early childhood oral health care community solutions for ... · early childhood oral health goal 1:...

Early Childhood Oral Health CareEarly Childhood Oral Health CareCommunity Solutions forCommunity Solutions for

Champaign CountyChampaign County20092009

Participating Agencies:Champaign-Urbana Public Health District

Smile HealthyUniversity of Illinois CRAYON Research

Head Start of Champaign CountyMaternal & Child Health

Crisis NurseryUnited Way of Champaign CountyParkland College Dental Hygiene

Francis Nelson Community Health Center

• Reduce the percentage of children ages 2-4 with untreated tooth decay down to 9%

• Reduce the percentage of children ages 2-4 years who have had a dental caries experience (tooth decay) to 11%

*The current percentage of children in Illinois age 2-4 years with

Early Childhood Caries is 33%

Healthy People 2010 Goals for Healthy People 2010 Goals for Early Childhood Oral Health:Early Childhood Oral Health:

www.c-uphd.org

Risk Reduction: Water FluoridationRisk Reduction: Water Fluoridation

Five Champaign County community water treatment facilities have met water fluoridation standards of 0.9-1.2 mil per liter for 2+ years:

www.c-uphd.org

Illinois American Water CompanyLudlow Water DepartmentRoyal Water DepartmentSadorus Water DepartmentSangamon Valley Water District

Risk Reduction: Preventative Dental CareRisk Reduction: Preventative Dental Care

Private DentistsChampaign County has three

Pediatric Dental Specialists providing services:

• Beginning by age 1 year • Accepting private insurance

payments• Providing sedation services• Providing services to children

with special needs

www.c-uphd.org

Risk Reduction: Risk Reduction: PreventativePreventative Dental CareDental Care

www.c-uphd.org

Smile Healthyis dedicated to working with the community to meet the oral health needs of underserved children and families by focusing on preventative care, treatment and education to provide a lifetime of excellent oral health through:

• Child Dental Access Program • Mobile Clinics• Head Start Dental Clinic• Dental Health Education• Handicap Accessible


Champaign-Urbana Public Health DistrictServes children who are residents of Champaign or Urbana with All Kids & Medicaid and

Champaign County children in foster care ages 3-18 years. Preventative, restorative, and educational services are provided through:

• Two full time clinics located in Champaign and Urbana that are handicap accessible

• Mobile clinics to Champaign & Urbana schools

• Dental Health Education

• Fluoride Varnish clinics offered 2 afternoons per month to MCH/WIC infants and toddlers

www.c-uphd.org


Parkland College Dental Hygiene

provides preventative and educationaldental services to ages 3-adult through:

• Hygiene Clinics; handicap accessible


• Dental Health Promotion through Community Volunteerism

www.c-uphd.or


Urbana Student Health Center

Provides preventative and restorative dental services to Urbana school students through

• Full time dental and hygiene services


• Handicap Accessible

www.c-uphd.org

Community Risk FactorsCommunity Risk Factors• Lack of parent awareness regarding the importance of

caring for developing primary teeth from birth

• Lack of Low-Literacy educational materials for infant/toddler oral health care

• Lack of oral health educational programming and educational materials for parents of children beginning at birth

• Low number of dental providers who accept children beginning at age 1 year

• Low availability of oral health educational materials in languages other than English and Spanish

www.c-uphd.o

Community GoalsCommunity Goals1. Increase availability of educational materials for

infant/toddler oral health care

2. Increase promotion of Early Childhood Oral Health Care

3. Increase availability of oral health presentations and information for parents of infants and toddlers

4. Increase access to dental homes for children beginning at age 1 year

5. Provide Bright Smiles from Birth training to Family Practice doctors and Pediatricians

www.c-uphd.or

Bright Smiles Bright Smiles from Birthfrom Birth

• Developed by the Illinois Chapter of the American Academy of Pediatrics

• Illinois began pilot program in 2006

• Utilizes pediatric dentists to train pediatricians to perform oral health screening of children as part of a well-child visit and provide oral health education and apply fluoride varnishto high risk children

www.c-uphd.or

• Early tooth eruption, (<6 months)• Poor parental dental health• Child goes to bed with a bottle• Frequent snacking (3 or more/day)• Enamel defects/pits• Prolonged bottle/breastfeeding (>1 year)• Well water• >3 Weeks (continuous) liquid medicine

www.c-uphd.or

Bright Smiles from Birth PreBright Smiles from Birth Pre--Existing Risk FactorsExisting Risk Factors

