Head Start and Partners Forum on Oral Health:
Paper # 2: Oral Health Assessment and Dental Prevention

Tooth decay remains one of the most common diseases of childhood. Even more troubling is the fact that low-income children are affected by tooth decay much more than are the rest of the population. Therefore, Head Start, and WIC need to take particular interest in the oral health of their families and children. Dr. Michael Kanellis, in his paper, "Caries Risk Assessment and Prevention" (published in the American Journal of Public Health Dentistry, Volume 60, No. 3, Summer 2000), suggests that to lower the rate of tooth decay in these preschool children, it is important to have oral health as part of the structure of the Head Start and WIC programs.

Screening
Oral screening exams for infants, toddlers, and preschoolers are an important first step in determining a child's oral health care needs. These exams can provide important information on the rate of current tooth decay and the risk of future decay.

Head Start Program Performance Standards require that Head Start programs provide dental exams for their children within 90 days of enrollment. Additionally, for those children in Head Start, Early Head Start, and WIC, a referral to a dentist should take place so that "dental homes" can be established for each child.

Risk Assessment
Screening exams provide an important first step is determining which children are at high risk for dental decay. They help establish different preventive strategies for each child. Children of low-income status should generally be considered at a higher risk of tooth decay. However, it is still important to conduct risk assessments at the individual level.

Risk assessment strategies that are most effective are ones that are easily performed, are low cost, require no special equipment, and provide reliable results. Strategies that meet these guidelines include–

• Review history – One of the best indicators of future tooth decay is past tooth decay.
  
• Look for cavities and white spot lesions – Look for brown or black spots that cannot be removed with a tooth brush; white spot lesions (pre-cavities) often follow the gum line.
  
• Look for plaque – The presence of visible plaque on a child's teeth indicates risk for tooth decay.
  
• Get a dental professional's opinion – Dentists, hygienists, and other health professionals can accurately predict a child's risk for tooth decay.
  
• Screen for bacteria –Streptococcus mutans is the bacteria in plaque that is necessary for tooth decay to begin. Tests that look for these bacteria are good risk indicators.
  
• Ask about dietary habits– Sleeping with a bottle containing sweet liquids or letting a child suck on a bottle or sippy cup throughout the day are risk factors for tooth decay.
  

Prevention
After a child has been screened and his or her risk of tooth decay has been assessed, preventive strategies should be planned. The following list of preventive measures are appropriate for nearly every child in Head Start, Early Head Start, and WIC.

• Education – Education has long been an important part of preventive dentistry programs. However, studies have shown that although education increases the knowledge levels about oral health issues, it is often ineffective in making people change their unhealthy oral health behaviors.
  
• Tooth brushing – It has long been understood that tooth brushing is an important means for reducing the risk of tooth decay. Yet, what is even more important is making sure that the toothpaste used with brushing contains fluoride. Preschool children should use less than a pea-size amount of toothpaste. It is best for children not to rinse or to minimally rinse after brushing to maximize the effects of the fluoride.
  
• Fluoride varnish – Fluoride varnish is suitable for young children at high risk for dental cavities. In some states, dental hygienists can apply the varnish without direct supervision. No special equipment is needed for the application, and children can eat and drink right after a varnish application. Fluoride varnish applications can be performed two times a year for all children, and more often for children who are at a higher risk of tooth decay.
  
• Sealants – Sealants protect the pits and fissures of teeth and are the single most effective means for preventing tooth decay, especially for permanent molars in children over the age of six.

Early screening, risk assessment, and preventive programs in WIC, Head Start, and Early Head Start children are important because children in these programs are generally at high risk for tooth decay and are sometimes unable to access preventive dental care through more traditional means.

This article is a summary of "Caries Risk Assessment and Prevention" by Dr. Michael Kanellis. The full text of this article is available in the Summer 2000 edition of the American Journal of Public Health Dentistry as well as on the Web site: http://www.headstartinfo.org.

Oral Health Prevention for Head Start and WIC Children

• Emphasize the importance of screening preschool children for tooth decay to dentists, hygienists, nurses, physicians, and parents.
  
• Consider all children enrolled in Head Start, Early Head Start, and WIC at high risk for tooth decay.
  
• Help find a dental home for each child.
  
• Do not rely solely on education to help prevent tooth decay.
  
• Incorporate daily brushing with fluoride toothpaste into daily routines.
  
• Incorporate twice yearly fluoride varnish applications into preventive dental programs.