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Action Steps

Table of Contents

Video Material
Recommendations for Action
Action Steps
Summary of State-Level Recommendations
Additional Sources of Support for MCH Program Directors

Video Material

MCH Professionals’ Expressed Needs for Information on Children’s Oral Health
MCH Professionals’ Expressed Interest in Children’s Oral Health
Organizations Recommending Action

Recommendations for Action

A variety of governmental, professional, child-health, and coalition groups - including the Association of MCH Programs - have developed recommendations for action to address poor oral health among US children.

One of the most comprehensive efforts to date, was a March 2000 US Surgeon General's invitational Workshop on Children and Oral Health . This forum convened 100 experts from a variety of disciplines to make recommendations to government and the public. Its 8 major proposals were presented at the June 2000 Surgeon General's Conference, The Face of the Child (52).

Background papers and fact sheets prepared for the Workshop include contributions on oral health disparities, ethical issues in pediatric oral health, US demographic and social trends affecting the health of young children, workforce issues, dental care delivery systems, science-based trends, strategic communications, and a review of state/ regional/ and national initiatives on pediatric oral health.

These recommendations can be used as action steps to help our nation's children obtain and enjoy the benefits of oral health. Within the general action steps described below are action steps specific to the MCH Title V Block Grant Porgram As suggested by AMCHP in its issue brief Putting Teeth in Children's Oral Health Policy and Programs: The State of Children's Oral Health and the Role of State Title V Programs.

Action Steps

8 Action Steps
Click on any step to jump down the page


Step 1: Start early and involve allIncludes establishing a child’s dental home at age one, identifying high-risk children and promoting individualized preventive regimens in both medical and dental practice, developing community-based health coordinators to promote ongoing integration of oral health with general health care, developing day-care accreditation standards on oral health, and addressing the oral health needs of caregivers to promote more widespread attention to oral health.

Title V can ensure that the provision and promotion of dental and oral health services are integrated into all aspects of maternal and child health program implementation, needs assessment, policies, and planning, including those affecting children with special health care needs (CSHCN).

Oral health status should be incorporated into every
prenatal care or public health clinic visit.

Step 2: Assure competenciesIncludes developing common core curricula on oral health for all health professionals and developing accreditation standards, guidelines, and performance measures that assure the inclusion of oral health promotion and, where appropriate, treatment in professional training and practice.

Title V can assist in training private and public health care practitioners about the oral health needs of children, pregnant women and other vulnerable populations, to ensure that these needs are covered in a comprehensive exam.

Title V can utilize its knowledge of training to expand the capacity of private and public sectors, to ensure oral health needs are incorporated into routine primary and preventive care.

Step 3: Be AccountableIncludes promoting school-based prevention, education, screening , and referral programs on oral health and developing performance measures and tracking systems to ensure that these programs are effectively implemented.

Title V can become involved in the development and/or acceptance of appropriate standards of care as well as more extensive performance measures to monitor what level of dental care children get.

Performance measures can be used to assess and evaluate dental health services, for example, what percentage of children enrolled in Medicaid and CHIP actually get dental services, reparative services, or complete care.

Step 4: Take public actionIncludes developing activist coalitions that ensure stable-funded, community-based comprehensive health promotion and disease prevention and crafting messages that specifically target providers,policy makers, and the public.

Title V can collaborate with oral public health programs, private dental delivery systems, dental schools and associations and others, to raise awareness of oral health needs of children (especially CSHCN), and pregnant women, to ensure access to care and to evaluate existing and new program approaches.

Step 5: Maximize the utility of scienceIncludes expanding the range and utility of science-based interventions; developing an evidence base on the effectiveness of oral disease management techniques; and developing a coordinated agenda across basic, applied , and health services research to promote oral health and effective dental care.

In many states, Title V plays a significant role in the development of prevention programs, such as fluoridation programs, screening and oral health education. However, some states do not have dental director or public health program. Thus, Title V can collaborate with the Association of Maternal and Child Health Programs (AMCHP) to ensure all states have a public oral health program.

Step 6: Fix public programsIncludes demonstrating cost benefits of prevention and disease management, overhauling Medicaid Early and Periodic Screening Diagnostic and Treatment Program (EPSDT) dental programs, encouraging provider participation in Medicaid through various incentives, and enhancing the strength and viability of the dental safety net.

