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Head Start 2007 Program Instruction in Oral Health – Making It Happen & other Tips Reg Louie, DDS, MPH California Head Start Association Summer Manager & Director Institute Sacramento, CA August 1, 2007 Link to Website for Program Instruction in Oral Health

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Head start 2007 program instruction in oral health making it happen other tips l.jpg

Head Start 2007 Program Instruction in Oral Health – Making It Happen & other Tips

Reg Louie, DDS, MPH

California Head Start Association

Summer Manager & Director Institute

Sacramento, CA

August 1, 2007


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Link to Website for Program Instruction in Oral Health Making It Happen & other Tips

  • http://www.mchoralhealth.org/HeadStart/index.html

  • Other helpful information will also be found at this site


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Toothbrushing for children age two and over Making It Happen & other Tips

“Once daily, after a meal, Head Start staff (or volunteers, if available) should assist children in brushing their teeth using a small smear of toothpaste that contains fluoride”


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Others rush through it carelessly? Making It Happen & other Tips

Toothbrushing.. Are some children reluctant?


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Make it a group activity…for learning..and fun.. Making It Happen & other Tipsand better oral health


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Advantages Making It Happen & other Tips

  • A calm systematic way to teach oral hygiene and accomplish daily requirements

  • Children see their teacher brushing – role modeling

  • Able to monitor amount of time each child brushes

  • Ability to observe techniques sitting at children’s level, rather than standing by a sink


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Using an egg timer allows children to learn how long they should be brushing and monitor their progress


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In Head Start, when to brush? should be brushing and monitor their progress

  • Once daily

  • After the meal


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1 & 2 - paper towels (table cloth & napkin) should be brushing and monitor their progress

3 - Less than pea size toothpaste on cup rim

4 - Cup for spitting

Note: no water in the cup

3

The equipment

4

2

1


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1. Toothpaste with fluoride should be brushing and monitor their progress

2. Less than pea size…

3. Put it on the rim…..

The toothpaste tube does not touch any toothbrushes – no germs are shared


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Toothbrushing is role modeled, monitored for cleaning all parts of the mouth and using adequate time


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Brush, brush, brush parts of the mouth and using adequate time

Scrubbing is fine. Don’t expect circles at this age



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Use the napkin and monitored


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Put the napkin in the cup to absorb liquid and monitored

..and dispose of the paper and cup


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Rinse the brush and monitored



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Many Methods of and monitoredToothbrush Storage: separation and drying are essential


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No toothbrush covers needed and monitored

Ventilation holes

Spacious compartments for drying

Wash drawers in a dishwasher

[email protected] $24.99

A system

to consider


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Not role modeled and monitored

Varied amounts of brushing time

Technique may note be as closely monitored

One child at a time is more time consuming

Uses water; toothpaste more likely to be swallowed


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For children between one and two years of age and monitored

  • Once daily, after a meal, Head Start staff (or volunteers, if available) must brush children’s teeth with a soft bristled toothbrush, using a small smear of toothpaste that contains fluoride


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Enables the child to begin learning how to brush and monitored

Toothbrush adaptations for 1-2 year old children


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Dispensing toothpaste for 1-2 year old children and monitored

  • Avoid spreading germs

  • Dispense toothpaste onto a tongue blade, and wipe it onto the brush or

  • Use individual small tubes of toothpaste


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For infants under the age of one and monitored

“At least once during the program day, staff or volunteers must wash their hands and then cover a finger with a gauze pad or soft cloth and gently wipe infants’ gums”


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Should gloves be worn while brushing 1-2 year old children’s teeth or wiping infant’s gums?

  • Gloves are not usually required, but wash hands before and after brushing each child’s teeth or wiping gums.

  • If glove are worn, be alert to possible latex allergies; wear latex free gloves


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Other Tips for Oral Health and Partnerships in children’s teeth or Head Start


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Helping Parents Whose Children Are Not Up-To-Date children’s teeth or

Includes, but not limited to:

  • Education about importance of prevention and care

  • Identify dentists who accept Medi-Cal or Healthy Families or provide free/low-cost services

  • Arrange transportation to dental office

  • Provide transportation (with written consent)

  • Bring dentist or mobile clinic to Head Start


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Who are appropriate dental professionals for examination and treatment ?

  • Most states, including CA, require that a dentist performs the examination, which results in a definitive diagnosis and treatment plan, and provides or supervises treatment

  • Some states allow dental hygienists to provide assessment, triage and referral

  • Dental screening by a non-dentist is not required and does not fulfill the examination requirement


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Why is Providing Dental Services a Challenging Task treatment ?

  • Many dentists

    • Don’t accept patients with Medi-Cal/Heathy Families (SCHIP)

    • Don’t accept very young children

  • Parents

    • Many parents don’t complete exams and treatment prior to enrollment (for many reasons)

    • Parents can’t be required to provide exams and treatment prior to enrollment

    • Parents may be unfamiliar with the dental care system


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Dental Provider Shortages? treatment ?

