Promoción de la salud oral de los niños

(En inglés)

Promoting Children’s Oral Health

Steve Shuman: My name is Steve Shuman. I’m with the National Center on Health, Behavioral Health, and Safety. I am the director of outreach and distance learning. And today’s session is Promoting Children’s Oral Health.

We are using the Adobe Connect platform, and I’m just going to give you a very quick tour of the platform. I hope all of you can see that the center part of your screen are the slides. That’s where all of the content for today will be displayed.

Many of you have found our chat box and have been using that quite well. And we’re glad that you are able to use that. And that’s a great place to share ideas with each other, say hello, and just keep in touch with your colleagues.

Right below the chat box, on the left-hand side of your screen, are some links if you’re having technical difficulties. Adobe Connect recently updated their systems. If you are having difficulty and you’re on a Windows operating system, then there’s a link for you. And if you’re on a Mac, there’s a link for you.

Just to the right of the Adobe Connect app information, you’ll see a web links pod. It’s right underneath the slide. And that is where you will find resources for today, and especially for many of you, will be concerned with submitting the evaluation and obtaining a certificate. The way you do … any of these web links, including the evaluation and certificate, is to select it with your cursor and then drop down to the bottom of that box, where it says, “Browse To,” and it will open in a new window.

When you get to that window, you’re going to be able to have that resource. The evaluation and certificate link will open up the evaluation. You go right through the evaluation at the end of today’s session.

And when you submit it, you’ll get a new link for the certificate. The only way will be able to get the certificate is if you submit the evaluation. And it will pop up when the platform closes as well. So, you have two ways of getting it, and I’m going to remind you again at the end.

Right next to the web links pod are some PDF resources for you to download, including today’s slides, multiple resources on children’s oral health, a description of our dental hygiene liaison project ‒ I’m going to talk about more of that in a second ‒ and some wonderful recipes for promoting the drinking of water. Again, you’re going to select what you want, or you can select them all at once, and then hit the Download files button and that will open up on your device. And then, you can save it or print it, whatever you like.

Then, finally, to the right of the file share box is the question box. And please use that for content-related questions or technical problem questions. Our staff behind the scenes, Kate Hamby-Hopkins and Anna Baur, will be able to answer your technical questions.

Barbara Lambiaso is going to help you with your questions that you may have about finding something on the screen. And Beth Lowe and our presenters will be responding to your content-related questions. But use the question box for your questions, and use the chat box for your chat.

And then, finally, I want to prepare us for today’s session by explaining our presenters’ roles. They are both dental hygienist liaisons, also known as DHLs. Most of our states and territories have DHLs. Some may not have filled positions right at the moment, but they will be.

And the DHLs provide a communication link between our National Center and Head Start agencies. They collaborate with state organizations such as oral health programs, state collaboration offices. They provide oral health presentations at state conferences at meetings.

They offer strategies to improve access to oral health care for pregnant women and children. They work with oral health professionals to establish partnerships with local programs. They share information about the importance of oral health and regular oral health visits with staff.

They can serve on Head Start committees. Not every DHL is going to be able to be available for every one of these tasks, but that gives you an idea of what they can do. And when you download that description, there is a link to find out who the DHL is in your state or territory and how to reach them. And with that, I’m going to mute myself and introduce today’s presenters, Heather Blair and Gina Sharps.

Heather Blair: Yes. So sorry about that. Can you hear me?

Steve: We can hear you clearly. Yeah.

Heather: OK. Well, here we go then. Thank you, Steve, for such a great introduction. Gina and I are so pleased to be here with you all today.

I would like to begin our presentation with the objectives that we’ll be covering this afternoon. The first that we’ll be covering is, we’re hoping to identify the flexibilities that are related to the Head Start Program Performance Standards on Oral Health during COVID-19. The second is to offer strategies and resources to help Head Start staff to promote oral health. And the third is to offer strategies and resources to engage parents in positive oral health practices at home.

The first standard that we’ll begin with focuses on ensuring an up-to-date child health status. And we are all familiar with the standard, and we strive to ensure that children are up to date on both their age-appropriate preventive and primary medical and oral health care based on their well-child visits and dental periodicity schedules as prescribed by EPSDT. But please remember that there is a difference between the state EPSDT well-child periodicity schedule, which focuses on their medical visits, even though it does include some oral health. The schedule that we want to follow is the state’s EPSDT dental periodicity schedule.

Some strategies that we’re offering for Head Start staff to consider and to help get the discussion going with parents and caregivers is to reinforce that dental visits are safe during COVID-19. Dental practices have always been careful to protect their patients and staff from communicable diseases like hepatitis and HIV, even before COVID entered the scene. Since COVID, they have taken more steps to help prevent the spread of disease. And we’ve done this by disinfecting even more surfaces, like door handles in waiting rooms and countertops in restrooms.