Title V can allocate appropriate staff, time, training and funds to identify, target, and help treat high risk children, including CSHCN.
By providing resources and technical assistance, MCHB can work with AMCHP and HRSA to assist in implementing oral health programs in states where none exist.

Step 7: Grow an adequate workforce Includes prioritizing community-based educational experiences for dentists and hygienists in training; expanding the number of pediatric and public health dentists; engaging allied personnel more effectively, especially in health promotion and disease prevention, and encouraging an expanded number of minority providers in the dental professions.

Through training and capacity building, Title V can help increase the number and quality of dental health auxiliaries to alleviate the provider shortage in underserved areas.

Title V can use “Bright Futures” guidelines, which contain units dedicated to Maternal and Child Health and oral health, to train health care providers.

Step 8:Empower families and enhance their capacities Includes developing media and key-contact campaigns to translate oral health needs into demands for dental educational and treatment services; and using risk-based methods to tailor care to the individual needs of children and their families while respecting family and cultural determinants of health and health behaviors.

Apply Title V expertise in providing outreach and other enabling services to ensure that every pregnant women, child and adolescent has access to full comprehensive, oral health services.

Regular Title V enabling services, such as transportation, translation, family support services and case management, can be used to assist families in accessing dental care.

Summary of State-Level Recommendations

What follows is the summary of State-Level Recommendations from the Surgeon General's Workshop and Conference on Children and Oral Health:

  1. Hold state Medicaid program and legislatures accountable for adequate financial support of Medicaid and SCHIP dental programs
  2. Consider revamping Medicaid administration, case management, and enabling services and make sure all who are eligible know of it
  3. Hold state Medicaid programs accountable to certain practice guidelines and oral health performance measures, as in such Bright Futures or EPSDT
  4. Ensure continuous enrollment for children under Medicaid which has been proven to improve access to care
  5. Hold insurance companies accountable for covering all organ systems of the body
  6. Utilize definitions of medical necessity specific for children that include oral health care and other components of comprehensive care: require all insurers covering children to cover such care
  7. Leverage the organizational capacity of Medicaid, SCHIP and other managed care to improve basic screening and preventive oral health measures. As permitted by professional practice laws, managed health care and primary care case management systems could integrate oral health screening, education and preventive care into primary pediatric care. Medicaid agencies and other institutional purchases could use contract specifications to purchase appropriate services and hold plans and providers accountable.
  8. Examine state health professional practice laws and consider modifying to permit mid- level practitioners and primary care physicians to provide oral health counseling and simple preventive measures such as fluoride varnishes not under direct supervision of a dentist
  9. Monitor oral health in the child welfare system
  10. Require oral health component in services for CSHCN (through Title V agencies)
  11. Monitor use of dental sealants through Title V agencies
  12. Develop state-level legislation supporting water fluoridation
  13. Increase number of school nurses and include oral health in certification requirements
  14. Promote/mandate school prevention, education, screening and referral programs, and
  15. Establish performance measures for such efforts
  16. Require oral health promotion standards for those providing day care for infants and young children (accreditation standards)

Additional Sources of Support for MCH Program Directors

In addition to recommendations made by the Surgeon General's Workshop and Conference and AMCHP's suggested action steps, recommendations for national, state, and local action have been proposed by:

Surgeon General's National Call To Action To Promote Oral Health

In May of 2003, the US Surgeon General again highlighted oral health in a Call to Action that envisions a national effort “To advance the general health and well-being of all Americans by creating critical partnerships at all levels of society to engage in programs to promote oral health and prevent disease. Proposed action steps for these public-private partnerships are:

  • Changing perceptions of oral health
  • Overcoming barriers by replicating effective programs and proven efforts
  • Building the science base and accelerating science transfer
  • Increasing oral health workforce diversity, capacity, and flexibility
  • Increasing collaborations

CDC's Division of Oral Health State Resources

CDC's publication Oral Health: Preventing Cavities, Gum Disease, and Tooth Loss; At-a-Glance, 2005 describes a variety of state-level resources including:

State Information and Infrastructure Development Tools

State and County Water Fluoridation Information

Oral Health Maps

  • CDC's Oral Health Maps provide up-to-date information on the fluoride content of water in 25 participating states as well as children's caries experience, untreated decay, and sealant rates.

Scientific Review of Evidence for Prevention

Association of State and Territorial Dental Directors (ASTDD) Best Practices

As the association of state dental directors that is analogous to the Association of State and Territorial Health Directors (ASTHO), ASTDD has compiled “best state practices.”

