Early Childhood Oral Health Care Early Childhood Oral Health Care Community Solutions for Community Solutions for Champaign County Champaign County 2009 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
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Early Childhood Oral Health Care Community Solutions for ... · Early Childhood Oral Health Goal 1: SmileHealthy will work with CUPHD to develop low-literacy oral health care instructions
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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
Risk Reduction: Preventative Dental CareRisk Reduction: Preventative Dental Care
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
Risk Reduction: Preventative Dental CareRisk Reduction: Preventative Dental Care
Parkland College Dental Hygiene
provides preventative and educationaldental 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 CareRisk 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 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.
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
Early Childhood Oral Health Goal 2:Early Childhood Oral Health Goal 2:
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.
Early Childhood Oral Health Goal 3:Early Childhood Oral Health Goal 3:
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.
Early Childhood Oral Health Goal 5:Early Childhood Oral Health Goal 5:
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