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4/22/2021 Oral Health Care

Promotion

Kourtnie Jarvis & Ashley Locke

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Oral Health Promotion

Children of all income levels are in need of better oral health care and education. Dental

caries, the most common chronic disease of childhood, affects 60% of children ages 5 to 17 and

35% of children under the age of 5 experience Early Childhood Caries (ECC) (Bersell RDH,

BASDH, 2017). Research has shown individuals who participate in the Medicaid group in

America have benefitted from intervention and education from pediatricians and dental

hygienists on behalf of the governmental agencies who monitor these programs to ensure parent

involvement and compliance. In contrast, for years we have ignored a vast majority of the

population which do not fall under the umbrella of Medicaid and government intervention.

Medicaid participants are typically in poverty and many low-income families do not qualify for

this program. We can expand the same parameters to all children with advertising, early

intervention in our schools, and behavioral changes which can make lifelong modifications that

will improve the overall health of the public well into adulthood. This goal can be accomplished

by the addition and modification of a public-school sealant programs which are already in place

in some areas and assistance from pediatricians with just a few questions added to a yearly

checkup. Modifying these programs to include oral health education, not only for parents, but for

children as well. Adopting these ideas is a great way we can make a difference in the way the

general public views oral health, oral care, and oral education. Additionally, quelling basic fears

and misconceptions about dental procedures through education can change the way families

perceive the dentist and oral health for generations.

For years, the amount of people who fall into the poverty level of income has increased

and does not show any signs of improvement, especially since the pandemic of 2020. Therefore,

more Americans do not have access to dental care. One must remember that low income is
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different than poverty. The poverty line is set at $2,184 for a family of four per month as

compared to low income at $25,790 for a family of five per month. As you can see a person in

poverty is in a much more dire situation than low income. Most studies for caries risk are based

on low-income families who do not always qualify for Medicaid services. Unless they are able to

pay out of pocket for dental services, they usually only seek treatment in an emergency situation.

The government has had great success with implementing guidelines that require parents to take

their children to a dentist every six months for a check-up, which payment is covered by

Medicaid. However, the uninsured or underinsured do not receive such hands-on attention; they

are frankly ignored. This is a population in great need of reform and education. As it stands now

caries is the most chronic condition in children in America, 1 in 5 children have at least one

untreated decayed tooth. School sealant programs can be an important intervention to increase

the receipt of sealant, especially among underserved children. Sealant programs can reduce or

eliminate racial and economic disparities. If sealant programs were provided to all eligible, high

risk schools, such as those in which have 50 percent or more of the children are eligible for free

or reduced-price meals (Clemans-Cope et al., 2015). Low-income households are in just as much

of a risk for caries as poverty level households and yet our focus in mainly in poverty level

homes. Further still the range of low income has drastically expanded in the past few years.

In addition to Medicaid there is another program for low-income families called

Children’s Health Insurance Program (CHIP). This is considered a low-cost insurance program

but does not always have all the coverage a parent would hope for. This program does have

dental insurance coverage. In a study comparing CHIP and uninsured children it found. The

parents of uninsured children were 67 percentage points less likely to report that the child had

dental coverage compared to the parents of CHIP enrollees. In addition, the parents of uninsured
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children appeared to have lower awareness of the need for dental care among children, as these

parents were 8 percentage points more likely to report that their child does not need a dentist

(data not shown). CHIP enrollees were 38 percentage points more likely than uninsured children

to have a usual source of dental care (Clemans-Cope et al., 2015). While chip is a low-income

insurance program, it is still considered a type of insurance and not monitored the same way as

Medicaid.

All school aged children are required to go for a physical and/or vaccinations prior to

every school year in America. In addition, all children who are on the Medicaid program get

letters in the mail to remind the parents it time for a well visit at the pediatrician’s office, in

addition, they also receive a letter to remind them it is time for a dental check-up for each child.