According to ASTDD, “Best Practice is based on a simple maxim: don't reinvent the wheel, learn in order to improve it, and adapt it to your terrain to make it work better. If we can demonstrate success and share what we know, it can enable us to go forward in different ways that may lead to innovation and establish other best practices.”

Best practices are categorized and described under three public health principles: Assessment, Policy Development, and Assurance.

ASTDD also provides a directory of state oral health officials

Association of Clinicians for the Underserved Links to State-by-State Oral Health Programs

The ACU has compiled web links to each state's oral health programs, most of which are housed within the state's MCH Title V program.

HRSA's MCH Oral Health Resource Center at Georgetown University

This resource center is a repository of information for policymakers and clinicians on:

American Dental Association Compendium of State Innovations to Improve Access to Oral Health Care for Low-Income Children

This state-by-state report considers both public health and public finance approaches to improving children's oral health and access to dental care. It reports each state's dental public health infrastructure, administrative policies and procedures, workforce resources, education/ communications/ and patient care facilitation, with a particular focus on Medicaid and SCHIP programs.

The Washington State Access to Baby and Child Dentistry Initiative

For over a decade the WA state government, dental educators, advocates, dentists, and local communities have worked together to develop a program for young children that includes oral health education, service, and health promotion. A variety of media resources are offered to assist program development and implementation


Children's Dental Health Project (CDHP) Resources

CDHP is an independent non-profit research, policy, and technical assistance organization committed to improving children's access to oral health. Of particular interest to MCH policymakers are:

Interfaces logo1. CDHP's Interfaces Project examines the roles of medical and dental providers in promoting the oral health of young children. An executive summary and White paper review findings of commissioned papers on six related topics:


  1. Children with special health care needs (pdf)
  2. Delivery systems and financing issues (pdf)
  3. Dental caries epidemiology, mechanisms, prevention and care delivery (pdf)
  4. Education and training issues (pdf)
  5. Health care policies (pdf)
  6. Legal opportunities and constraints (pdf)

2. CDHP's NewsBytes State Press Clipping Service: News*Bytes is CDHP's biweekly email newsletter that collects and disseminates press reports on children's oral health and dental care. The newsletter gives a sense of how the public and policymakers view these issues and provides decision makers with information on what the public is learning about oral health access. A searchable database (by state, topic, paper, reporter etc) facilitates finding articles pertinent to MCH and dental professionals.

3. Perinatal Oral Health Project: CDHP is the program office for the American Academy of Pediatric Dentistry's $1M MCHB 2005-2010 grant to advance the oral health of pregnant women and very young children including those in Head Start, WIC, and MCH programs across the country.

4. Dental Care Considerations for Young Children: This HRSA Bureau of Health Professions commissioned paper reviews the oral health status of young children and makes a series of recommendations regarding medical and dental workforce to address disparities.

5. State Oral Health Database: This database compiles information from public sources on each state's workforce, demographics, Medicaid/SCHIP programs, safety net, and access andutilization.

American Academy of Pediatric's PedsCare Project on Oral Health of Young Children

AAP's web-based oral health resources

This site provides extensive information on

American Academy of Pediatric Dentistry's Policies and Guidelines for Children's Oral Health

AAPD's Policies and Guidelines detail the recommendations of pediatric dental specialists on a variety of topics germane to early childhood oral health including:

  • Definitions of dental neglect, dental disability, early childhood caries, medically necessary care, and persons with special healthcare needs.
  • Policies on oral healthcare programs for infants and children, the dental home, child identification programs, school entrance examinations, emergency services, caries risk assessment, use of fluorides, dietary recommendations, oral habits, use of sedation and anesthesia in dental care for young children,
  • Clinical Guidelines on child abuse and neglect, infant oral health care, periodicity of preventive services, dental trauma management,
  • Resources including a caries risk assessment tool.

Volunteers in Healthcare Oral Health Toolbox

Volunteer efforts can complement MCH programs and can demonstrate new approaches worthy of institutionalization or incorporation into Title V and other state oral health programming. VIH has posted a range of useful materials for voluntary programs including:

  • Guides to starting a dental program and recruiting dentists
  • Field reports on clinic and van programs, public-private partnerships, and management tips
  • Resource tips for developing a volunteer program
  • Presentations on volunteer programs
  • Descriptions of local community collaborations for oral health care

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