September 29, 2000
San Ysidro Health Center (SYHC) recently implemented an Infant Oral Care Project (IOCP) that represents an innovative approach to preventing dental disease in children under 5 years of age.
"Early childhood caries (ECC) in San Diego County have reached epidemic proportions that severely impact infants and young children from minority, low-income families," said Ed Martinez, chief executive officer of the Center. "While traditional oral health initiatives generally focus on dental treatment for school age youngsters, the IOCP targets children between 12 months to 6 years of age at highest risk for ECC.
"Children with healthy teeth chew food easily, learn to speak clearly and smile with confidence. They have good dental hygiene and nutritional habits, regular access to care as well as parents who prioritize oral health as part of an overall health regimen," he said. "Unfortunately, too many of San Diego County's children are not orally healthy even though tooth decay remains the single most common and preventable disease of childhood."
According to Martinez, San Ysidro Health Center's dental clinic treats more than 350 children each month. "We are seeing an increased rate of untreated oral diseases, especially those requiring urgent care, in children from families who do not have health insurance, or who are under-insured."
Tooth decay, he said, begins when children are less than a year old and much of it goes untreated. In fact, 27 percent of pre-school children have untreated decay and 9 percent of those suffer from pain, trauma or infection and are in urgent need of dental treatment. Martinez cited recent research that has documented the fact that up to 30 percent of parents of preschool children report feeding practices, such as nighttime bottles, that can contribute to early development of tooth decay.
"ECC is an infectious disease that can be transmitted directly from the caregiver (often the mother) to the child during the infant and toddler years," he said. "The capacity of the bacteria to generate sufficient acids to damage teeth depends upon a child's diet and feeding practices, fluoride exposure and oral hygiene. Dental caries is, therefore, a dietary and behavioral disease much like obesity and cardiac disease.
"Since SYHC is a community-based, safety-net provider of children's dental services, it is quite evident we are dealing with an increasingly complex dental disease epidemic that, unless checked, threatens to overwhelm our community's limited resources."
The main objectives of the IOCP are to increase the proportion of 1 to 5 year-old children examined and treated by a qualified oral health professional for preventive and restorative services. Other priorities include providing community outreach, early intervention, family-focused education and preventive care to hinder the development of dental disease that leads to the needless expense and pain associated with delayed treatment.
Martinez explained that 2,000 age-appropriate children who live in the South Bay will be eligible for the program. Women who are currently enrolled in San Ysidro Health Center prenatal care programs will also receive educational services and be offered therapeutic mouth rinses to help reduce the transmission of strep mutans (decay causing bacteria) from mother to child.
"The IOC will focus on developing a comprehensive education and behavioral modification initiative targeting low-income families and children," said Martinez. "In order to achieve our objectives, we will train community health advisors, or `Promotoras,' who will coordinate with pre-schools and day care centers to establish small group and individual education sessions with parents regarding the importance of early preventive oral health care for their children."
Topics covered will include age-specific oral care, baby bottle use, prevention and treatment of early childhood caries, and the importance of early and regular visits to a qualified dentist.
Promotoras will screen and enroll children and families in IOC programs and provide comprehensive health information that emphasizes parental involvement in their child's oral health. They will also train families for appropriate dental office behavior and assure barriers such as language, child care and transportation are addressed.
According to Martinez, the promotoras model is based on the assumption that there are formal and informal social networks within each community through which health information is exchanged. Promotoras are indigenous lay health advisors who exist in all communities. A SYHC coordinator will recruit promotoras who have experience in this role from other similar projects.
"SYHC provides the only effort/service in the South Bay that targets, low-income, high-risk infants and toddlers with a community-based oral health promotion initiative," he said. "Good oral health begins before a child is born and continues even before baby teeth emerge. Because dental disease is preventable and is less expensive when prevented rather that treated, prevention strategies are critical to a cost-efficient, effective system of dental care."