Bright Smiles from Birth Oral Health Care QuestionsBright Smiles from Birth Oral Health Care Questions

• Does someone clean the child’s teeth daily?

• Do they use toothpaste containing fluoride?

• Does the child take fluoride supplements?

• Does the child go to bed with a bottle?– If “yes”, what are the contents of the

bottle?

• Does the child use a pacifier-If “yes”, is it dipped in anything?

Individual Risk Factors for developing EarlyIndividual Risk Factors for developing Early Childhood Caries:Childhood Caries:

21

818

27

10 6 40

102030405060708090

100

Tooth erutionbefore 6months

Poor parentaldental care

Goes to bedwith bottle

3+ snacksper day

Breadfedafter age 1

year

Drinks wellwater

3+consecutive

weeks ofliquid meds

Survey of 100 WICchildren age 0-35months

www.c-uphd.o

*Bright Smiles from Birth Assessment Tool

Parental Preventative Measures as ReportedParental Preventative Measures as Reported

100 WIC parents of children age 0-35 months were surveyed regarding preventative care of their child’s teeth and gums.

67

31

0102030405060708090

100

Child's teeth/gums arecleaned by an adult

daily

Fluoride Toothpaste isused (44 children in thesurvey were under age

2 years)

www.c-uphd.or

CRAYON Research CRAYON Research Juhee Kim, Ph.D, University of IllinoisJuhee Kim, Ph.D, University of Illinois

• The CRAYON group will explore the role of early risk factors forpediatric obesity in both the home and child care environment such as:

Exploration• feeding practices • physical activity • media influences • Collaborative studies reflect disciplines from the UIUC campus

and other US and South Korea institutions and include:Studies include• public health • preventive medicine • dental medicine • social sciences The CRAYON group focuses on examining health behaviors of the

underserved and high-risk population and people with disabilities in the context of family and organizational environment and health policy.

Age n %<6 months 23 23.23

6-11 months 21 21.21>=12 months 55 55.56

Total 99 100

Spring 2009Dr. Juhee Kim & Dr. Jae Eun Shim, UIUC

Two screeners were administered to examine feeding practices and oral health risk factors among WIC children under age 3 years.

247 participants were surveyed for the CRAYON screener and 120 were for the Early Childhood Caries screener.

99 participants from both the CRAYON and ECC screeners were compiled for the following preliminary analysis.

Table 1. Distribution of subjects by age:

www.c-uphd.or

CRAYONCRAYON--WIC ScreenersWIC Screeners

The prevalence of oral hygiene practices are presented in Table 2.30% of parents reported children going to bed with bottle

23.3% reported frequent snacking 20% of infants 12 months and older were given prolonged bottle and breast feeding.

53% of infants 6-11 months old were not being given sugared drink, however,the percentage decreased to 26.67% in children age 12 months and older.

Table 2: Distribution of dental health related practices by age.

Total<6

months6-11

months>=12

months

n % n % n % n %

Frequent snacking (n=99) 23 23.23 1 4.35 6 28.57 16 20.09

Prolonged bottle/breast feeding >1 yr.(n=55)

11 11.11 - - - - - -

Pacifier use (n-90) 46 51.11 17 89.47 12 60.00 17 33.33

Toothbrush use (n=64) 43 67.19 1 9.09 7 46.67 35 92.11

Goes to bed with bottle (n=93) 28 30.11 6 28.57 8 38.10 14 27.45

Not introduced to sugared drinks (n=69)

29 42.03 9 100 8 53.33 12 26.67

Dental Health Practices

CRAYONCRAYON--WIC ScreenersWIC Screeners

Survey of Community AgenciesSurvey of Community Agencies

A list of area agencies who serve children and parents of children age 0-4 years was developed.

