LA PREMIЀRE DENTColored lithograph by Bove

After the drawing by Louis Léopold Boilly (1761‐1845)

A young woman shows her infant’s first tooth to a friend, while two children look with interest.  The obviously proud father stands behind, and a dog looks on at the scene.

Mid‐ 19thC

Courtesy of

Menzies Campbell Collection

Royal College of Surgeons, Edinburgh, Scotland

The Experiment

Lithograph by

1922

Courtesy of 

Private Collection

Bacteria

Tooth

FermentableCarbohydrate

Imagine breaking the circle!

Head Start/AAPDDental Home Initiative

Nicholas G. Mosca, DDSHHS Region 4 Oral Health Consultant

2009 ADEA Annual SessionMarch 16, 2009

Office of Head Start

• Head Start: Established in 1965. Federally funded pre-school for low-income 3-5 year-old children.

• Early Head Start: Established 1995. Serves children age 0-3. ~10% of HS children are in EHS.

• Promotes school readiness through the provision of educational, health, nutritional, social and other services to enrolled children and families.

FY 2006 Head Start Program StatisticsENROLLMENT 909,201

Ages:5 year olds & older 4%4 year olds 51%3 year olds 35%Under 3 years of age 10%

Racial/Ethnic Composition:American Indian/Alaska Native 4.2%Black/African American 30.7%White 39.8%Asian 1.8%Hawaiian/Pacific Islander .9%Bi-Racial/Multi-Racial 6.4%Unspecified/Other 16.2%Hispanic / Latino 34%

# of Grantees 1,604# of Centers 18,875# of Classrooms 50,030

Avg. Cost/Child $7,209Paid Staff 218,000Volunteers 1,365,000

• 91% of Head Start children had health insurance.• 87% of those with health insurance were enrolled in Medicaid EPSDT or SCHIP programs.

• Within 90 days of enrollment:– determination that each child is up to date on a

schedule of age-appropriate preventative dental care.

– determination that each child has an “ongoing source of continuous, accessible health care”.

• For those without a Dental Home, Head Start must assist families in accessing a source of care, that includes prevention and treatment.

Conditions for Federal FundingHead Start Performance Standards

OHS/AAPD Dental Home Program

• Project leadership and organizational support– Federal Office of Head Start consultant– Oral Health Consultant in 12 federal HHS regions– Head Start Dental Home Leader in 50 States

• Head Start Mentorship Teams• Local Dental Home Networks

• Resource Development and Training

Head Start RegionsHead Start Regions

American Indian & Alaska Natives

27

states

Migrant

Head Start

40

states

Peer-to-Peer Model• Model relies on peer-to-

peer professional efforts.• Dentists have the ability to

organize services for various groups when those efforts provide mechanisms for aligning dentists’interests and skills with local community program needs.

National Level Activities• Expert Workgroup

• National Organizational Partners• Policy Analysis

• Project Evaluation

Regional Level Activities• (List goals)

State Level Activities• Organize and train

Head Start Mentorship Teams• Oversee and monitor implementation

of Dental Home Initiative activities

Local Level Activities• Build and sustain Dental Home networks

Opportunities for Dental Academic Institutions

Questions

• Contact Information

©© LMCLMCáárdenas/2008 rdenas/2008

ANTICIPATORY GUIDANCEANTICIPATORY GUIDANCE

Lina MarLina Maríía Ca Cáárdenasrdenas--Dentchev, DDS, MS, PhDDentchev, DDS, MS, PhDDiplomate American Board of Pediatric DentistryDiplomate American Board of Pediatric Dentistry

Department of Pediatric DentistryDepartment of Pediatric Dentistry

Anticipatory GuidanceAnticipatory Guidance

““Anticipatory GuidanceAnticipatory Guidance is the process of providing is the process of providing practical, developmentallypractical, developmentally--appropriate information about appropriate information about childrenchildren’’s health to prepare parents for the significant s health to prepare parents for the significant physical, emotional, and psychological milestonesphysical, emotional, and psychological milestones””

Pediatr Dent. 2008;30(7 Suppl):112-118.

Anticipatory GuidanceAnticipatory Guidance

Anticipatory GuidanceAnticipatory Guidance

Talking (educating) to your patient…..

Anticipatory GuidanceAnticipatory Guidance

Through his/her parent…..

Anticipatory GuidanceAnticipatory Guidance

““SHOT FDDSHOT FDD””

•• Speech Development / SmokingSpeech Development / Smoking

•• Health & HabitsHealth & Habits

•• Oral HygieneOral Hygiene

Anticipatory GuidanceAnticipatory Guidance

•• Fluoride ExposureFluoride Exposure

•• Diet / Development of the Diet / Development of the

dentitiondentition

Speech and Language Speech and Language

•• Early recognition of speech and language Early recognition of speech and language developmentdevelopment

•• Early referralEarly referral•• Coordination of ServicesCoordination of Services

©© LMCLMCáárdenas/2009 rdenas/2009

Smoking and smokeless Smoking and smokeless TobaccoTobacco

•• Very often established in adolescenceVery often established in adolescence

©© LMCLMCáárdenas/2009 rdenas/2009

HealthHealth

•• Some medical conditions affect the caries Some medical conditions affect the caries risk of the patientrisk of the patient

•• MedicationsMedications•• XerostomiaXerostomia

©© LMCLMCáárdenas/2009 rdenas/2009

HabitsHabits

•• NonNon--nutritive habitsnutritive habits–– Thumb suckingThumb sucking–– Pacifier usePacifier use

©© LMCLMCáárdenas/2009 rdenas/2009

Oral HygieneOral Hygiene

•• Cleansing of mouth prior tooth emergenceCleansing of mouth prior tooth emergence•• Tooth brushing upon emergence of the Tooth brushing upon emergence of the

first toothfirst tooth•• OHI involves parent and patientOHI involves parent and patient

©© LMCLMCáárdenas/2009 rdenas/2009

TraumaTrauma

•• AgeAge--appropriate injury preventionappropriate injury prevention•• Playing objectsPlaying objects•• Car seatCar seat•• ““child proofchild proof”” homehome•• Use of mouth guards in older childrenUse of mouth guards in older children

©© LMCLMCáárdenas/2009 rdenas/2009

Fluoride ExposureFluoride Exposure

•• Drinking waterDrinking water•• Bottled waterBottled water•• Fluoride content in nursing waterFluoride content in nursing water

©© LMCLMCáárdenas/2009 rdenas/2009

Fluoride Supplementation Fluoride Supplementation ScheduleSchedule

Pediatr Dent. 2008;30(7 Suppl):121.

DietDiet

•• Never to bed with a bottleNever to bed with a bottle•• AAP recomend eliminating bottle use by AAP recomend eliminating bottle use by

age 1age 1

DietDiet

•• High risk dietary habits are established by High risk dietary habits are established by 12 months and maintained through 12 months and maintained through childhoodchildhood

Development of the DentitionDevelopment of the Dentition

•• Sequence more important than timingSequence more important than timing•• Generalized spacingGeneralized spacing

©© LMCLMCáárdenas/2009 rdenas/2009

Relationship between Mother’s and Children’s oral health

• There is a relationship between Mother’s and child’s level of LB & MS in saliva and plaque

Wisconsin Dental Association – Dental Home Initiative

Background and History

Knee-to-Knee Exam

For more information about the WDA Dental Home, contact your state dental association executive director

orWDA Executive Director Mark Paget

mpaget@wda.orgor

414-755-4100