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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

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
Link to Website for Program Instruction in Oral Health
  • http://www.mchoralhealth.org/HeadStart/index.html
  • Other helpful information will also be found at this site
toothbrushing for children age two and over
Toothbrushing for children age two and over

“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”

advantages
Advantages
  • 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
slide7
Using an egg timer allows children to learn how long they should be brushing and monitor their progress
in head start when to brush
In Head Start, when to brush?
  • Once daily
  • After the meal
slide9
1 & 2 - paper towels (table cloth & napkin)

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

slide10
1. Toothpaste with fluoride

2. Less than pea size…

3. Put it on the rim…..

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

slide11
Toothbrushing is role modeled, monitored for cleaning all parts of the mouth and using adequate time
slide12
Brush, brush, brush

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

slide15
Put the napkin in the cup to absorb liquid

..and dispose of the paper and cup

slide19
No toothbrush covers needed

Ventilation holes

Spacious compartments for drying

Wash drawers in a dishwasher

prevdentsp@aol.com $24.99

A system

to consider

slide20
Not role modeled

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

for children between one and two years of age
For children between one and two years of age
  • 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
dispensing toothpaste for 1 2 year old children
Dispensing toothpaste for 1-2 year old children
  • Avoid spreading germs
  • Dispense toothpaste onto a tongue blade, and wipe it onto the brush or
  • Use individual small tubes of toothpaste
for infants under the age of one
For infants under the age of one

“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”

should gloves be worn while brushing 1 2 year old children s teeth or wiping infant s gums
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
helping parents whose children are not up to date
Helping Parents Whose Children Are Not Up-To-Date

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
who are appropriate dental professionals for examination and treatment
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
why is providing dental services a challenging task
Why is Providing Dental Services a Challenging Task
  • 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
dental provider shortages
Dental Provider Shortages?

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

benefits of onsite exams
Benefits of Onsite Exams
  • 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 …
the goal
The Goal –

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

making the contact
Making the contact
  • 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

what to discuss
What to Discuss
  • 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
understand incentives for dentists
Understand Incentives for Dentists
  • 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
incentive for dentists cont
Incentive for dentists (cont.)
  • 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
providing on site exams may encourage providing follow up dental services
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
equipment supplies to provide onsite exams
Equipment & Supplies to Provide Onsite Exams
  • 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
equipment to provide
Equipment to Provide
  • 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
offer help
Offer Help
  • 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
offer help continued
Offer Help (continued)

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
invite parents to come to the head start site to be present during the examination
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
slide43
Additional Strategies/Issues:Promoting 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
additional strategies issues promoting partnership with ccddpp 2
Additional Strategies/Issues:Promoting 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
additional strategies issues promoting partnership with ccddpp 3
Additional Strategies/Issues:Promoting 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
additional strategies issues promoting understanding
Additional Strategies/Issues:Promoting understanding
  • Include a dentist and dental hygienist on the Health Services Advisory Committee
  • Mid-career dentists may be more willing to volunteer
additional strategies issues waivers parental refusal to consent to dental examinations treatment
Additional Strategies/Issues: Waivers - 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
additional strategies issues if you can t find a local dentist mobile programs what to ask
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?
additional strategies issues fluoride varnish
Additional Strategies/Issues: Fluoride Varnish
  • 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
slide50
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
what to discuss with dental dental hygiene school faculty
What to Discuss with dental/dental hygiene school faculty:
  • 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
access to medi cal and healthy families
Access to Medi-Cal and Healthy 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
children oral health for
Children Oral Health For….

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
oral health web sites
Oral Health Web Sites

Reg Louie, DDS, MPH

E-mail: rlouie@acf.hhs.gov

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

acknowledgements to
Acknowledgements to:

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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