Earlier Is Better

Reducing dental caries among children engaged with the Wisconsin Early Head Start program

Full Project Name:Earlier is BetterPrimary Community Organization:Children's Health Alliance of WisconsinPrimary Academic Partner:Earnestine Willis, MD, MPH, PediatricsAward Amount:$746,485
Award Date
January2012
Project Duration:48 months

Project Description Narrative:


Dental caries is the most common preventable disease of childhood, with more than 51 million school hours lost annually due to mouth pain. In Wisconsin, 2009 statewide Head Start survey data showed 3-year-old children enrolled in Head Start had a caries experience rate of 25%. By 5 years of age, that rate nearly doubled. Additionally only 33.9% of pregnant women enrolled in Wisconsin Early Head Start received a dental exam in 2009-2010, compared to 40.7% nationally. There is well-documented evidence showing mothers with poor oral health have poorer birth outcomes and pose a higher threat of transferring infectious organisms that cause early childhood caries.

While broad efforts have focused on improving access to care, attention must also be given to informing parents and caregivers of the value of early oral care and the critical role they can play in order to lower the current oral disease burden of young children. Through this project, partners aim to reduce dental caries in children through evidence-based prevention and educational interventions through Wisconsin's Early Head Start program.

Community partners:
Wisconsin Dental Association, Wisconsin Department of Health Services Oral Health Program, Wisconsin Head Start Association

Additional MCW academic partners:
Lisa Olson, Center for the Advancement of Underserved Children; Chelsea Hamilton, Center for the Advancement of Underserved Children

Outcomes & Lessons Learned:


• Established an oral health partnership, meeting consistently and conducting regular assessments to maintain strength of partnerships

• Produced educational training materials to use in training Wisconsin Early Head Start agency home visitors and parent educators, including three oral health motivational interviewing videos (in collaboration with Kansas Head Start Association)

• Implemented Parent Oral Health Education Toolkits (POHET), documenting positive knowledge and behavior change with 70% of Wisconsin Early Head Start agencies participating in Earlier is Better, adopting POHET, and/or having their home visitors or parent educators collect data from early head start parents/caregivers

• Trained 210 Wisconsin Early Head Start staff members across 14 sites, documing that more than 90% of home visitors and parent educators indicated they were likely to provide oral health education to early head start families. Six-month follow-up evaluation indicated that those trained retained 86% of their oral health knowledge

• Increased the number of Early Head Start children with a dental home, reporting increases in the dental home rates for the families' youngest child by the third home visit, increases in the youngest child having seen a dentist within the last 12 months, increases in reports of the youngest child brushing twice or more per day, and increases in the number of parents/caregivers who assist their youngest child with brushing their teeth

• Sponsored additional training and education programs for dental hygiene studens and pediatric nurse practitioner students

• Disseminated projects results widely to share outcomes and lessons learned, engaging in 10 statewide and national conference presentations including a workshop at the National Oral Health Conference, as well as eight publications including a guest editorial for the American Dental Hygienists' Association Access magazine, Wisconsin Dental Association Journal, and Journal of Public Health Dentistry

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