We’re using disposable one-time-use supplies wherever we can, our instruments continue to be sterilized, and we’re wearing more protective gear than ever before. We’re wearing face shields and hair bonnets. I mean, we are really quite a sight now in the dental practice.

In fact, I’d like to share that in July 2020, it was reported by the dental officer for the CDC and COVID-19 response team that there have been no confirmed cases of COVID-19 transmission in a dental office to date. And I like to think that that’s because our infection control was so good before. Hopefully, this will help to reinforce that we can be confident about recommending routine and restorative oral health care during this time.

We hope to also please share with parents the importance of primary or baby teeth. You know, they’re the space holders for the permanent teeth. They help children chew a variety of foods to help with adequate nutrition, and they are needed for proper speech development.

Poor oral health can also have a negative effect on learning behavior and sleep patterns. And unfortunately, some of you may have already seen this firsthand in some of the children that you see. There are great benefits to developing a good oral health routine at home at a young age, and we really encourage the whole family to do this together.

Also, now, let’s talk to parents about what they can expect during their child’s dental visit. Start with them entering the office, then meeting their hygienist, and having their teeth counted, using the tooth tickler to polish their teeth, discussing how the application of fluoride works, the exam with the dentist, and finally, getting their new oral health supplies at the end of the visit. Also, make sure to ask parents if they have concerns or questions about upcoming appointments.

They might be nervous that their child will be hurt during an appointment, or that they’ll be separated from their child. And by addressing these concerns ahead of time, it’ll help parents and caregivers to feel more comfortable going forward. And lastly, we’re all doing this: Help the families to find an oral health professional that is a good fit for their child.

Another strategy to help engage parents in feeling comfortable about returning to the dental office is maybe to share some questions that they could ask the dental office about how the practice has put more protective measures in place to protect their patients from COVID-19. So, for instance, what will happen now when you arrive to the dental office? An example could be that now, when you arrive at the dental office, many offices are having you call from outside, and they’re asking you to wait outside until they’re ready for you.

And then, you also probably will ask some COVID questions to make sure everything is good before you come in. What will happen when you come in the waiting room? A lot of times, they’ll take temperatures now. They’ll ask you to put a mask on, and they’ll ask you and the child ‒ you know, the parent or caregiver and the child ‒ to sanitize their hands.

Ask the office, “What changes have you made to protect me and my family from COVID-19?” A lot of offices have increased their air filtration. They’re asking patients to wear masks. They’re disinfecting all those high-touch surfaces like the door handles, counters, and bathrooms, so much more than we were before.

The protective clothing ‒ we’re wearing high-filtration masks. The treatment providers are wearing head coverings and face shields. And of course, the room disinfection hasn’t changed, because we were all following the standard of care to start with.

Another question could be, “Can I be in the room during my child’s appointments?” And generally, the answer is yes. Because with early childhood visits, there is so much education that happens during these appointments that it is so important for parents and caregivers to attend with their child.

Remember that children need help with brushing and flossing for many years. There’s a handout that’s going to be coming up here in a couple of slides, called the Coronavirus Disease and Oral Health Information for Parents About Visiting the Dental Office. There’s pictures on the handout. You can show the family and the kids, and you can download it. The handout is also available in Chinese, Spanish, Tagalog, and Vietnamese.

We’ll talk about that when we get there. So, here are some resources also for Head Start staff. All of these issues of Brush Up on Oral Health were developed for Head Start staff to increase their understanding of the importance of primary teeth in a child’s health and development, and the importance of the age 1 dental visits’ role in acclimating young children to receiving oral health and finding and treating oral health problems early.

And the last is oral health and its impact on the child’s ability to learn and achieve school readiness. The Brush Up on Oral Health provides information on current practice, practical tips for Head Start staff and parents for promoting good oral health. And we know from the data that Brush Up is one of the most frequently downloaded resources from ECLKC. So, thank you for all of your past and current efforts to continue promoting good oral health.

Another resource that you might be interested in is Understanding the Dental Periodicity Schedule and Oral Exam: A Guide for Head Start Staff, which was developed to help staff learn the difference between a dental periodicity schedule and a well-child periodicity schedule. This helps to identify when a child’s first oral exam should occur, which should be six months after the eruption of the first tooth or by age 1; who can perform the exam; and what is included in the exam. And all of these links can be found below in the file share. Here are some resources that are designed especially for families.

Here is that Coronavirus disease handout to help parents understand what to look for and expect when they take their child to the dental visit. You could also use this handout to role-play asking the dental staff questions when parents make an appointment for their child. The information in the handout can also be used to explain to children what will happen during this dental visit.

