1. Preventing Cavities in Preschoolers: Testing a Unique Service Delivery Model in American Indian Head Start Programs
Principal Investigator: David Quissell, PhD.
University of Colorado Anschutz Medical Center
Colorado Native Oral Health Research (CNOHR)

2. Study Team Co-investigators Interventionists/COHS Judith Albino, PhD.
Terry Batliner, DDS.
Patty Braun, MD., MPH.
Lucinda Bryant, PhD.
Diana Cudeii, RDH.
Carmen George, MS.
Nicolas Johs, BA.
David Quissell, PhD.
Vong Smith, BA.
Nikola Toledo, MSA.
Others
Stella Begay
Helen Curley
Nicole Garcia
Tracy Goldtooth
Rose Lee
Lolita Spencer
Nikola Toledo
Cherise Watson

3. Partnerships Colorado School of Public Health
University of Colorado School of Medicine
University of Colorado School of Dentistry
Colorado Native Oral Health Research Program
Navajo Head Start
Navajo Nation Human Research Review Board

4. Early Childhood Caries
Dental caries in the primary teeth of children 0-6 years of age
Most common chronic disease of childhood
5 times more common than asthma
Infectious disease
Largely preventable

5. Disparities 79% of AI/AN preschool children have caries experience
3 times greater than their non-Native counterparts
Navajo children have highest rates among American Indians
Mean number of dental surfaces = 19
IHS not able to meet need

6. World Health Organization
Oral Health Promotion
“the process of enabling people to increase control over, and to improve their health”
“moving beyond a focus on individual behavior towards a wide range of social and environmental interventions”
World Health Organization. 2010:

7. WHO Goals of Oral Health Promotion
Increase awareness of oral disease, its severity and factors that contribute to it
Reduce the number and intensity of risk factors for oral disease, e.g. reduce sugar intake
Decrease barriers to oral health, e.g. increase access to tooth-healthy foods
Increase access to prevention activities, e.g. fluoride varnish, dental visits
Create healthy environments, e.g. fluoridated water

8. Conceptual Framework

9. Theoretical Framework
Well-being of children depends primarily on the household production of health
the physical and social setting in which the child lives,
the customs of child care and child rearing regulated by the culture in which the setting is embedded, and
the psychology of the child’s caretakers
Harkness S. Super CM. The developmental niche: a theoretical framework for analyzing the household production of health. Soc Sci Med. Jan 1994; 38(2):

10. Study Setting Navajo Head Start Centers Federal program-105 HS Centers
Comprehensive child development program serving children ages 3-6 years and their families
Community-based, child-focused program
Overarching goal: increasing the social competence of young children in low-income families
Head Start performance standards

12. Study Design Design: Phase 4 cluster randomized trial
Unit of analysis: Head start classroom
Intervention: fluoride varnish + parent oral health promotion education + classroom activities, delivered by Community Oral Health Specialists (COHS)
Control: usual care
Sample: 26 intervention classrooms + 26 usual care classrooms
Timing: 2 years of intervention; 3 years of data collection

13. Intervention Structured for Academic Year
Quarterly Fluoride Varnish Application
Four Parent/Caregiver Events
Five Child Activities

14. Community Oral Health Specialist
Community Lay Health Worker
Oral Health Specialist
Child Educator
Parent Educator
Culturally Sensitive

15. Educational Strategy Engage the Learner Active Learning Small Groups
informal conversations, storytelling
Active Learning
emphasize hands-on
Small Groups
encourage opportunities to interact
Application of Knowledge
practical applications
Appropriate Communication
culturally appropriate, ‘teach-back’
Reinforcement
messages will be presented in a variety of formats, repeated

16. Curriculum Curriculum targets many influences on disease process Teeth
Fermentable carbohydrates
Bacteria
Parent/caregiver
Child
Head Start teacher

17. Curriculum- Messages Improving oral health
Tooth brushing twice daily
Use fluoridated toothpaste
Drink fluoridated water
Fluoride varnish
Help child brush
Regular dental visits
Reducing fermentable carbohydrates
Reduce sugary/sticky foods
Reduce frequent snacking
More healthy snacks
Reduce vertical transmission of S. Mutans
Reduce oral sharing

18. Fluoride Varnish Application

19. Parent/Caregiver Events
Kick–Off event with parents/caregivers and children
Brings caregiver/child together
Incorporates Head Start classroom into the intervention
Engages the Head Start teacher into the process

20. Parent/Caregiver Events
Begins with an educational presentation to give necessary knowledge to empower caregivers to make change
Move to small group stations
Engaging
Hands on
Self goal setting
Follow up contact to assess progress on goal

21. Brief Educational Presentation
Baby Teeth are Important for:
SMILING!
SPEAKING and SINGING!
HOLDING SPACE FOR PERMANENT TEETH!
EATING!

22. Small Group Stations

23. Caregiver Goal Setting Tool

24. Child Specific Sessions
Builds on primary concepts
Tooth function
Tooth brushing
Healthy eating
Fluoride
Dental visits
Short, fun activities
Coloring
Sorting games
Role playing
Matching games

25. Summary
Early childhood caries affects many Navajo children and is preventable
Innovative use of Community Oral Health Specialists
Directed toward the household production of health
Head Start classrooms
Theory-based curriculum

26. This research is supported by funding from the National Institute of Dental and Craniofacial Research agreement #1U54DE

27. Thank you! Ahéhee!