Head Start and Partners Forum on Oral Health:
Paper # 3: Access To Dental Care For Preschool Children

Children's access to dental care is closely related to age and income. Young children and low-income children obtain far less care than others. Children involved in Head Start and WIC programs often do not receive dental services beyond screening and nutritional counseling. When they do see a dental professional, they frequently obtain less care than they need to resolve all of their dental problems. This problem persists even though most qualify for dental coverage through Medicaid or the State Child Health Insurance Program.

A paper written by Dr. Burton Edelstein entitled "Access to Dental Care for Head Start Enrollees" (published in the summer edition of the American Journal of Public Health Dentistry, Volume 60, No. 3, Summer 2000) discusses the problems that limit Head Start and WIC eligible children from getting good dental care. These include problems stemming from Medicaid and SCHIP (burdensome administration, low fees, contracting issues, and some limited benefits in SCHIP plans); problems stemming from dental delivery systems (few safety net dental facilities, dentists' unfamiliarity with treating very young children, cultural barriers, and lack of dentists located close to children's homes); and problems stemming from parents and families (lack of awareness about oral health and dental care needs, problems using the private dental care system, and competition from other daily living activities). Because of these barriers, low-income children with dental problems often do not receive adequate care. As a result, these young children frequently have high levels of disease and experience dental pain and oral infections.

One of the first steps in solving the problems of dental care for Head Start and WIC children is screening to identify obvious dental problems and children at high risk of dental disease. Head Start and WIC could also develop training materials to advance and refine the approaches used by dentists and other health professionals to screen children and assess them for risk. By working with dental schools, WIC and Head Start could develop evaluation tools that measure the effectiveness of screenings and assessments. By linking efforts with safety net providers, particularly community health centers, programs serving young children could help integrate oral health services into overall primary health care.

Head Start and WIC should also work with local dental associations to encourage dentists to support their oral health programs. With the local associations, Head Start and WIC can arrange for training programs that teach dentists and hygienists how to deal with young children and can provide social rewards for those engaged in seeing the children they serve. Furthermore, Head Start and WIC can involve parents in raising their awareness about oral health and in preparing them and their children for dental visits. For example, dental visits should never be used as a threat or punishment. Parents also need to be advised of expectations about their use of dental services, from appointment making and appointment keeping to office decorum and compliance with oral health promoting recommendations. Additionally, staff in these programs can help tremendously to engage families in essential dental care by–

• helping make dental appointments,
  
  
• assisting with transportation to dental offices,
  
  
• assuring child care for siblings during dental visits,
  
  
• accompanying concerned parents to the dental office, and
  
  
• providing translation services.

Modern dental care offers children tremendous and unprecedented opportunities to obtain and maintain excellent oral health. Head Start and WIC programs can go a long way toward reducing access disparities for young, low-income children by understanding barriers and removing them in supportive and thoughtful ways.

This article is a summary of "Access to Dental Care for Head Start Enrollees" by Dr. Burton Edelstein. 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.