This article originally appeared in the July-August 2006 issue of the Children's Advocate, published by Action Alliance for Children.

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Early Care and Education

Healthy smiles

Child care teachers and health experts give tips for starting kids early on good oral health

By Aimee Strain

Nearly a third of California third-graders have untreated dental problems—and dental disease is five times more common than asthma, says a recent report from the Dental Health Foundation (see “Mommy, it hurts to chew”). But tooth decay—and pain—don’t only affect school-age children.

While experts recommend that children brush twice a day and start seeing a dentist regularly (as soon as a baby has teeth), most children don’t go to a dentist until kindergarten, says Darlene Burton, disability specialist for Glendale’s Center for Community and Family Services.

Early care and education teachers and providers, along with health experts, offer tips for teaching kids about oral health.

Kids “flourished after their teeth were fixed”

“Children with (tooth decay) often have pain with eating, so they don’t want to eat,” says Shawn Henson, health specialist for Shasta Head Start. “I recall numerous children (with health problems) who flourished after their teeth were fixed. Children in pain can’t learn, they can’t eat, they don’t sleep well, and they don’t sit still.”

Last year, Henson recalls, three children were “cranky, hitting, biting, throwing things, or not able to sit still.” Routine dental screenings revealed cavities and, after the children’s teeth were fixed, “teachers noticed the behavior issues resolved themselves.”

Another child was underweight, anemic, and had severe dental decay. “She ate very little because her mouth hurt,” says Henson. Head Start home visitors worked with her parents to improve her diet and get her vitamins. She drank Pediasure (a diet supplement) at Head Start but still didn’t eat enough. It took two years to find a dentist in her area who would accept Denti-Cal (state dental insurance). Head Start staff took her to dental appointments because “transportation was a barrier,” says Henson. But once her teeth were fixed, “she gained weight until she was within normal range.”

Make brushing routine

“If you encourage kids to brush after meals, it becomes a habit,” says Henson. Children in her program start brushing when they can spit out toothpaste (about 2 years). After meals, they take turns brushing while other kids play or help clean up—and children designated as “tooth-brushing monitors” choose the next child to come brush. Younger children dry brush with easy-to-hold toothbrushes and, after infants eat, teachers wipe their mouths with a soft washcloth.

Head Start programs provide children with toothbrushes and toothpaste. Other programs can get brushes donated by local dentists or toothbrush companies. If children can’t brush after meals, they should swish their mouth with water, gargle, and spit it out.

Make brushing fun

It’s easy to make children want to brush, says Robbie Bergerson, community outreach coordinator for Sonrisas (Smiles) Community Dental Clinic in Half Moon Bay. “We have them count to 10” on each side of the upper and lower teeth. Other teachers suggest children hum “Happy Birthday,” the alphabet song, or another familiar song.

“When our kids (go) to the dentist, we tell (them) how cool it is to go, so (they) get excited,” says Teresa Campbell, who runs a family child care, Kidsink Preschool, in San Mateo.

Build good habits

“Eating healthy is really important,” says Julia McKeon, executive director of Sonrisas. She uses a sugar cube chart to show kids just how much sugar is in the food they eat. When children eat lunch, she adds, “we tell them to eat anything crunchy (such as an apple or carrot), that will clean their teeth, last.”

Henson advises teachers to give kids water throughout the day instead of milk or juice, and milk at mealtimes. Campbell doesn’t allow pacifiers in her program because “there’s bacteria all over them.” And she recalls one child’s teeth sticking out from using his pacifier so much.

Talk with parents

“The most important thing is (that) parents understand how important oral health is,” says Maryanne Lewis, principal at Sea Breeze Preschool in Foster City. Let kids “pick out their favorite toothbrush,” she adds.

Teachers can suggest that “parents teach kids how to brush, encourage brushing twice a day, and (offer) healthy snacks and diet,” says Bergerson. She gives stickers to parents to put by the mirror to “remind kids to brush before bed.”

Teachers can tell parents about free and low-cost state dental insurance for children—though in some areas it may be hard to find a participating dentist. Henson’s program provides translation at dentist appointments and plans to follow-up with families.

Get help from the pros

Sonrisas Dental Center visits early care and education programs to teach kids about oral health. “We have two-foot-high puppets that children practice brushing on,” says Executive Director Julia McKeon. “One is a ladybug named Bruno and one’s a bug named Gloria. We also (give out) brushing charts, and when children bring them back, they get stickers.”

Sonrisas also recruits local dentists and hygiene students to do free dental screenings at programs. Other programs contact local dentists directly. After Henson spoke about Head Start at a dental hygiene school, board members and students began giving free dental exams. Burton contacted a retired dentist to come do dental screenings once a year. One of the parents at Kidsink is a dentist who gives exams and teaches kids about oral health.

“Grinning ear-to-ear”

“One child had 20 cavities, every tooth was infected,” recalls Henson. “After he got treatment, “he grinned ear to ear (as he showed) his Head Start teacher his new teeth.”

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“Mommy, it hurts to chew”

A recent Dental Health Foundation report finds

• Dental disease is five times more common than asthma.

• Children with severe tooth decay are often in pain, unable to concentrate, and missing school.

• By third grade, 70% of California’s children have had tooth decay—28% have untreated decay.

• Poor children and children of color are much more likely to have untreated tooth decay.

• 72% of Latino children surveyed have had tooth decay—nearly twice the rate for non-Latino children.

For more info: DHF, 510-663-3727, www.dentalhealthfoundation.org

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First Smiles

An initiative of First Five, First Smiles provides oral health education and training for early childhood educators and parents of young children. California Head Start Association works with First Smiles to train Head Start staff about oral health.

• First Smiles, http://first5oralhealth.org

• CHSA trainings, http://caheadstart.org/OralHealthEducation.html

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Extra resources from the Children’s Advocate bulletin

• Bright Futures Toolbox, from the National Maternal and Child Oral Health Resource Center, compiles links for families and human services professionals to information on improving oral health. Includes oral health curricula, guides, and screening tools, as well as hand-outs and information for parents in 15 languages. Online at http://www.mchoralhealth.org/toolbox

• Facts Sheets for Families, from the California Child Care Health Program, include 40 hand-outs for families on health-related issues. Topics include tooth decay, toothbrushing, tooth and mouth care, sugar, and good nutrition. In English and Spanish at http://www.ucsfchildcarehealth.org/
  html/pandr/factsheetsmain.htm

• National Head Start Oral Health Resource Center, also from the National Maternal and Child Oral Health Resource Center, offers oral health resources, including a monthly email newsletter, frequently asked questions, materials for Head Start staff and parents, and related links. Online at http://www.mchoralhealth.org/HeadStart/index.html

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