To examine the implications of implementing a multi-component oral health program in early childhood centers throughout Hampden County, Massachusetts.
As highlighted in the Surgeon General’s May 2000 report, tooth decay is the single most common chronic disease of childhood - 5 times more common than asthma and 7 times more common than hayfever. Early Childhood Caries (one or more missing, filled, or cavitated teeth in a child less than 71 months) can occur as early as 6 months of age with the eruption of the first tooth. Poor children suffer disproportionately with some 80% percent of oral disease concentrated in 25% of the population. Hampden County has the highest percentage of children on Medicaid of any county in the Commonwealth, and the rate of early childhood caries is twice that of the national average.
A demonstration project was completed at 5 preschool sites in Springfield and involved 119 children (ages 3-5), 84 parents and 181 teachers and administrative staff members. The project combined 4 components: in-school oral health education, parental involvement, dental screenings and fluoride varnish applications in an effort to address early childhood caries. Currently, the goal is to expand this program over a three-year period to target all children ages 0-5 in early childcare settings in Hampden County.
Prior to taking the next steps involved with instituting the program, a thorough evaluation of the target population, the school sites and the number of dental providers in the region needed to be completed. A total of 128 licensed nursery and group care centers were mapped. Due to the response rate, phone interviews were conducted with directors from 96 sites. Pediatric and general dental practitioners were also mapped, with a focus primarily on MassHealth providers. Phone interviews were conducted with these providers.
Directors from sites with large numbers of children whose parents receive government assistance for childcare more readily reported the desire to incorporate a dental component into school curriculum. On the other hand, directors from sites in more affluent areas of the county assumed that children were not in need of dental services. In general, caregivers and teachers are not necessarily aware of the oral health needs of their students. Perceived oral health condition by nursery and preschool directors is often affiliated with perceptions about parents’ education level and socioeconomic status.
There are a limited number of dental providers in Hampden County. Of the 3 pediatric dentists practicing in that region, none of them accept MassHealth. Among 34 general dentists accepting MassHealth, 13 see patients younger than three years old, and only 2 general practitioners offer treatment via sedation or general anesthesia for uncooperative children.
Caregiver education is needed.
There must be more study to better understand how perceptions of oral health by caregivers correlate with reality.
Early intervention is critical in preventing early childhood caries.
Water fluoridation in all areas of Hampden County would be of great benefit in addressing the caries epidemic.
Economics play a role in unmet need.
On-site mobile dental services should be incorporated into the program to reduce barriers in access to care.
Collaborations are needed with schools that have existing dental programs.
Legislative involvement is the key to statewide mandated dental exams prior to starting kindergarten.
Frank Robinson, PhD, Partners for a Healthier Community
Stacey Auger, MPH, Health Care for All