A survey was sent to each agency to determine:

• What oral health services and education was currently being provided to them and,

• What services they would be willing to promote to their clients

Refugee Mutual

AssistanceCenter

ChildcareResource Services

CrisisNursery

Mental HealthCenter

MOPS

Urbana &Champaign

EC

Cultvadores“Latin Kids

Club”

Head Start

Agencies serving

children 0-4

www.c-uphd.or

Response from Community AgenciesResponse from Community Agencies

CultivadoresC-U Early Childhood

Head StartMentalHealth Center

Crisis Nursery

Serves parents of children age 0-4?

YES YES YES YES YES

Partners with an agency providing dental care to children age 0-4?

NO NO YES NO NO

Partners with an agency providing oral health education?

NO NO YES NO NO

Dental coverage of children served by agency.

All Kids Medicaid

All KidsMedicaid

All KidsMedicaidUninsured

All KidsMedicaidUninsured

All KidsMedicaidPrivate Uninsured

www.c-uphd.org

5 Agencies Responding

Agency Requests by %Agency Requests by %

0 10 20 30 40 50 60 70 80 90 100

Materials in other languages

Materials in Spanish

Materials in English

Referral information for clients

Oral Health presentations

Oral Health education tools

Oral Health training for staff

Educationas materials for clients

Toothbrushes, Toothpaste, Floss

Oral Health education for parents and children 0-4

Dental treatment for expectant and new moms

Dental treatment for children age 0-4

www.c-uphd.o

Early Childhood Oral Health Goal 1:Early Childhood Oral Health Goal 1:

www.c-uphd.or

SmileHealthy will work with CUPHD to develop low-literacy oral health care

instructions for parents of infants and toddlers and provide these in English and Spanish.

CUPHD will provide low-literacy oral health materials and infant toothbrushes to all MCH/WIC children age 0-35 months and provide

referral information to SmileHealthy and CUPHD for fluoride varnish application.

CUPHD will work with SmileHealthy to translate and provide low-literacy oral health care instructions to

Korean, French, and Mandarin Chinese.

CUPHD will provide low-literacy materials and infant tooth brushes to each child born in Champaign County through proposed

partnership with Carle and Provena hospitals.

Increase educational materials for Infant/Toddler oral health care


www.c-uphd.or

Increase availability of oral health presentations for parents of infants and toddlers

CUPHD & SmileHealthy will provide dentists forBright Smiles from Birth Training to Francis Nelson

Health Center and area Family Care PractitionersAnd Pediatricians.

Crisis Nursery will promote arly Childhood oral health care through

presentations in parenting classes in partnership

with SmileHealthy.

CRAYON Research at theUniversity of Illinois will promote Early Childhood Oral Health Care through two Intervention Groups:

1: Oral health care instructions & provider information2: Free infant finger toothbrushes + oral health care instructions & provider information.

SmileHealthy will contact Child Dental Access families about oral health education & encourage

families to have Children age 0-5 years participate inthe program.


www.c-uphd.or

Increase availability of oral health presentations for parents of

infants and toddlers

SmileHealthywill promote & offer

Oral health Care Presentations in English & Spanish

throughoutChampaign County.

They will provide oral health presentations

for Crisis Nursery & HeadStart

CUPHD will provide oral health presentations

to Champaign &

Washington (Urbana) Early Childhood Centers

& to WIC families in partnership with

Maternal & Child Health

Crisis Nursery will schedule

Oral Health Presentationsfor all

parenting classes.