In fact, they will also send a letter six months later to again remind the parents it is again time for

a dental check-up for each child. The uninsured or underinsured do not receive this level of

communication from their provider or pediatrician. Studies have indicated that with minimal

assistance from the pediatrician more children receive a regular dental check than children who

do not have this level of interaction from providers. In 2020, a pilot study was published showing

that a simple 45 minutes online self-paced instructional course for pediatricians once a year was

sufficient in educating the provider with enough oral health knowledge to not only intervene

when necessary, but to also educate the parents on the importance of regular oral health

screenings, dental referrals, and the need for young children to visit the dentist. Topics that were

included in the online course for the providers were healthy and unhealthy dentition appearance,

and self-care strategies to help care givers take care of the child’s teeth. The study was also able

to show that providers can assist and improve the education level of parents, the interest in oral

health, and encourage parents to seek dental checkups for their children. Since a pediatrician is
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more widely used in the community, the child will be seen more regularly, therefore, it is vital to

have cooperation for medical health providers to help educate the public about oral health as

well. By the end of the study, the participating providers agreed upon four questions being added

into their check-up criteria. Providers’ answers to the four questions indicated (yes or no)

whether they: (1) examined child’s teeth for white or brown spots, (2) asked if child saw dentist

in past 12 months, (3) communicated oral health facts, and (4) gave prescription and list of

dentists (Nelson et al., 2020). The results of the study showed 51 of the 86 children aged three to

six had dental caries and 59% of the children made or had taken the child to a dental appointment

within two months of the well child visit. Clearly showing with just a simple reminder or

intervention parents took their children to the dentist more frequently.

Behavior modification is essential to the maintenance of a healthy mouth and to

thwart oral health complications. For years, the focus has been placed on the parents or

guardians of the child for all the needs when it comes to proper home care. Why not direct this

focus to the children themselves? Children, as we know, are like little sponges and retain

information not only faster than adults but want to learn as much as possible. A study published

in 2019 has demonstrated that involving the children in their own oral health care routine and

education can have profound and excellent outcomes. As the study states, in the past most

attempts at educating have either been towards the parent or the child but rarely both, if at all.

The hygienists were able to accomplish success with a mere five to twenty five-minute

educational session on the initial visit, with an additional follow up mailed out to the family.

After six months the child’s oral health was reassessed, and the results showed promise. The

procedures proved popular, and participants exposed to the intervention additionally reported

believing that forming implementation intentions was effective. Descriptive statistics generally
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showed oral health improvements across all conditions, although the effects were more marked

in the intervention plus booster condition, where plaque improved by 44.53%, gingivitis

improved by 20.00% and free sugar consumption improved by 8.92% (vs. 6.43% improvement,

15.00% deterioration and 15.58% improvement in the control (Armitage, Walsh, Mooney,

Tierney & Callery, 2019). What the study calls a booster is just the letter mailed out to the

families. Such an easy and simple way to assist families in making a change. If the letter is

addressed directly to the child, this too could be a way of holding the child accountable for their

own oral health.

Combining the school sealant program into all public schools not just low-income

schools, the involvement of pediatricians, and implementing a more child centered educational

program in the dental setting we could change our nation. This could have widespread positive

consequences for our country’s health, the way our children view their self-worth, improve self-

esteem, possibly even opening the door for better career opportunities. A great smile changes

how we carry ourselves.

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References

Armitage, C., Walsh, T., Mooney, J., Tierney, S., & Callery, P. (2019). Proof of concept trial for

a new theory-based intervention to promote child and adult behavior change. Journal Of

Behavioral Medicine, 43(1), 80-87. https://doi.org/10.1007/s10865-019-00061-0 Bersell RDH,

BASDH, C. (2017).

Access to Oral Health Care: A National Crisis and Call for Reform. Critical Issues In Dental

Hygiene, 91(1). Retrieved 17 April 2021, from.

Nelson, S., Slusar, M., Curtan, S., Selvaraj, D., & Hertz, A. (2020). Formative and Pilot Study

for an Effectiveness-Implementation Hybrid Cluster Randomized Trial to Incorporate Oral

Health Activities into Pediatric Well-Child Visits. Dentistry Journal, 8(3), 101.

https://doi.org/10.3390/dj8030101

Clemans-Cope, L., Kenney, G., Waidmann, T., Huntress, M., & Anderson, N. (2015). How Well

Is CHIP Addressing Oral Health Care Needs and Access for Children?. Academic

Pediatrics, 15(3), S78-S84. https://doi.org/10.1016/j.acap.2015.02.009

Clemans-Cope, L., Kenney, G., Waidmann, T., Huntress, M., & Anderson, N. (2015). How Well

Is CHIP Addressing Oral Health Care Needs and Access for Children?. Academic

Pediatrics, 15(3), S78-S84. https://doi.org/10.1016/j.acap.2015.02.009