Goal is to improve oral health among youngest children / /
The latest New Hampshire Third Grade Healthy Smiles-Healthy Growth Survey identified statistically significant oral health issues among children in Coos County. They had the highest prevalence of decay experiences and untreated decay and the lowest prevalence of dental sealants statewide.
The survey discovered that approximately 35% of New Hampshire 3rd graders experienced tooth decay, compared to 56% in Coos County. Unfortunately, the significant disparity in Coos County’s 3rd graders characterizes the overall condition of oral health in the area.
The not-for-profit North Country Health Consortium, home of the regional public health network, is working to address the oral health disparities among children in northern New Hampshire. Geographically, this is a huge area, encompassing Littleton, Woodsville, Haverhill, Lisbon and all of Coos Country including Whitefield, Colebrook and Berlin-Gorham and all the rural communities in-between.
The Consortium has a long history of creating systems change. In the area of oral health, it has worked with more than 20 schools in northern New Hampshire to educate school nurses and administration about the importance of oral health care. Introducing school staff to referral systems, screening tools, and oral health education modules, schools have systems in place to continue to promote oral health to students beyond a dental visit.
With funding from the New Hampshire Children’s Health Foundation, the Consortium’s latest effort, the Oral Health Education and Connection Project, has been working over several years to reach an even younger cohort of children.
The project targets the infant to 5 year-old age group by providing education to pre-school teachers, staff and parents about important oral health topics such as toothbrushing, feeding and eating practices, the importance of fluoride, how to locate and establish a dental home, and how to utilize dental insurance such as Medicaid. The idea is that by using a train-the-trainer approach, the Consortium can create sustainable change in the way in which oral health is viewed and addressed and get kids off to a better, healthier start.
The pandemic had a silver lining
The Consortium’s Public Health Program Manager Anette Cole (pictured above), a Certified Public Health Dental Hygienist, is spearheading the project. Her original plan for the three-year project, pre-Covid 19 pandemic, was to provide in-person train-the-trainer lunch and learns on preventing early childhood caries for preschool staff and to do in-person presentations at parent evenings.
In addition to training, Cole’s original program design included creating and delivering “tool kits” to childcare providers containing lots of dental supplies specifically for the infant to 5 year-old age range as well as for their parents.
She had to “pivot” as she puts it when the pandemic closed many childcare centers and then adapt her approach once they reopened. “It may have actually turned out to offer a silver lining,” Cole said because “Zooming in” to sessions with childcare providers allowed her to customize her timing and training to be more flexible depending on the needs of each specific childcare center or the age level of children that providers worked with. It also saved a huge amount of travel time.
“I actually have done more presentations than I originally anticipated because the interactive virtual option gave me more flexibility,” Cole noted.
Since beginning, Anette Cole and her project have reached 22 preschools and childcare centers with enrollments totaling 438 children in the infant to 5-year-old population. The live, interactive, virtual presentations have been followed by “contactless” delivery of resource materials and oral health supplies for 503 parents, preschool instructors, and childcare providers. And 94 staff members and student teachers have been trained using the Train the Trainer Oral Health Toolkit.
Caries is a contagious disease
Among the points Cole makes in her presentations are that although children’s baby teeth are replaced, tooth decay in a young child not only can be very painful, it can also affect their speech development. It affects a child’s ability to eat nutritious foods, and the health of baby teeth influences the development of the adult teeth that replace them.
One of the lightbulb moments for pre-school staff members or parents comes when she explains how the decay process in children often begins. “Decay is caused by bacteria and children aren’t born with bacteria in their mouths,” Cole explains. Bacteria are most often passed “vertically” from a caregiver or parent to a child.
“The caregiver may stir food with a spoon, test it to see if it’s too hot, then feed the child with the spoon passing along the bacteria in their own mouth,” she said. “Caries is a contagious disease.”
Cole notes that she is clear that she does not expect child care providers to give children intraoral examinations. “The points I make are that, first these are some things to look for. Second, this is what normalcy looks like. And third, these are some things you might see if a child is in pain but can’t express it,” she said.
She also stresses the importance of every child establishing a “dental home” and that a professional “knee-to-knee” dental exam is important for young children. Her tool kit contains information and referral forms to local dentists and dental clinics at area health centers and information about Medicaid coverage for children’s oral health services.
While the coronavirus may have disrupted the usual system of oral healthcare in the North Country, the Oral Health Education and Outreach Project has served in some measure to counter balance that and to close the disparity that the youngest children in Coos and Northern Grafton Country face in oral health prevention and care.
“What we teach are things that people can do now,” Cole said. “The outreach and education is always fun and exciting and I enjoy that. But the idea that the education we are providing may be sustainable and continue to have a ripple effect in the North Country is even more exciting.”