Early Childhood Caries—tooth decay among children under age six—is a disease process that can cause pain that affects a child’s ability to eat, speak, and learn at a time when he or she should be developing and thriving. Almost half of all children develop this decay before they reach kindergarten, with the greatest burden occurring in low-income children.

Like the American Dental Association, we are encouraged at seeing preliminary data showing that untreated decay among preschool children has fallen. But we’re still disturbed that many young children are getting cavities, because this disease is almost always preventable.

In 2011 the Health Foundation for Western and Central New York partnered with the Centers for Disease Control and Prevention to fund the development of a simulation model that compared the cost-benefit/effectiveness of seven strategies for children ages zero to five years. The model built on work done previously in Colorado. The Children’s Dental Health Project, the New York State Department of Health, and consultant Gary Hirsch, an expert on this type of model, collaborated on design, data collection, and analysis. The Children’s Dental Health Project has developed a paper outlining the key findings of the model.

The model tested oral health strategies that evidence showed were most effective at preventing Early Childhood Caries and saving Medicaid money. These included community water fluoridation, increased tooth-brushing, and fluoride varnish application. Fluoridation yielded the highest potential Medicaid cost savings in the model, although the other strategies also showed promise for reducing disease and producing Medicaid savings. Overall, researchers found that proven public health practices such as fluoridation were effective in the model, but there are opportunities that exist to increase effectiveness by using clinical guidelines and better risk assessment to reduce disease.

It is common for research to be put on a shelf or stored online, with none of that knowledge transferred to organizations working in the field. However, understanding that this model could benefit children if it were used as the basis for community engagement, the Health Foundation sought partners to create a replicable, community-based program to reduce Early Childhood Caries.

Around the time that this simulation model was ready, New York State’s health department released its Prevention Agenda. This document is the blueprint for state and local activities to improve the health of New Yorkers. For the first time, it contained specific goals for reducing dental disease in children. A program designed around the simulation model was an opportunity to help communities achieve these goals through the application of evidence-based strategies.

The Health Foundation and the New York State Health Foundation teamed up to fund the Schuyler Center for Analysis and Advocacy to manage a partnership charged with developing an oral health program to be piloted in two sites in 2014. The center is a statewide, nonprofit, nonpartisan, human services advocacy organization with a long history of working to promote policies to improve oral health in New York State.

The Schuyler Center collaborated with the Children’s Dental Health Project to develop a Community Campaign Kit and training workshops. This kit helps communities apply the simulation model results and guides community engagement activities. The New York State Department of Health and the newly created New York State Oral Health Center of Excellence provided data guides for each community and resources on best practices.

The local campaigns are designed to bring together community residents, service providers, and local leaders to better understand the impact of early tooth decay in their community and the different strategies that can address it. The idea for a local campaign is that each community should decide how to use limited resources and the assets already available to improve the oral health of its children. The process makes community members informed decision makers and advocates for what interventions get funded and sustained in the community.

The first pilot started in Jefferson County, a rural county in northern New York with one city (Watertown) in the spring of 2014. The first step was to create a Community Leadership Team led by the Jefferson County Public Health Service, which is the local health department. In addition to local health department leaders, the team consists of what might be considered traditional oral health partners—dentists, hygienists, and health clinics—as well as more nontraditional players— the Women, Infants, and Children (WIC) program, the perinatal network, schools, nutritionists, and the local water superintendent. Some team members recognize dental disease in children they serve but do not know how to directly help them. Others see the value of broader public health interventions to reduce disease at the community level. They all see this as a chance to take action.

The Schuyler Center, Children’s Dental Health Project, and the Oral Health Center for Excellence conducted two full-day workshops for the team. Team members received in-depth data on the oral health needs of children in the county, coaching on the outcomes of the various strategies tested by the simulation model, and training to recognize and build upon existing opportunities to promote oral health. They also learned how to develop messages and communicate about oral health to the broader community.

“Keep Jefferson Smiling,” the oral health pilot project in Jefferson County, is now working on rolling out three evidence-based strategies to reduce Early Childhood Caries in its community. For the first strategy, integrating tooth-brushing curricula into early care programs, the project sent one public health educator and two early childhood educators to learn how to implement an evidence-based oral health education program, Cavity Free Kids, and have plans to train at least fifteen preschools in 2015.

A second strategy is maintaining access to community water fluoridation at 74 percent of the Jefferson County population and supporting expansion where feasible. Work will encompass support of statewide initiatives as well as education of local communities on the importance of community water fluoridation.

The group’s third strategy is encouraging primary care providers to apply fluoride varnish to young children’s teeth.

The project is developing and sustaining a community conversation about the importance of oral health. Working with the partners, the team is receiving ongoing technical assistance. The team is also seeking grants for some of the work.

The program has now launched its second pilot in Buffalo, incorporating what has been learned so far from Jefferson County. Developers are testing this model in two very different communities to learn how this model works in both a rural and an urban setting.

On October 7, the Schuyler Center, Children’s Dental Health Project, and the Oral Health Center for Excellence held an introductory meeting in Buffalo as work began on the second pilot community. Meeting participants discussed the impact of poor oral health on children, looked at data on the oral health of young children in the community, and heard an overview of the simulation model.

As these first two pilot projects are being conducted, the Community Campaign Kit is being revised to incorporate “real time” needs and experiences of each local team. It is also being designed to reflect differences between a rural model and an urban model. We hope that the Jefferson County and Buffalo projects will demonstrate how a diverse group of community members in each locality using an evidence-based set of strategies can change community norms to create a generation of cavity-free kids.

Our challenge is to ensure that families don’t view early childhood cavities as “normal.” We want to make sure that they take steps in their homes and communities to prevent tooth decay from happening in their children’s mouths.

Editor’s Note

Related resource:

“Foundations See Importance of Oral Health,” Lee-Lee Prina, Health Affairs GrantWatch column, June 2014 issue.


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