PROBLEM
Dental care especially in low income and minority children, has recently been identified as the most prevalent unmet health need in US children. Tooth decay is the most common chronic disease of childhood. It affects more than 50% of children by mid- childhood and is 5 times more common than asthma. A recent survey of 3-6 year old Head Start children in Wisconsin indicated 48% had a history of dental caries. 22% of the children had Early Childhood Caries (ECC) as defined as any child 3 years old or younger with at least one of six upper front teeth either decayed, filled, or missing due to cavities. Hispanic children in Wisconsin are disproportionately affected by dental caries. According to Dr. Warren LeMay, 29.2% of Hispanic Head Start children had ECC compared to 21.2% of white and 9.9% of black children. Following these statistics, Hispanic Head Start children were also more likely to require early or urgent dental treatment, (28.2% compared to 22.6% of white and 19.8% of black children). In addition, the highest proportion of children with untreated decay was Hispanics, 28.3% compared to 24% of white and 19.8% of black children. Our patient population is primarily low-income, Hispanic young children who, based on the above data, are at high risk for childhood tooth decay. In addition, many of our providers lack basic oral health knowledge and the causes and preventive actions for dental caries. We are proposing to implement a preventive program targeting Hispanic children, which will focus on both education and direct treatment to reduce the incident of dental caries.
It is well known that pregnancy causes many changes in mouths of the prospective mother. Changes in hormone level during pregnancy have been shown to influence the composition of plaque and to exacerbate the gingival response to plaque. In addition, there is significant evidence that many conditions that occur in the mother pose a risk to the child both pre and post-natally. Peritonitis (the loss of the soft tissue attachment and destruction of tooth supporting bone) has been established as a significant risk factor for premature birth and low birth weight. Offenbacher et al documented that women who have low birth weight infants as a consequence of either pre-term labor or premature rupture of membranes tend to have a more severe periodontal disease than mothers of full term normal birth weight infants. More recent studies from the University of Alabama have shown that after adjusting for different confounding factors the risk of having a pre-term birth was 4.5 times more likely if the mother showed generalized peri-odontitis at the second trimester of pregnancy.
GOALS & OBJECTIVES
The goals and objectives of the Hispanic Children’s Oral Health Project are: 1) to provide basic oral health education to our medical providers. We plan to educate our medical providers (family practitioners, pediatricians, physician assistants, nurse practitioners and midwifes) in the basics of oral; 2) To provide oral health education and counseling to our expectant mothers, particularly those exhibiting high risk, as determined by the Caries Risk Assessment Tool developed by the American Academy of Pediatric Dentistry. The teaching will cover the dental disease process and oral hygiene, specifically, the effects of the mother’s dental status on the health of her newborn. Free samples of fluoride gum and rinses will be provided to all pregnant patients; 3) To institute a fluoride varnish program, in which a high concentration fluoride is painted directly onto the teeth. The application of the fluoride varnish will be done at the time of the well child checks (WCC) from the time the first tooth erupts through age 5; and 4) Improve oral health care access in order to establish a “dental home” for both mother and baby.
METHODOLOGY
The Project proposes to educate our medical providers in the basics of oral. This will be done by distributing pertinent information during provider monthly meetings and training sessions with specialists in the different areas. This will allow a better understanding of the associations between oral and general health and will give the providers tools to screen, counsel and refer appropriately. An “Oral Health During Pregnancy” information packet will be developed and distributed in English and Spanish to all of our pregnant patients with additional one-on-one teaching provided to those exhibiting high risk. All uninsured pregnant women will be offered dental appointments at our Dental Clinic during their pregnancy and oral health education and fluoride treatments will be provided postnataly to their children.
COORDINATION
SSCHC has a long and successful relationship with the State of Wisconsin MCH program, the State of Wisconsin Dental Association, and other service providers in our community. In addition, SSCHC is a member of the Wisconsin Healthy Smiles Coalition.
EVALUATION
An evaluation will be conducted to determine the level of oral health knowledge exhibited by our provider teams and our pregnant patients. In addition, the rate of children receiving fluoride varnish will be monitored.
ANNOTATION
The Hispanic Children’s Oral Health Project will motivate prenatal care providers to routinely screen for oral health risk during pregnancy. Strategies include: staff training, patient education, dental care referrals, and post natal education and fluoride treatments.
KEYWORDS
Bilingual services, case management, community based health services, community health centers, comprehensive primary care, cultural sensitivity, dental treatment of children, family centered health care, early intervention, family centered health education, health insurance, health promotion, Hispanics, low birthweight, low income, maternal nutrition, medical home, nutrition, oral health, parent education, pediatric dentistry, Pediatricians, pregnant women, prematurely, prenatal care, preventive health care, primary care, Spanish language materials, uninsured, Well Baby Care Well Child Care.
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