A limited solution for providing dental examinations:

  • Local dentists may be willing to provide examination at the Head Start site

  • A mobile dental clinic may

    be engaged to provide

    examinations/ treatment

    on site


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Benefits of Onsite Exams treatment ?

  • Can avoid transporting children in small groups to dental office: inefficient use of personnel time

  • Identifies the ~ 25-35% of enrollees who will need follow-up care – only those who’ll need for follow-up care will need to be transported to a dental office

  • Can provide exams and fluoride varnish to fulfill two PIR reporting items (cleaning not required)

  • Dentist(s) will see extent of need and have a better understanding of Head Start’s role and accomplishments … BUT the goal is …


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The Goal – treatment ?

A Dental Home

A source of continuous, accessible comprehensive, family-centered, coordinated, compassionate, and culturally effective oral health care delivered or directed by a licensed professional dentist


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Making the contact treatment ?

  • Don’t assume a local dentist won’t help, based on previous refusals – try again with a different approach

  • Contact the president of the local dental society to inform of the intention of recruitment

    • Ask for recommendations of whom to contact first

    • Ask for a few minutes on a Board of Directors meeting agenda to describe Head Start and ask for dentists to participate

  • Use phone book for listing of all local dentists

  • Contact as many dentists as possible, but let all know who has already agreed to help. Foster collaboration among the dentists.

  • Recruit for exams and fluoride varnish, even

    if they won’t immediately agree to do follow-up

  • Seek the help of other health care providers as

    advocates, e.g., pediatricians, nurses


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What to Discuss treatment ?

  • Describe Head Start:

    • Stress that it is a comprehensive child development program and underscore the differences from other pre-school programs

    • Why Head Start is important in your community

    • How other agencies/individuals in your community help Head Start fulfill health related requirements

    • Outline Head Start requirements for dental services

    • Describe ways in which Head Start can and will help the dentist(s) provide services for the children


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Understand Incentives for Dentists treatment ?

  • Don’t expect or ask dentists to volunteer

    • Will not promote sustainability – likely to volunteer one year but perhaps not ongoing

    • If they are willing to volunteer they will offer

  • Promote accepting Medi-Cal fees

    • Do the math

      • # kids x exam fee + fluoride varnish fee

      • For example for 50 children

        • Examination = $25.00

        • Fluoride = $5.00

      • 50 children = $1,500.00

      • 50-75 children can be examined in a day


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Incentive for dentists (cont.) treatment ?

  • Media coverage including a photo of the participating local dentist(s)

    • Especially important in smaller towns

  • Help the dentists understand their role in helping Head Start to survive/thrive in their community

    • Without dentists’ help Head Start cannot fulfill a required Performance Standard

  • Providing exams on site will eliminate one of the most frequently cited reasons for dentists not accepting Medi-Cal patients, i.e., failure to show up for appointments


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Providing On-site Exams May Encourage Providing Follow-up Dental Services

  • Through providing examinations on-site at Head Start, local dentists will:

    • See the extent of dental need among the children

    • Have a greater understanding and value for Head Start through being on-site and observing the program

    • See that most of the children are very cooperative


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Equipment & Supplies to Provide Onsite Exams Dental Services

  • Equipment

    • Portable dental equipment

      • Cost: Approximately $2,000

      • Durability:

        • Decades

        • Can share cost & use with other sites/ programs

  • Supplies

    • Gloves, masks, disposable paper clinic gowns, disposable mirrors & explorers, dose pack fluoride varnish

      • Cost: approximately $1.50 per child


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Equipment to Provide Dental Services

  • Portable equipment will make it possible to do a thorough examination

    • Adjustable Chair = good positioning

    • Operator’s stool = dentist’s comfort

    • Adjustable light = good visibility


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Offer Help Dental Services

  • Offer to:

    • Supply a person to record examination results

    • Supply a person to get the children from classrooms and return them

    • Put a name tag on each child to assure accurate records

    • Provide a translator if needed

    • Promise to make it well organized AND MAKE IT WELL ORGANIZED


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Offer Help (continued) Dental Services

Offer to fill-out and submit Medicaid forms

  • Will eliminate one of most frequently cited reasons for not accepting Medi-Cal patients – Medi-Cal paperwork

    • Don’t expect to cover Head Start personnel costs for this effort – consider it an investment in obtaining services

    • Will be especially appealing to retired dentists who do not have an office staff


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Invite parents to come to the Head Start site to be present during the examination

  • Allows the dentist to talk with parents about their child’s oral health

    • Educational for parents

    • Begins to establish parent/dentist rapport


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Additional Strategies/Issues: during the examinationPromoting Partnership with CA Children’s Dental Disease Prevention Program

  • Direct provision of preventive services to preschool/school kids

  • Contribute to achievement of HP2010 Oral Health Objectives

  • Development of community resources for preventive services and community participation in advocating for preventive oral health services for children

  • Provision of oral health education services


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Additional Strategies/Issues: during the examinationPromoting Partnership with CCDDPP (2)

