What the Early Childhood Caries Prevention Training Project Offers

With support from the Robert Wood Johnson Foundation, the ACU Early Childhood Caries Prevention Project (ECCP) set a goal of training 50 primary care clinicians and patient educators. To reach this goal, training sessions were held in Philadelphia, PA, Baltimore, MD and Washington, DC. Those selected to participate in this regional demonstration project represented federally qualified health centers, hospital outpatient clinics, urban and rural non-profit clinics, free clinics, health departments, school based primary care programs, and specialty programs such as a foster care facility and the Women Infants and Children's Program (WIC).

Given the transdisciplinary focus of this training, participants included physicians, nurse practitioners, physician assistants, nurses, health educators and dentists. Using PowerPoint presentations and a professional tool kit of materials and resources, Scott Wolpin, DMD provided an overview of the scope and cause of early childhood caries and how to recognize different stages of dental caries. His presentation included pictures of caries and how to recognize them, as well as illustrations of the proper way to position a parent/caregiver and infant/toddler to complete a preventive oral health assessment of such a young child. Emphasis was placed on how to screen for those most at risk for severe tooth decay. This assessment is illustrated and summarized in a simple step by step clinical tool card developed by ACU in partnership with the Children's Dental Health Project in Washington DC.

A short video using the "lift the lip" technique was shown to demonstrate how clinicians and parents can assess infant/toddlers for ECC. This video can be used to train other clinicians and health educators working with young children at risk for early tooth decay. At most training sessions, ACU worked with community clinics and programs such as WIC to invite several parents and young children to join the training for a demonstration of the oral health assessment techniques. Dr. Wolpin and the parents worked with the clinicians to practice the lap position and assessment techniques. Clinicians were introduced to the "Dent light" and disposable mirrors used by dentists to exam the mouth, especially the back of the front teeth were early caries are formed. A number of participants are using an adaptation of this Dent light which fits on the head of a normal opthalmoscope, allowing primary care providers to have tools to thoroughly examine a child's mouth.

Lastly, Lois Wessel, RN, CFNP continued the PowerPoint Session to provide anticipatory guidance during pregnancy and well baby visits (0-36 months), and how to approach difficult issues such as weaning from the bedtime bottles, all night breastfeeding and poor nutrition habits. The presentation included discussion on providing patient education in a culturally respectful manner. A second infant oral health tool card summarizing this information is included in the professional tool kit.

Evaluation of this training, approved for continuing education credit by the American Academy of Family Practice, included a pre and post test on their knowledge and attitudes of the importance of an oral exam and their ability to integrate this assessment into their daily practice. Each participant was asked to develop a work plan for integration of this new set of skills and resources into their site, and they were provided 30 parent tool kits to assist in this education and counseling of high risk families. The parent tool kit includes, a baby tooth from Gerber, a washcloth, a simple brochure in English or Spanish on preventing early tooth decay and a 4" x 6" magnet in English or Spanish that restates the 8 steps to protect children's' teeth. Between February and June, all participants are participating in a listserv to share information and resource on using this new information with families. A more structured evaluation will be completed later this summer.