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Oral Health in Children: The Role of the Nurse in Community Settings

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Oral health has been largely forgotten since 2000, when the Surgeon General’s report, Oral Health in America, declared early childhood caries a silent epidemic, five times more common than asthma and the most common chronic disease of childhood. Although the Surgeon General called for pediatric preventive oral health practices to be integrated into well-child care, evidence from national databases reveals that the incidence and prevalence of dental caries continue to be high, especially in lower socioeconomic and minority group populations.

Data from the 2009–2012 National Health and Nutrition Examination Survey reveal that approximately one in four children (14 percent) aged 3 to 5 years living at the poverty level have untreated dental caries. The survey data further reveal that 19 percent of non-Hispanic Black children aged 3 to 5 years and 26 percent of Hispanic children aged 6 to 9 years had untreated dental caries, compared with non-Hispanic White children aged 3 to 5 years (11 percent) and 6 to 9 years (14 percent). Although national statistics show an improvement in access to oral health care for children 5 years and older, the data reveal significant disparities in access to care for children aged 2 to 4 years.

This teaching strategy focuses on developing oral health competencies to educate parents and children on the importance of oral health and hygiene, fluoride, and having a dental home. It also focuses on recognizing abnormal findings in the mouth.

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Oral Health in Children: The Role of the Nurse in Community Settings

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Learning Objectives
Students will:
- Describe the importance of oral health in the child
- Describe the development of early childhood caries
- Demonstrate oral hygiene tips for child
- Describe the importance of fluoride for dental health
- Describe the role of the nurse when providing oral health care to children in the community
Learner Pre-Work
Read
- CDC Fact Sheet – Oral Health in America: Summary of the Surgeon General’s Report
Complete
- Smiles for Life Course #2
Students should download the following for clinical use:
- Smiles for Life pocket card (SFL Child Oral Health Pocket Card)
- Smiles for Life App for mobile devices
Suggested Learning Activities
Early Childhood Caries Education in a Preschool Setting

Students will integrate oral health into their preschool clinical experience.
(Materials: colored pencils, crayons, paper, mirror, toothbrushes, toothpaste)

Oral Health Education for Preschool Child

In a classroom setting, students can deliver education to a select group of children. Approach the assignment using the following suggestions:

1. Help children describe why their teeth are important.
- Children will look at their teeth in a mirror and draw a picture of their own teeth.
- Students will ask children to describe what their teeth do (help them eat, talk, smile).
2. Teach children how to keep their teeth clean.
- Student will demonstrate tooth brushing with large brush and tooth model.
  - 2 minutes 2x/day
  - Use fluoride toothpaste
- Children will practice tooth brushing with their own toothbrush and toothpaste.
Oral Health Education for Preschool Staff

Students can provide staff professional development in the following ways:
- Describe the causes of early childhood caries (ECC).
  - Emphasize how the combination of bacteria, sugar, acid, and frequency of eating contribute to development of ECC.
- Discuss ways that staff can help prevent development of ECC:
  - Healthy snacks
  - Tooth brushing time
Oral Health Education for Parents

Students can provide education for parents. Select one topic for an oral health information column in the preschool newsletter for parents:
- Importance of fluoride and available sources. Discuss the different types of fluoride and the benefits/risks of each:
  - Topical fluoride – toothpaste – fluoride varnish
  - Systemic fluoride – community water, dietary supplement
- Definition of a dental home and identification of resources available in the preschool community with reasons for having a dental home.
  - Identify possible dental homes in specific zip code for patients with Medicaid.
- Causes of early childhood caries. Describe how the combination of bacteria, sugar, acid, and frequency of eating contribute to development of ECC.
- How to prevent development of ECC. Discuss how good nutrition combined with keeping a child’s mouth clean can prevent ECC.
  - Students will describe healthy snacks.
  - Students will describe proper tooth brushing.
Suggested Reading
- The following article describes transitioning the traditional HEENT exam to the HEENOT exam to include the oral cavity: Haber, J., Hartnett, E., Allen, K., Hallas, D., Dorsen, C., Lange-Kessler, J., . . .Wholihan, D. (2015). Putting the mouth back in the head: HEENT to HEENOT. American Journal of Public Health, 105(3), 437-441. Retrieved from https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2014.302495
- Become familiar with Smiles for Life, an Interprofessional Oral Health Curriculum consisting of eight 45-minute courses that contain the core components of oral health throughout the lifespan. The Smiles for Life curriculum format can be easily implemented in an academic setting. Included is a comprehensive set of educational objectives based on the Accreditation Council for Graduate Medical Education (ACGME) competencies, test questions, resources for further learning, oral health web links, an implementation guide, and detailed module outlines. CE credit is available for each module upon completion. Choose “Teach Curriculum” Course 2 – Child Oral Health.Each course has downloadable slides and speaker notes for class presentation. The slides can be arranged as you wish using the SFL slide sorter on the right side of the page. Retrieved from www.smilesforlifeoralhealth.org
- Become familiar with Cavity Free Kids (http://cavityfreekids.org), an oral health education program that contains many oral health learning activities designed for use in the community for pregnant women and young children. See Cavity free kids: Oral health education for pregnant women and children birth through age five and their families (Arcora Foundation, 2015)
- Dye, B.A., Li, X., & Thornton-Evans, G. (2012). Oral health disparities as determined by selected Healthy People 2020 oral health objectives for the United States, 2009–2010. NCHS data brief, no 104. Hyattsville, MD: National Center for Health Statistics. Retrieved from https://www.cdc.gov/nchs/data/databriefs/db104.pdf
- US Department of Health and Human Services, Health Resources and Services Administration. (2014). Integration of oral health and primary care practice executive summary. Retrieved from https://www.hrsa.gov/publichealth/clinical/oralhealth/primarycare/integrationoforalhealth.pdf
- US Preventive Services Task Force. (2015). Dental caries in children from birth through age 5 years: Screening. Retrieved from https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/dental-caries-in-children-from-birth-through-age-5-years-screening
Author Information

Erin Hartnett, DNP, APRN-BC, CPNP
NYU Rory Meyers College of Nursing
New York, NY