Infant Oral Health Program to move to
Colorado Area Health Education Center
Cavity Free at Three to Expand Training and Reach

July 23, 2009 (DENVER) - More young children in olorado will be able to avoid dental disease as a successful oral health program targeting children expands to its new home with the Colorado Area Health Education Center (AHEC).

Cavity Free at Three, (CF3) a statewide effort to prevent oral disease in children from infancy to age 3 is moving from a foundation-run program to a permanent home with Colorado AHEC. CF3 is a three-year, $1.5 million effort on the part of six local health foundations: Caring for Colorado Foundation, The Colorado Health Foundation, The Colorado Trust, Delta Dental of Colorado Foundation, Kaiser Permanente and Rose Community Foundation. The foundations launched the effort in 2007 and went to communities statewide with a technical assistance team to train doctors, dentists, dental hygienists, public health nurses and other health professionals on how to prevent dental disease in young children. This program is now being implemented in communities across Colorado. Under the direction of Dr. Jack Westfall, MD, MPH, Director of Colorado AHEC, CF3 will expand its reach. Karen Savoie, an experienced Dental Hygienist will serve as the Director of Education for CF3.

The Colorado AHEC is honored to provide leadership and management of the Cavity Free at Three Program. This program takes advantage of the statewide efforts of AHEC.

"Family Doctors, Pediatricians, Physician Assistants, and Family Nurse Practitioners see children 10 times between birth and age 4. This is a great opportunity for primary care providers to provide early education and preventive services to improve oral health. We can prevent cavities if we start early."

Westfall says AHEC will help incorporate the CF3 training into the University of Colorado medical school, nursing school, and dental school curricula. According to Westfall, students who are part of the University's Interprofessional Rural Track will get additional exposure and education on CF3. The Colorado AHEC and its outstanding group of technical advisors will educate and train primary care providers, public health workers, and dentists throughout Colorado in a variety of settings, from professional meetings to on-site trainings. Dozens of community sites will be trained annually with an emphasis on safety-net and public health clinics. Community marketing efforts will help educate the public about the importance of establishing a dental home for a child by age one.
For health professionals who have been part of a CF3 training, some describe it as a shift in thinking about how to take care of young children's teeth. The shift in comes in preventing a disease called Early Childhood Caries (ECC). According to the American Dental Association, a child's teeth are susceptible to decay as soon as the teeth begin to erupt. The ADA says ECC is a significant public health problem in selected populations and is considered an infectious disease. It is also found throughout the general population.

ECC used to be blamed solely on inappropriate bottle use, which is why it is sometimes called "baby bottle tooth decay." However, it is now known that the tooth decay results from a combination of tooth strength, sugar exposure, and mouth bacteria. The transfer of bacteria comes from a common practice among mothers, often testing the temperature of a baby's food or milk in her own mouth, and then offering it to the child. That, say dental experts, is how the infectious disease is passed. Combine that bacteria with prolonged exposure to sugar and one can quickly see how a child is at an increased dental and health risk.

A key component of the CF3 program marries infant oral and well child care, which means educating parents, but first, changing fundamentally how primary care is provided for children. It targets providers with an easy and efficient way to reach parents, and to provide dental screening and preventive fluoride treatments.

Dr. Patricia Braun, a board-certified pediatrician at the Denver Health Medical Center's Eastside Neighborhood Health Center and an Associate Professor of Pediatrics at the University of Colorado Health Science Center says that marriage makes sense.

"As a pediatrician, we have ten or eleven opportunities to provide preventive medical care to a child by the age of 3. We see children often for well child care visits, and the focus of those visits is around disease prevention. Early childhood caries is the most prevalent chronic disease in children and is preventable. ECC is also a very disparate disease, affecting children who are poor and without dental insurance. It makes sense for pediatricians, especially those who serve children with public or no insurance, to start addressing ECC in their practices. These children have very limited access to dental care but could receive some preventive dental care if the CF3 model were integrated into the medical home."

"This model could start to remove the disparities that exist in Early Childhood Caries. By providing preventive dental care to at-risk children who normally have no dental access, we can begin to reduce the incidence of this chronic disease," says Dr. Braun

"The impact of reducing caries in primary and permanent teeth is broad. First, there would be cost savings from not having to restore caries. The large majority of caries in primary teeth and permanent teeth require restoration. ECC, because they are in young children, frequently need to be restored under general anesthesia. The cost of restoring ECC ranges from $1200 to $6000 per case. Second, in Colorado, more than $1 billion is spent on dental care each year. The cost of hospitalizations, emergency department visits and of restoring cavities in the out-patient setting could be reduced if caries were prevented. Colorado's children also miss an estimated 7.8 million school hours annually due to dental pain. By reducing caries and the pain they cause, the children can attend school, receive their education and continue on to have productive jobs. Lastly, there are rare deaths from severe infections caused by dental abscesses which could be avoided with ECC prevention."

Westfall says the Cf3 efforts also have started to produce a change in the underlying policy about the care of children. Starting July 1, 2009, Colorado joined 30 other states in allowing physicians to bill Medicaid for oral exams and fluoride applications for children up to age five. This change in Medicaid billing rules was the result of several years of work and advocacy from the Cf3 program, the University of Colorado Denver School of Medicine, Dept. of Family Medicine and the University of Colorado Denver School of Dental Medicine. "By extending the opportunity for preventive services into medical settings, where children are seen as many as 15 times during the first three years of their lives, we fully expect to significantly reduce the burden of oral disease on the children of Colorado," said Chris Wiant, President and CEO of Caring for Colorado.

Westfall says those Medicaid reimbursements for primary care physicians should be coupled with an increase in the number of dentists who will see children in their practices starting at age one. Moreover, he said, we hope to see an increased number of dental providers who accept Medicaid; and pregnant mothers, and parents must have more awareness about infant oral care.

###