Improving Perinatal and Infant Oral Health American Academy of Pediatric Dentistry and Children’s Dental Health Project

Improving Perinatal and Infant Oral Health Project Partnership: HRSA, Maternal and Child Health Bureau American Academy of Pediatric Dentistry Children’s Dental Health Project Alliance for Information on Maternal and Child Health Purpose: Support membership organizations that have a maternal and child health focus

AIM Collaborative Goals Improve public and private Maternal and Child Health programs Encourage multidisciplinary collaboration Raise awareness Disseminate new information Develop policies and clinical guidelines Improve delivery of MCH care services The AIM collaborative primarily includes grantees under two MCHB programs: (a) Partnerships to Promote Maternal and Child Health (PPMCH), comprised of organizations whose members are focused on MCH; and (b) Improving Understanding of Maternal and Child Health (IUMCH), including organizations whose members who have decision-making responsibility for MCH as one of many areas of concern. Beyond the value of these grant programs individually, there is added value to convening grantees from both groups together. The collaborative they form provides opportunities for these organizations, with very different perspectives, to share expertise and concerns, to forge partnerships, and to educate one another and the MCHB about promising practices in MCH as well as emerging MCH issues across the Nation.

AIM partners American Academy of Pediatrics (AAP) American Academy of Pediatric Dentistry (AAPD) American Bar Association (ABA) Association of Maternal and Child Health Programs (AMCHP) Association of State and Territorial Health Officials (ASTHO) CityMatCH (University of Nebraska) Grantmakers for Children, Youth & Families (GCYF) Family Voices Grantmakers in Health (GIH) National Association of County and City Health Officials (NACCHO) National Business Group on Health (NBGH) National Conference of State Legislatures (NCSL) National Conference of State Legislatures Consortium (with NGA, ASTHO, AMCHP) National Governors Association (NGA) National Healthy Start Association (NHSA) National Institute for Health Care Management (NIHCM) Today's Child Communications Maternal and Child Health Bureau Its members include decision makers within state and local government, maternal and child health (MCH) professions, philanthropy, the health insurance industry, and business, as well as advocates for children and families. Give examples of collaboration- Today’s Child, ABA Center on Children and the Law , NBGH, etc. TC: national parenting magazine is dedicated to black and other parents of color raising children from infancy through their teen years. It delivers accurate and up-to-date information on parenting, child health and development, education, lifestyle and relationship issues.

Current Trends in Perinatal and Infant Oral Health 1 in 5 women who gave birth in 2004 saw a dentist during pregnancy Recent studies report associations between oral diseases and an increased risk for poor birth and pregnancy outcomes (preterm birth, low birthweight, and gestational diabetes) CDC: tooth decay in baby teeth has increased 15% among U.S. toddlers and preschoolers ages 2 to 5 years old. During the 1999-2004, 28% of young children had experienced cavities Dental caries is the most common, chronic disease of childhood, and is usually established before age 2 Prevention is cost-effective: Low-income children who have their first dental visit by age one are less likely to have subsequent restorative or ER visits, and their average dentally related costs are almost 40% lower over a 5 year period than children who receive their first visit preventive visit after age one Ggood oral health throughout the perinatal period can also help establish a solid foundation for promoting the oral health of her children after birth. Research indicates that children whose mothers have poor oral health and high levels of oral bacteria are at greater risk of having oral infections at a young age and developing dental caries.

Goals of Improving Perinatal and Infant Oral Health 1.Expand availability of prenatal oral health care 2.Expand availability of infant oral health care 3.Raise public awareness regarding dental care for pregnant women and infants

Goal 1: Expand availability of prenatal oral health care Addressing existing barriers: Disseminate resources on dental care for pregnant women to clinicians, health educators, and patients Identify, develop, and disseminate resources on preventive oral health guidance for infants Existing barriers: providers reluctance to refer, dentists reluctance to treat, women are not aware of importance of OH, absence of national practice guidelines This goal functions to promote and provide informational and programmatic awareness on prenatal oral health care and guidance. We provide resources to these communities and to pregnant women themselves, And support the integration and coordination of care among providers

Primary Activities Maternal and Child Health Bureau Perinatal Oral Health Workgroup Collaboration with New York State Department of Public Health New Parent Kit pilot study Inclusion of perinatal component in AAPD Guideline on Infant Oral Health Care Resource guide for Medicaid Coverage of Dental Services for Pregnant Women Provision of CE to AAPD membership MCHB: reps from MCHB divisions, AMCHP (Title V), ADA, ACOG, ADEA, AAPD ORAL HEALTH CARE DURING PREGNANCY AND EARLY CHILDHOOD PRACTICE GUIDELINES What is assured on a federal level, what varies by state, and promising practices We want to ensure that we are giving AAPD membership all the information they would like to receive-assuring breadth of courses/resources are available to membership, while we are also collaborating with partners external to AAPD membership

Goal 2: Expand availability of infant oral health care Addressing existing barriers: Expand adoption of age one dental visit and dental home policies by pediatric and general dentists Expand dental care for infants at greatest risk for early oral disease Barriers include a shortage of pediatric dentists, we engage general dentists in seeing infants, and support coordination of care among providers and other sources of care such as WIC and HS Providing support and CE necessary for pad dentists, engaging general dentists in treating infants, addressing disparities in access to oral health care – by income, race, and for CSHCN This goal seeks to close the gap between dentists’ practices and the AAPD policies of the “dental home” and “age one dental visit.” It also emphasizes the need to target those infants at greatest risk due to social disadvantage, special needs, or oral risk factors. It is based on identified needs to engage public and private insurers, program managers, and early child-care sites in developing the infrastructure necessary to implement early and effective care.

