Professionals
  • Managing Maladaptive Behaviors: The Use of Dental Sedation for Persons With Disabilities
  • Managing Maladaptive Behaviors: The Use of Dental Restraints and Positioning Devices
  • Oral Manifestations in Genetic Syndromes with Mental Retardation
  • Providing Dental Care to Persons with Severe Disabilities Under General Anesthesia

  Many more modules can be found on their Web site at: saiddent.org/modules.asp

Web sites/Organizations
AAP Oral Health Information: www.aap.org/commpeds/dochs/oralhealth/
The American Academy of Pediatrics in partnership with the federal Maternal and Child Health Bureau (MCHB), have implemented the Pediatrics Collaborative Care (PedsCare) Program, Oral Health Initiative. The purpose of the program is to promote improved child oral health by offering pediatricians the tools and support they need to provide community-based, collaborative care. The goal of the first stage of the initiative is to provide training on oral health care.

Association of State and Territorial Dental Directors (ASTDD): www.astdd.org
The Association of State and Territorial Dental Directors (ASTDD) is a national non-profit organization representing the directors and staff of state public health agency programs for oral health. ASTDD formulates and promotes the establishment of sound national dental public health policy and assists state dental programs in the development and implementation of programs and policies for the prevention of oral diseases.

1. The Medical Home. Pediatrics. Elk Grove Village, IL: American Academy of Pediatrics; 2002.

2. Oral Health Risk Assessment Timing and Establishment of the Dental Home. Elk Grove Village, IL: American Academy of Pediatrics; 2003.

3. The Pediatrician's Role in Community Pediatrics. Pediatrics. Elk Grove Village, IL: American Academy of Pediatrics; 1999.

Last Updated August 18, 2008