Policy on Oral Health in Child Care Centers

Policy statement

The AAPD encourages child care centers, early education providers, and parents to implement preventive practices that can decrease a child’s risk of developing ECC.¹⁴ The AAPD recognizes that increasing health promotion in out-of-home child care settings could improve the oral health of millions of preschool-age children. Therefore, the AAPD encourages child care centers to:

• utilize oral health consultation, preferably by a pediatric dentist, at least once a year and as needed. The health consultant should review and observe program practices regarding oral health and make individualized recommendations for each program.
• promote the concept of the dental home by educating their personnel, as well as the parents, on the importance of oral health and providing assistance with establishment of a dental home no later than 12 months of age of the child.
• maintain a dental record, starting at age 12 months with yearly updates, as part of the child’s health report. It should address the child’s oral health needs including any special instructions provided to the caregivers.
• have written, up-to-date, comprehensive procedures to prepare for, report, and respond to medical and dental emergencies (including pain/toothache). The source of urgent care should be known to caregivers and acceptable to parents.
• sponsor on-site, age-appropriate oral health education programs for the children that will promote good oral hygiene and dietary practices, injury prevention, and the importance of regularly scheduled dental visits.
• provide in-service training programs for personnel regarding oral hygiene concepts, proper nutrition choices, link between diet and tooth decay, prevention of ECC, and children’s oral health issues including proper initial response to traumatic injuries along with dental consequences. Personnel with an understanding of these concepts are at a great advantage in caring for children.
• encourage parents to be active partners in their children’s health care process and provide an individualized education plan, one that is sensitive to cultural values and beliefs, to meet every family’s needs. Written material should be available and, at a minimum, address oral health promotion and disease prevention and the timing of dental visits.
• familiarize parents with the use of and rationale for oral health procedures administered through the program and obtain advance parental authorization for such procedures.
• incorporate an oral health assessment as part of the daily health check of each child.
• promote supervised or assisted oral hygiene practices at least once daily after a meal or a snack.
• provide well-balanced and nutrient-dense diets of low caries-risk.¹⁹
• have clean, optimally-fluoridated drinking water available for consumption throughout the day.¹⁹
• not permit infants and toddlers to have bottles/sippy cups in the crib or to carry them while walking or crawling while under the child care center’s supervision.
• minimize saliva-sharing activities (e.g., sharing utensils, orally cleansing a pacifier) to help decrease an infant’s or toddler’s acquisition of cariogenic microbes.²⁰
• consider implementation of comprehensive oral health practices when legislative regulations are limited or nonexistent.⁸