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Oral Health: Birth through Five Years of Age


Oral Health for Head Start Children: Best Practices




January 31, 2007



Oral Health for Head Start Children: Best Practices provides evidence-based
approaches and interventions to improve the oral health of Head Start children
and their families. The Best Practices are divided into three key points of
intervention; pregnancy, birth through two years, and two years through five
years of age. The prevention of Early Childhood Caries requires an approach
that involves pregnant women and infants. Interventions during the preschool
years are primarily targeted to the prevention of dental caries in the permanent
teeth.

We expect this document to be helpful to Head Start administration and staff and
all of the medical, dental, and community health staff who will need to work
together to effectively improve the future oral health of American Indian and
Alaska Native children. We hope to spread our vision of a future where American
Indian and Alaska Native children no longer suffer from Early Childhood Caries at
the alarming rates that they do currently.

We will continually update this document and you will be able to access those
updates on the IHS Head Start Program website:

www.ihs.gov/nonmedicalprograms/headstart/


You can also find current information and bulletins on oral health as it relates to
Head Start at the Head Start Bureau Learning Center at the following website:

http://www.eclkc.ohs.acf.hhs.gov/hslc




IHS Head Start Program
Albuquerque, NM Oral Health for Head Start Children: Best Practices
Just The Facts

Early Childhood Caries (ECC) is the single most common chronic disease of
childhood, occurring at least five times more frequently than asthma, the second
most common chronic disease of childhood.

American Indian and Alaska Native (AI/AN) children experience dental caries at a
higher rate than the general U.S. population. Data from 2,663 children ages 2-5
years documented that 79 percent had experienced dental caries (filled or
unfilled decay) and 68 percent had untreated dental caries. Over 50 percent of
the children ages 2-5 years had severe Early Childhood Caries (ECC).*

By two years of age, only 30 percent of AI/AN children surveyed were caries-free,
supporting the fact that prevention interventions must be implemented with
pregnant women and infants. In order to prevent dental caries in the primary
teeth, we must intervene before the first cavity develops, working with both
mothers and infants. For children in Head Start, we want to prevent future decay
in the erupting permanent teeth.

Dental Caries is a preventable, infectious, transmissible disease caused by
mutans streptococci, lactobacilli, and other acid-producing bacteria.

The bacteria that cause tooth decay are fueled by sweet foods and drinks and
other fermentable carbohydrates like white crackers. Over time, the enamel
breaks down, resulting first in a chalky white spot that then progresses to a cavity.

Severe ECC causes pain and infection. ECC can also result in poor self-esteem
and a reluctance to smile. The primary teeth are important for eating, holding
space for the permanent teeth, talking, and smiling.

Severe ECC can cost from $2,000-$5,000 or more per child to treat. Some of
these children need to be hospitalized, and treatment may need to be completed
under general anesthesia. ECC places a huge financial burden on insurance,
Medicaid, Indian Health Service, Tribal programs, and families least able to
afford treatment.

Dental treatment does not remove the disease-causing bacteria. Even after
treatment, the disease rages on for high-risk children.



No child can be truly healthy
if he or she has poor oral health.


IHS Head Start Program: http://www.ihs.gov/nonmedicalprograms/headstart/
1 Oral Health for Head Start Children: Best Practices
Introduction

Early Childhood Caries (ECC) is a term used to describe tooth decay, including filled or
extracted teeth due to decay, in the primary teeth (baby teeth). Other names for this
disease are Baby Bottle Tooth Decay (BBTD), nursing mouth, and bottle rot. Severe
ECC is characterized by a distinctive pattern of tooth decay in infants and young children,
often beginning on the maxillary anterior teeth and rapidly progressing to the other
primary teeth as they erupt.

ECC is a preventable, infectious, transmissible disease caused by mutans streptococci,
lactobacilli, and other acid-producing bacteria. While the transmission is primarily vertical
between mothers or other primary caregivers and infants, studies have also
demonstrated horizontal transmission from infants to infants, as well as from older
children to infants. We now know that the organisms that cause dental caries can begin
to colonize in the mouth of an infant even before the eruption of teeth. The bacteria that
cause tooth decay produce acids from carbohydrates. The bacteria are fueled by sweet
foods and drinks and other fermentable carbohydrates. Over time, the enamel
demineralizes, resulting first in a chalky white spot that then progresses to a cavity. It is
important to rethink the way we treat dental caries. Traditionally, we would wait until a
child had a cavity and treat the cavity with a filling. In order to prevent ECC, we must
intervene before the first cavity develops, working with both mothers and infants.


Problem Statement


American Indian and Alaska Native (AI/AN) children experience dental caries at a higher
rate than the general U.S. population. Data from 2,663 children ages 2-5 years
documented that 79 percent had experienced dental caries (filled or unfilled decay) and
68 percent had untreated dental caries.* Over 50 percent of the children ages 2-5 years
had severe Early Childhood Caries, constituted by decay on a maxillary incisor or six or
more decayed teeth. At two years of age, only 30 percent of the AI/AN children were
caries-free, supporting the fact that prevention interventions must be implemented with
pregnant women and infants.

Severe ECC causes pain and infection. Many of these children learn to live with this pain
day in and day out. ECC results in increased missed school days and an inability to
concentrate at school. Pain also affects a childs sleep and nutrition, resulting in poor
overall health and well being. ECC can also result in poor self-esteem and a reluctance
to smile. The primary teeth are important for eating, holding space for the permanent
teeth, talking, and smiling. We can no longer ignore this infection until a child is 3-4
years old, any more than we would ignore any other infection that a child might have.


*
The 1999 Oral Health Survey of American Indian and Alaska Native Dental Patients:
Findings, Regional Differences and National Comparisons. DHHS, IHS Division of Oral
Health.


IHS Head Start Program: http://www.ihs.gov/nonmedicalprograms/headstart/
2 Oral Health for Head Start Children: Best Practices
Recommendations
Oral Health: Best Practices during Perinatal Period



Collaborate with the
medical, community
health, and dental
providers to assure
that all pregnant
women visit the
dental clinic during
the early months of
pregnancy.

Educate the mother
about the
transmissibility of
dental caries and
ways to prevent
ECC.

Provide nutrition
counseling to
reinforce the
importance of a
healthy diet during
the perinatal period.

Provide education
and support to
promote
breastfeeding.

Recommend that
pregnant women stop
using tobacco.

The dental staff can
provide an oral
exam, periodontal
disease screening,
prophylaxis,
recommendations for
completing any
needed dental
treatment, caries

Why?
Pregnant women should get their teeth cleaned and checked early
in their pregnancy. Gum disease has been linked to premature low
birth-weight babies.
The caries risk assessment gives you the opportunity to assess
whether the baby will be at high risk for future dental caries and
also provides an opportunity to educate the mother about ways
to prevent ECC.
Modification of the mothers dental flora during the period from birth until the
child is two years of age can lower t