By Marcia A. Manter, M.A.
Early Childhood Committee , Association of State and Territorial Dental Directors
Tooth decay is the most common chronic childhood disease. Statistics from CDC indicate that close to 50 percent of children entering kindergarten already have decayed primary teeth, which puts them at risk for having tooth decay in their permanent teeth. If left untreated, the infection can result in pain and affect children's overall health and well-being. This can lead to difficulty with learning, concentrating and socializing. The good news is that tooth decay is almost entirely preventable. Early childhood professionals, such as home visitors, that serve families with young children have an important role in helping to increase the number of children who enter kindergarten cavity free.
The role of home visitors in promoting oral health is not only important but challenging. Families may not think they need to care for their children's primary teeth due to misconceptions that primary teeth are not important because "they will fall out." Many parents are not aware of the connection between oral health and overall health and that many of the primary teeth do not exfoliate until approximately 12 years of age. This common myth increases the necessity for home visitors to offer parents oral health guidance beginning during the first month of the child's life. As the child develops, home visitors have many oral health topics to explore with families. These include cleaning the mouth even before the first teeth erupt, safe practices for teething, toothbrushing with fluoride toothpaste to keep the teeth protected from decay, "teeth healthy" food choices and eating practices, and a first dental visit by age one. Caring for the oral health of young children with special needs may require additional counseling and referral to a pediatric dental specialist depending on the complexity of the needs.
Many home visitors report a lack of oral health knowledge and do not initially feel comfortable providing comprehensive oral health information to families. To support home visitors in adopting and expanding oral health messages and coaching for families, the Association of State and Territorial Dental Directors (ASTDD) Early Childhood Committee researched a number of online and print resources that home visitors can access to gain information, and to find lesson plans and parent educational materials.
Some curricula developed for national home visiting programs, such as Parents as Teachers and Nurse Family Partnership, imbed oral health information into infant/toddler modules covering each developmental stage. Teeth for Tots from Kansas Head Start Association is an oral health curriculum that provides fourteen modules covering every aspect of healthy tooth development. Each module includes evidence-based oral health information for home visitors, and 15-minute lesson plans based on Motivational Interviewing principles. The curriculum includes a CD with photos and parent handouts that can be turned into a flip chart. More information can be found at ksheadstart.org/oral-health. Another resource is Help Me Smile from Ohio Department of Health, which includes materials designed for home visitors to use with families including oral health risk assessments, training modules and educational resources. It is available at no charge and can be downloaded at mchoralhealth.org/materials/multiples/helpmesmile.
For home visitors looking for an oral health flip chart, Massachusetts Head Start Association offers one available in multiple languages. It can be downloaded from their website massheadstart.org/oral-health.php. University of Iowa College of Dentistry also offers a flip chart designed for home visitors and other family educators. It is available for purchase through the college website dentistry.uiowa.edu/pediatric-fact-sheet.
Brief videos can enhance a home visit lesson plan. Tooth Talks is a website from Head Start of North Carolina, with support from the University of North Carolina. It contains twelve early childhood oral health videos featuring parents and children practicing healthy habits such as toothbrushing, food choices, weaning from a bottle, and baby's first dental checkup. It also features a video demonstrating Motivational Interviewing as a way to support parents adopting oral health practices for their young children at
The complete listing of oral health materials available to home visitors identified in the ASTDD environmental scan can be found at astdd.org/docs/home-visitors-environmental-scan-11-13-2014.pdf. Additional resources can also be found on the National Maternal and Child Oral Health Resource Center's page on home visiting at mchoralhealth.org/highlights/homevisiting.html.