• Are children fed nutritious foods and snacks like lots of fruits and vegetables?


• Do children brush their teeth after meals, snacks?


• Do caregivers help young children with brushing?


• Are infants' teeth wiped with a moist cloth to remove any remaining liquid after feeding?


• Is juice served in a cup, not a bottle?


• Are all infants held while being fed with a bottle?



Note: Infants should never be put to bed with bottles in their cribs and bottles should not be "propped" in their mouths.

Healthy Habits In Child Care For Good Dental Health

• Are children given healthy foods instead of sugary items for snacks - vegetables, yogurt, peanut butter, fruits instead of cookies and other starchy foods?


• Does the program serve only 100% fruit juice?


• Is drinking water readily available throughout the day? (reduces the acid in the mouth, acid contributes to cavities)


• Do children brush their teeth after meals and snacks? The younger the child, the more the caregiver should help the child with brushing. Preschool children do not have the fine motor skills to brush properly on their own.


• If brushing is not possible, do children rinse out their mouths with water?



• For children 2 and over, there should be regular educational activities on topics related to good dental care appropriate to their age, such as:


• Healthy eating that builds good teeth.Good brushing skills.What happens during a dental visit and why dental visits are important.
• What is plaque.

For older children, topics should include:

• Flossing.What are dental sealants.Effect of tobacco -chewing and smoking - on teeth and gums.
• Importance of mouth guards.





Safety Issues with Dental Care

• Toddlers should not carry bottles around with them (to prevent injury to mouth, ear infections, and dental cavities).


• Each child should have their own toothbrush, labeled and appropriate to the child's age. No sharing or borrowing should be allowed.


• Each child should have their own toothpaste tube. If toothpaste is from one large tube for all children, then the toothpaste should be given out on a clean piece of paper instead of directly on the toothbrush to prevent sharing of germs.


• Caregivers should wash their hands before helping a child with brushing.


• If a child's gums are bleeding, then the caregiver should wear gloves when helping them with brushing their teeth.


• Most first aid for the mouth involves blood, and therefore gloves for the caregiver should be readily available.



Hint: Caregivers should consider wearing a zippered waist pack containing gloves and other basic first aid supplies while they are on the job. This could save precious time in the event of an emergency.





If A Dental Emergency Occurs At Child Care

• Does the caregiver know how to determine the seriousness of a dental emergency?



Note: Knowing what to do, and when to do it, helps a person to stay calm, act quickly and keep other children safe during an emergency. See Also Emergency Preparedness Section


• Does the caregiver have a plan for handling the following types of dental related problems/emergencies?


• Core sores.Toothaches.Broken braces/wires.Cut or bitten tongue, lip, or cheek.Knocked-out permanent tooth.Broken tooth.Broken jaw.
• Bleeding after a baby tooth falls out.


Hint: Print out this Good Dental Health Practices information sheet: http://nrckids.org/dentalchecklist.pdf and discuss with your caregiver.


• Does the caregiver have a plan for how to transport a child with a dental emergency to the nearest source of emergency dental care? (For a family home caregiver, that plan could be call 911, if the substitute or parents are not readily available.)


• Does the caregiver have current contact information on each child's dental provider (dentist, dental clinic)?


• If an emergency calls for a cold pack, is ice covered in a protective bag and never placed directly on the skin or gums?




Preventing Baby Bottle Tooth Decay

• Does the caregiver always hold the infant while giving the infant a bottle?


• Are children only fed a bottle during mealtimes? Children should not be allowed to walk around with a bottle or use the bottle as a pacifier.


• Are children taught to drink from a cup as soon as possible?


• Are baby's gums and any teeth wiped cleaned after every feeding?



Note: Water and a soft toothbrush are recommended after a child has 7 or 8 teeth.

See Additional Resources Section for more information

How to help your caregiver with this topic

• Don't put your baby to bed with a bottle, even just water. It is a hard habit to unlearn and makes it more difficult for the caregiver who isn't giving your child the bottle in the crib.


• Teach your baby to drink from a cup (usually by one year of age).


• If your child does not have a dentist, find one. See Sources of Health and Dental Care Section.


• Make sure your caregiver has current contact information for you, and anyone that is authorized to pick up your child.


• If you are called for a dental emergency, make sure that someone responds immediately.


• Include dental information on health records supplied to the caregiver.


