Introduction
Dental caries is the most common chronic disease among children, with low-income children and ethnic minority children bearing a disproportionate burden of the disease (U.S. DHHS 2000, 2003). Studies show that children living in poverty suffer twice as many dental caries as their higher-income peers (U.S. DHHS 2000, 2003). Since the publication of Oral Health in America: A Report of the Surgeon General (2000) and its companion document, A National Call to Action to Promote Oral Health (2003), increased national attention has focused on the unmet oral health needs of many of the nation’s children and families. This crisis was further brought to light by the deaths of two young children in 2007 from complications related to untreated oral health needs (Berenson 2007).
In addition to the high prevalence of caries, low-income children face barriers to accessing dental care. Data from the National Health and Nutrition Examination Survey indicate that from 2001 to 2004, low-income children and adults were more likely than their higher-income peers to have untreated dental caries (Centers for Disease Control and Prevention 2007). Commonly cited factors contributing to these unmet needs in dental care are cost of care; lack of insurance coverage; lack of understanding about the need for oral health care for young children; and an overall inadequate supply of dentists, including dentists willing to treat Medicaid-eligible children (Mouradian et al. 2000).
Promoting oral health is an important concern for the Office of Head Start, since many of the risk factors for dental caries—children from racial and ethnic minority families and low-income families are disproportionately affected by caries—characterize the Head Start population. The Head Start Program Performance Standards require that a health care professional determine within 90 days of enrollment whether children are up to date on a schedule of age-appropriate preventive dental care. Dental followup must include necessary preventive measures and further dental treatments as recommended by the dental professional. Many Head Start grantees, however, face challenges in meeting these requirements because of barriers to accessing oral health services faced by many Head Start families.