Early Childhood Oral Health Care
Community Solutions for
Champaign County
2009
Participating Agencies:
Champaign-Urbana Public Health District
Smile Healthy
University of Illinois CRAYON Research
Head Start of Champaign County
Maternal & Child Health
Crisis Nursery
United Way of Champaign County
Parkland College Dental Hygiene
Francis Nelson Community Health Center
Healthy People 2010 Goals for
Early Childhood Oral Health:
• 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%
www.c-uphd.org
Risk 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:
Illinois American Water Company
Ludlow Water Department
Royal Water Department
Sadorus Water Department
Sangamon Valley Water District
www.c-uphd.org
Risk Reduction: Preventative Dental Care
Private Dentists
Champaign 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: Preventative Dental Care
Smile Healthy
is 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
www.c-uphd.org
Risk Reduction: Preventative Dental Care
Champaign-Urbana Public Health District
Serves 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
Risk Reduction: Preventative Dental Care
Parkland College
Dental Hygiene
provides preventative and educational
dental services to ages 3-adult through:
• Hygiene Clinics; handicap
accessible
• Dental Health Education
• Dental Health Promotion
through Community
Volunteerism
www.c-uphd.or
Risk Reduction: Preventative Dental Care
Urbana Student
Health Center
Provides preventative and
restorative dental services to Urbana
school students through
•
Full time dental and hygiene
services
•
Dental Health Education
•
Handicap Accessible
www.c-uphd.org
Community 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 Goals
1.
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
from 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 varnish
to high risk children
www.c-uphd.or
Bright Smiles from Birth Pre-Existing Risk Factors
•
•
•
•
•
•
•
•
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 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 Early Childhood Caries:
*Bright Smiles from Birth Assessment Tool
100
90
80
70
60
50
40
30
20
10
0
Survey of 100 WIC
children age 0-35
months
27
21
18
8
Tooth erution Poor parental Goes to bed 3+ snacks
before 6
dental care with bottle
per day
months
10
Breadfed
after age 1
year
6
4
Drinks well
3+
water
consecutive
weeks of
liquid meds
www.c-uphd.o
Parental 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.
100
90
80
70
60
50
40
30
20
10
0
67
31
Child's teeth/gums are Fluoride Toothpaste is
cleaned by an adult used (44 children in the
daily
survey were under age
2 years)
www.c-uphd.or
CRAYON Research
Juhee Kim, Ph.D, University of Illinois
• The CRAYON group will explore the role of early risk factors for
pediatric 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.
CRAYON-WIC Screeners
Spring 2009
Dr. 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:
Age
<6 months
6-11 months
>=12 months
Total
n
23
21
55
99
%
23.23
21.21
55.56
100
www.c-uphd.or
CRAYON-WIC 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.
Dental Health Practices
Total
<6
months
6-11
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
Survey 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
Head Start
Refugee
Mutual
Assistance
Center
Childcare
Resource
Services
Cultvadores
“Latin Kids
Club”
Agencies
serving
children 0-4
Crisis
Nursery
Urbana &
Champaign
EC
MOPS
Mental
Health
Center
www.c-uphd.or
Response from Community Agencies
5 Agencies Responding
Head Start
Cultivadores
C-U Early
Childhood
Mental
Health
Center
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
All Kids
Medicaid
Uninsured
All Kids
Medicaid
Private
Uninsured
Dental coverage of children
served by agency.
All Kids
Medicaid
All Kids
Medicaid
All Kids
Medicaid
Uninsured
Crisis
Nursery
www.c-uphd.org
Agency Requests by %
Dental treatment for children age 0-4
Dental treatment for expectant and new moms
Oral Health education for parents and children 0-4
Toothbrushes, Toothpaste, Floss
Educationas materials for clients
Oral Health training for staff
Oral Health education tools
Oral Health presentations
Referral information for clients
Materials in English
Materials in Spanish
Materials in other languages
0
10 20 30 40 50 60 70 80 90 100
www.c-uphd.o
Early Childhood Oral Health Goal 1:
Increase educational materials for Infant/Toddler oral health care
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.
www.c-uphd.or
Early Childhood Oral Health Goal 2:
Increase availability of oral health presentations for parents
of infants and toddlers
CUPHD & SmileHealthy will provide dentists for
Bright Smiles from Birth Training to Francis Nelson
Health Center and area Family Care Practitioners
And Pediatricians.
Crisis Nursery will promote
arly Childhood oral health care through
presentations in parenting
classes in partnership
with SmileHealthy.
CRAYON Research at the
University of Illinois will promote
Early Childhood Oral Health Care
through two Intervention Groups:
1: Oral health care instructions &
provider information
2: 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 in
the program.
www.c-uphd.or
Early Childhood Oral Health Goal 3:
Increase availability of oral health
presentations for parents of
infants and toddlers
SmileHealthy
will promote & offer
Crisis Nursery
Oral health Care Presentations
will schedule
in English & Spanish
Oral Health Presentations
throughout
for all
Champaign County.
parenting classes.
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
www.c-uphd.or
Early Childhood Oral Health Goal 4:
Increase access to dental homes for children
beginning at age 1 year
CUPHD & SmileHealthy
will promote
Bright Smiles from Birth
to all community
dentists through the
local Dental Society.
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 will begin to see
Champaign & Urbana
children at age 1 year.
Preventative care and
oral health education will
be provided along
with restorative care as
tolerated.
www.c-uphd.o
Early Childhood Oral Health Goal 5:
Provide Bright Smiles from Birth training to Family Practice
doctors and Pediatricians
Step 3
Step 2
Step 1
Bright Smiles from Birth
Available through:
Francis Nelson Health Center
Family 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 Practitioners
Pediatricians
www.c-uphd.or
Measuring Outcomes
CUPHD
SmileHealthy
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.
will continue survey of
families of children
age 0-5 and assess
dental caries of 3 year
old children
participating in
programs.
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.
www.c-uphd.or
SUCCESS
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.org
The Champaign-Urbana Public Health District would like to thank the following
committee members and agencies for their participation:
Ann Ambrose, Crisis Nursery
Beverly Baker, United Way of Champaign County
Peg Boyce, RDH, BA, Parkland College Dental Hygiene
Liliana Castelari, Head Start of Savoy
Chifan Cheng, DDS
Alicia Ekhoff, Champaign-Urbana Public Health District - Dental Program
Deb Fruitt, Champaign-Urbana Public Health District - Wellness and Health Promotion
Nancy Greenwalt, Smile Healthy
Vickie Heman, DDS
Heidi Kaufmann, Head Start of Savoy
Juhee Kim, Ph.D., University of Illinois CRAYON Research
Michelle Kramer, RDH, Champaign-Urbana Public Health District - Dental Program
Brandon Meline, Champaign-Urbana Public Health District - Maternal and Child Health
Jill Myers, RDH, Smile Healthy
Nicole Wente, Champaign-Urbana Public Health District - Maternal and Child Health
Kara Ruffatto, DMD, Champaign-Urbana Public Health District - Dental Program
Awais Vaid, Epidemiologist, Champaign-Urbana Public Health District
www.c-uphd.or