Early Childhood Oral Health Goal 4:Early Childhood Oral Health Goal 4:Increase access to dental homes for children

beginning at age 1 year

www.c-uphd.o

SmithHealthy will provide preventative care

and treatment to HeadStart children and

siblings age 0-5 years. Focus will be

placed on re-check appointments and family oral health counseling.

CUPHD & SmileHealthy will promote

Bright Smiles from Birthto all community

dentists through thelocal Dental Society.

CUPHD will begin to see Champaign & Urbanachildren at age 1 year. Preventative care and

oral health education will be provided along

with restorative care as tolerated.


Step 3

Step 2

Step 1

Provide Bright Smiles from Birth training to Family Practice doctors and Pediatricians

www.c-uphd.or

Bright Smiles from Birth Available through:

Francis Nelson Health CenterFamily Care Practitioners

Pediatricians

CUPHD & SmileHealthy will send Dentists For Bright Smiles from Birth Certification To train Francis Nelson

Health Care Practitioners, Family Care Practitioners, & Pediatricians to

apply fluoride varnish.

Until Bright Smiles from Birth certification is available,CUPHD & SmileHealthy will promote and provide

Early Childhood Oral Health Care training to:Francis Nelson Health Center

Family Care PractitionersPediatricians

www.c-uphd.or

Measuring OutcomesMeasuring Outcomes

CUPHD

will track Bright Smiles from Birth screening responses for all children age 1-3 years and report the incident of caries in children age 2-4 years at their first dental appointment.

CRAYON Research

will conduct a parent survey at 6 month Well Child Care visit to assess whether intervention group has more favorable oral health practices and less risk behaviors compared to those of group receiving no new intervention.

SmileHealthy

will continue survey of families of children age 0-5 and assess dental caries of 3 year old children participating in programs.

www.c-uphd.org

SUCCESSSUCCESS

Ish Patel is an active 3 year old. Ish’s parents brought him to a Champaign-Urbana Public Health District Fluoride Varnish Clinic when he was 2 ½. CUPHD’s Dental Clinic does not

begin services to children until age 3 years, but began to offer Infant & Toddler dental exams, oral health education with a Registered Dental Hygienist, and fluoride varnish

applications through a partnership with Maternal & Child Health.

Ish was still using a bottle at 2 ½ so Michelle Kramer, RDH talked to his parents about switching him from a bottle to a cup to lower his risk of developing tooth decay and, after

Kara Ruffatto, DMD examined Ish’s teeth, fluoride varnish was applied.Ish arrive at the CUPHD Dental Clinic 6 months later for his first complete dental

appointment; he was no longer using the bottle and had only 1 small area of decay. Early intervention is key to avoiding and breaking habits that lead to Early Child Caries,

formerly known as Baby Bottle Decay.

www.c-uphd.or

The Champaign-Urbana Public Health District would like to thank the following committee members and agencies for their participation:

Ann Ambrose, Crisis NurseryBeverly Baker, United Way of Champaign CountyPeg Boyce, RDH, BA, Parkland College Dental HygieneLiliana Castelari, Head Start of SavoyChifan Cheng, DDSAlicia Ekhoff, Champaign-Urbana Public Health District - Dental ProgramDeb Fruitt, Champaign-Urbana Public Health District - Wellness and Health PromotionNancy Greenwalt, Smile HealthyVickie Heman, DDSHeidi Kaufmann, Head Start of SavoyJuhee Kim, Ph.D., University of Illinois CRAYON ResearchMichelle Kramer, RDH, Champaign-Urbana Public Health District - Dental ProgramBrandon Meline, Champaign-Urbana Public Health District - Maternal and Child HealthJill Myers, RDH, Smile HealthyNicole Wente, Champaign-Urbana Public Health District - Maternal and Child HealthKara Ruffatto, DMD, Champaign-Urbana Public Health District - Dental ProgramAwais Vaid, Epidemiologist, Champaign-Urbana Public Health District

early childhood oral health care community solutions for ... · early childhood oral health goal 1:...

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