Primary Activities Pre-doctoral dental school survey of infant and toddler oral health curricula Provision of CE to AAPD membership on promoting infant oral health Promotion of age one and dental home policies by general dentists, hygienists, and pediatricians, and promotion of training resources AAPD Periodicity Schedule Initiative Documents: ECC chapter, model benefit, ASTDD Best Practices The Pre-doctoral Dental School Survey of Infant and Toddler Oral Health Curricula was developed and disseminated to all 54 dental school pre-doctoral pediatric directors in March 2006. This survey is a follow-up to the McWhorter et al. survey conducted in 2000. The purpose was to determine the extent to which perinatal, infant and toddler oral health is included in pre-doctoral dental school curricula. Based on information reported, the extent to which dental schools include perinatal and infant oral health in pre-doctoral curricula is variable. 74% of the dental schools responded. Information obtained from this survey will be used to assess current dental school practices regarding infant oral health curricula, and to make recommendations for curricula development and implementation in pre-doctoral dental school programs. Results were presented at the 2007 Annual Session of the American Dental Educators Association The survey data will also be used as baseline data for measuring project accomplishments. A follow-up survey is planned for the final year of the Project to measure the effectiveness of such strategies. The Age 1 visit in private practice: embrace it and make it work for you provided by RC ECC chapter to be included in latest ECC textbook by Berg and Slayton Baby Oral Health Program UNC- kit includes preparatory materials to provide infant OH services in a clinical setting Best Practices Project promotes best practices for state, territorial and community oral health programs.  information provided on the website is meant to help programs develop their best practices within the context of their environment. EC OH NBGH Investing in Maternal and Child Health: an Employer’s Toolkit- concrete recommendations on employer-sponsored health benefits and programs for children, adolescents, and pregnant women. The Project- BE- wrote the model dental benefit. The Plan Benefit Model is NBGH’s rec on minimum health benefits- evidence-based and comprehensive health benefits package that emphasizes prevention, aims to reduce employee cost barriers to care services, and strives to balance employee affordability with employer sustainability. Makes the case for why improving the health of children, adol, and women childbearing age benefits employers. NBGH: the nation's only non-profit organization devoted exclusively to representing large employers' perspective on national health policy issues. Members are primarily Fortune 500 companies and large public sector employers - who provide health coverage for more than 50 million U.S. workers, retirees, and their families.

Goal 3: Raise public awareness regarding dental care for pregnant women and infants Addressing existing barriers: Target AAPD’s public awareness campaigns and policies to pregnant women Promote inclusion of perinatal oral health components in public health campaigns Development of a cadre of professionals to provide training on science-based perinatal and infant oral health practices We know that inadequate health literacy is a major barrier to optimal health, and that more than 90 million Americans lack the ability to understand basic health information. We know that the issue of children’s oral health is unknown to many Americans, and that from policy perspective there are certain dominant frames that lead the public to see OH as a cosmetic issue and one related to parental responsibility, without seeing it in a broader policy and prevention context We focus on the public, but also on raising awareness among a diverse group of providers- with our cadre in development

Primary Activities Research on health literacy and health messaging Distribution of AAPD public education resources, policies, and recommendations Development and distribution of parent education materials, materials for MCH providers, and policy briefs Children’s Dental Health Month parent education events Provision of TA and consultation Exploring new, nontraditional collaborative relationships Addressing health literacy challenges critical in providing effective consumer education. Also engaging partners and policymakers is key to promoting an awareness of importance of OH- different strategies. Researching health literacy strategies and health communication for changing consumer behavior. FrameWorks- research on the conceptual frameworks people use to reason about children's OH. Learning about critical elements that children's advocates should consider in framing this issue for public support. the translation challenges associated with moving this issue, and policy-related solutions, higher on the public's agenda TA: Parents Magazine on ECC, public coverage of infants and pregnant women, AAPD policies like dental home, AIM partners- agenda setting and consultation (GIH and ABA), UM MCH Scholars program SSW course- The Oral Health Care Crisis New rltshps: AIM and other MCH partners external to oral health, also social justice mission as a response to Deamonte Driver

Summary Dental disease is transmissible, chronic, and progressive, but it is also SOLVABLE Together we can promote the oral health of children and ensure they begin life with the best chances to succeed We’re so excited that AAP is working on this and look forward to collaborating in the future Together we can set them on a path to a healthy life

Contact Information Jessie Buerlein, MSW Project Manager, Improving Perinatal and Infant Oral Health jbuerlein@cdhp.org (202) 833-8288 ext. 208 Dr. Ned L. Savide, Chair, AAPD Ad Hoc Committee on Perinatal Oral Health nlsavide@aol.com