• Make sure you caregiver has current contact information for your child's dentist in case of emergency; keep this information with you (in your purse or wallet). In an emergency, you may be the one to call ahead - your caregiver will be busy with the emergency and the other children.


• Supply your caregiver with child sized toothbrushes for your child.


• Ask you child's dentist if s/he would be willing to speak at a parent's meeting about the importance of good oral health.


• Make your caregiver a cold pack bag using a soft fabric in a print that appeals to kids.

Additional Resources

Where to Find Low Cost Dental Care (National Institute of Dental and Craniofacial Research)
http://www.nidcr.nih.gov/FindingDentalCare/ReducedCost/FLCDC.htm


Dental Schools: National List
http://www.nidcr.nih.gov/FindingDentalCare/ReducedCost/USDentalSchools.htm

Bureau of Primary Health Care
http://bphc.hrsa.gov/


How to Find a Dentist


American Dental Association Find a Dentist
http://www.ada.org/public/directory/index.asp

American Academy of Dental Pediatrics - Find a Pediatric Dentist
http://www.aapd.org/finddentist/index.asp

State Dental Organizations
http://www.ada.org/ada/organizations/searchcons1.asp
http://www.aapd.org/about/affiliated.asp

Finding Dental Care (National Institute of Dental and Craniofacial Research)
http://www.nidcr.nih.gov/FindingDentalCare/

Materials


Baby Bottle Tooth Decay (American Academy of Pediatrics)
http://www.medem.com/MedLB/article_detaillb.cfm?article_ID=ZZZKBW52R7C&sub_cat=11

Bright Futures in Practice: Oral Health
http://www.brightfutures.org/oralhealth/pdf/index.html

Brush Up on Healthy Teeth (poster) (Centers for Disease Control and Prevention)
http://www.cdc.gov/OralHealth/pdfs/BrushUpPoster.pdf

Brush Up on Healthy Teeth: A Quiz for Parents about Simple Steps for Kids' Smiles (Centers for Disease Control and Prevention)
http://www.cdc.gov/OralHealth/pdfs/BrushUpQuiz.pdf

Dental Emergency Tips (New York State Dental Association)
http://www.nysdental.org/img/pdf_files/emerg.pdf

Healthy Mouth for Your Baby (National Institute of Dental and Craniofacial Research)
English - http://www.nidcr.nih.gov/OralHealth/Topics/ToothDecay/AHealthyMouthforYourBaby.htm
Spanish - http://www.nidcr.nih.gov/OralHealth/OralHealthInformation/Spanish/UnaBocaSaludableParaSuBebe.htm

Oral Health Parent Resource Center (American Academy of Pediatric/American Academy of Pediatric Dentistry)
http://www.aapd.org/parents/


Organizations


American Academy of Pediatric Dentistry
http://www.aapd.org/pediatricinformation/

American Academy of Pediatrics
http://www.aap.org

National Institute of Dental and Craniofacial Research
National Institutes of Health
http:// www.nidcr.nih.gov

National Maternal and Child Oral Health Resource Center
http://www.mchoralhealth.org/

Research


Oral Health and Learning: When Children's Oral Health Suffers, So Does their Ability to Learn (National Maternal and Child Health Resource Center)
http://www.mchoralhealth.org/pdfs/learningfactsheet.pdf

Promoting Awareness, Preventing Pain: Facts on Early Childhood Caries (ECC) (National Maternal and Child Oral Health Resource Center)
http://www.mchoralhealth.org/PDFs/ECCFactSheet.pdf



Healthy Kids, Healthy Care is based on Caring for Our Children: National Health and Safety Performance Standards: Guidelines for Out-of-Home Child Care Programs, 2nd Edition, 2002, (American Academy of Pediatrics, American Public Health Association, and National Resource Center for Health and Safety in Child Care)

3.010 ROUTINE ORAL HYGIENE ACTIVITIES
3.011 ORAL HEALTH EDUCATION
3.026 PREVENTION OF EXPOSURE TO BLOOD AND BODILY FLUIDS
4.005 JUICE
4.006 AVAILABILITY OF DRINKING WATER
4.012 INTRODUCTION OF SOLID FOODS TO INFANTS
4.014 TECHNIQUES FOR BOTTLE FEEDING
5.095 TOOTHBRUSHES AND TOOTHPASTE
5.151 STORAGE AND LABELING OF PERSONAL ARTICLES
8.022 WRITTEN PLAN AND TRAINING FOR HANDLING URGENT MEDICAL CARE OR THREATENING INCIDENTS