  • CCD2P2 Brings to the Table

    • Classroom Experienced Staff

    • Client follow-up

    • Continuation of Education

    • Preventive Care for Clients

    • Access to Schools

  • Collaboration Outcome

    • Continuity of Education

    • Shared Resources

    • Parent Involvement

    • Stronger Advocates for Oral Health

    • United Front

    • Healthier Children – Healthier Families


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Additional Strategies/Issues: during the examinationPromoting Partnership with CCDDPP (3)

  • Respective Advisory Groups

    • HS Health Services Advisory Committee

    • Local DDPP Advisory Group

  • Program Planning

    • N/A’s and Plan Development

  • Health Education/Promotion Efforts

    • Target priority populations, e.g., EHS

    • Share curricula

    • Co-train

  • Provider Pools

    • Cultivate referral pools and share


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Additional Strategies/Issues: during the examinationPromoting understanding

  • Include a dentist and dental hygienist on the Health Services Advisory Committee

  • Mid-career dentists may be more willing to volunteer


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Additional Strategies/Issues: during the examinationWaivers - Parental refusal to consent to dental examinations & treatment

  • Assure translation of information into their first language

  • Examine reasons if more than a few parents refuse dental examinations and treatment


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Additional Strategies/Issues: If you can’t find a local dentist…..Mobile programs – what to ask

  • What services does the mobile dental program provide?

    • Preventive only?

      • Can fulfill examination and preventive requirements

      • Requires cooperation with local dentists to provide follow-up care? Do the local dentists endorse the mobile program?

    • Restorative?

      • Can fulfill all dental requirements

      • What are the arrangements for follow-up care for emergency needs?

  • Do they have a local permanent site for follow-up care or emergencies?

  • Are x-rays readily available to be mailed to another dentist?

  • Are they endorsed by or have good communication with the local dentists?


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Additional Strategies/Issues: Fluoride Varnish dentist…..Mobile programs – what to ask

  • Fluoride Varnish is a new method of providing topical fluoride – fluoride adheres to teeth longer to make treatment last longer

  • Children from low income families are at higher risk for dental decay and therefore are more likely to need fluoride treatment

  • Fluoride varnish is new (in US) and not yet

    used by many private dental offices: Head

    Start should offer to provide it

  • Optimal for Head Start programs because:

    • Low dose of fluoride for young children

    • Does not require prophylaxis (cleaning)

    • Can be done at the Head Start site

      together with examination

    • In many states can be done by a

      dental hygienist

    • Medi-Cal reimbursable


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Additional Strategies/Issues: Approach dental and dental hygiene schools for help with examinations and follow-up care

  • Call the school - ask for the director of community-based programs

  • Dental hygiene schools have dentist faculty supervisors

    • May consider bringing dental hygiene students for community experience to:

      • Provide classroom education

      • screenings and fluoride varnish done by students followed by exam by faculty dentist (fulfill exam requirement)

    • Call the school – ask for the director of community-based programs or dental public health teacher


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What to Discuss with dental/dental hygiene school faculty: hygiene schools for help with examinations and follow-up care

  • Describe Head Start

  • Outline Head Start requirements for dental services

  • Describe how Head Start can provide an educational experience for dental/dental hygiene students:

    • Classroom education experience

    • Experience providing screening for young children

    • Child management

    • Experience observing the results of disparities in access to care

  • How other professional schools in your state/area are involving students in working with Head Start

  • Describe ways in which Head Start will help the school or program provide services for the children


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Access to Medi-Cal and hygiene schools for help with examinations and follow-up careHealthy Families

  • Help parents enroll their children in Medi-Cal or Healthy Families to enable payment for dental AND medical services

  • California Health Disability Prevention Program (CHDP): http://www.dhs.ca.gov/pcfh/cms/CHDP/pdf/denetalguide.pdf

  • Know eligibility criteria, periodicity schedule, service coverage, and provider reimbursement practices

  • Denti-Cal help line (Delta Dental): 800-322-6384


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Children Oral Health For…. hygiene schools for help with examinations and follow-up care

NEED

  • Freedom from pain and infection

  • Ability to study and learn

  • Normal facial development

  • Ability to eat nourishing food

  • Ability to speak clearly

  • Self esteem


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Oral Health Web Sites hygiene schools for help with examinations and follow-up care

Reg Louie, DDS, MPH

E-mail: [email protected]

Association of State and Territorial Dental Directors

http://www.astdd.org/

American Academy of Pediatric Dentistry-oral health guidelines

http://www.aapd.org/media/policies.asp

Local CCD2P2 Program Contacts

http://www.dhs.ca.gov/ps/cdic/cdcb/Medicine/OralHealth/Children's_Dental/html/coordinatorlist.htm

First Smiles Oral Health Program

www.first5oralhealth.org

Division of Oral Health, Centers for Disease Control and Prevention (CDC)

http://www.cdc.gov/nccdphp/oh/index.htm


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Acknowledgements to: hygiene schools for help with examinations and follow-up care

Thank you !

  • Regional Head Start Oral Health Consultants, and especially Karen Yoder, PhD, Region V

  • University of Iowa’s DVD “Modified Toothbrushing Protocol” for group brushing concepts


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