And you know, there’s a picture on here of the hair bonnet and the face shield that we’re all wearing. These other resources may help to reinforce the Head Start staff discussion with parents. There are some pictures here of the Healthy Habits series of handouts, which is designed specially to share directly with parents and caregivers, which is a brief and easy-to-understand informational with pictures about topics, such as, “Why is it important to begin dental care by age 1?” “Why are primary teeth important?” And ideas on how to find a dental office that’s a good fit for a family. And then, there’s the Sesame Street in Communities, Starting Early, which is web-based and has some short, cute, engaging videos that both parents and caregivers and their children will enjoy about oral health.

So, what makes a great meeting? Participation. These meetings are always more fun when there’s audience participation, and you all come up with the most creative new ideas that can all help us learn together. We would love for you to share some of your successful strategies that you’ve used in your programs to help engage families in returning to the dental office during this time.

And there are some of those challenging concerns or barriers that you may have faced and how you tackled them. So, please take a moment, and there’s the chat box over there on the left side of your screen, and share some of these strategies that you’ve learned, that you are using.

Once we get those all in there, we’re going to put them together, and we’ll share them with today’s meeting attendees to help increase all of our success and help the families that we serve. So, take a moment over there in that chat box, and put down some of these things that are working really well in your programs. So, it looks like some programs are ‒ boy, this is moving so fast. I can’t see it fast enough.

Some people are explaining what it was like because they’ve gone themselves. So, it sounds like there’s been maybe some peer engagement. They’ve had a mobile dentist come. It looks like there are a lot of great ideas coming in, and it is scrolling so fast that ‒ I’m sorry, I can’t even keep up with this.

So, this is awesome. Keep those ideas coming as we continue to present, because together we’re all better. So, let’s keep going.

The next standard that we’re going to focus on is extended follow-up care and treatment needs. Each program has a tracking system in place, whether it’s on paper or it’s computer-based, to help track and follow up on referrals and the implementation of necessary follow-up oral health care. Here are some strategies that could be considered to assist the Head Start staff with successful follow-through with treatment needs.

One strategy could be asking why the child hasn’t been for their follow-up care. You know, sometimes, it isn’t why we think. For instance, we might think that the family doesn’t understand the importance of this care, when in reality, they just don’t have transportation.

So, asking the question will help us to address and work through the barrier to care, whatever it is. Another strategy could be, parents and caregivers have many questions, and sometimes we may not be able to answer them, or they might just like to hear it from someone else. Consider hosting a virtual ask-a-dentist or ask-a-dental-hygienist event.

This can also help families to feel a connection to an office, even before they walk through the door. Another could be for the children. Arrange a virtual field trip to the dental office, use a whiteboard or a screen or a laptop, something to project this on in the classroom.

And then, have the dental provider use their smartphone, beginning at the entrance of the office, have them introduce themselves, and talk about what this field trip is going to be like. Have them show the waiting room and introduce the children to the front office staff. Continue the tour into the hygienist room, and demo all of the things ‒ the chair, the light, the tooth counter, the sunglasses, the Mr. Thirsty, etc.

Then, tour them right down the hall to meet the dentist. Show them the sterilization area where the instruments get cleaned, and then wrap it up back at the front desk, maybe even showing them the treasure chest. This is a good way for the children ‒ and maybe if there are some parents or family members there ‒ to feel a connection to an office even before they walk through the door.

And then, I am sure that each program has some parent champions that could be engaged to help other parents or caregivers overcome challenges in moving forward with treatment. For instance, there might be a family that needs urgent care for their child’s extensive cavities, but they’re reluctant to schedule because of fear. Pairing them up with another parent that has gone through it and had a good experience may allow them to feel more comfortable about scheduling their child for necessary care.

Another strategy could be try role-playing with parents, whether it is in person or virtually, about what happens during a dental visit. Talk to them about the need for routine exams. Let parents know it’s OK if their child cries, because if they cry, we can see everything in their mouth.

And if the parent is right there, they know we’re not hurting the child. That doesn’t mean the parent is not going to feel horrible, because as a parent, we do if our child starts crying. But as a provider, if they cry, I can see everything going on in their mouth. And let parents know that sometimes it takes a couple of happy visits before a child is ready for treatment, and that the office will work with them.

Here are some great resources to help the Head Start staff tackle those conversations. Check out the Applying Consultation Skills to Oral Health Promotion webpage. There is a brief PowerPoint video presentation about a child that has oral health problems, and how they may not always present by telling us they have a tooth problem, and how we can recognize it, and then work through these challenging situations.

There’s also a Brush Up on Oral Health that focus is on follow-up oral health care. And if your program is still using paper, well, Head Start has a form to help you track that. And then, there is a resource titled Understanding Family Engagement Outcomes, Research to Practice Series, Family Connections to Peers and Community that may help with peer engagement.

The next is some great resources that you can share with parents to help introduce children to the equipment that they’ll see in a dental practice, since it is very different from what they see in their medical practice. Check out the Let’s Pretend resources from Sesame Street, The Oral Help from Maryland Kids Curriculum, and the ADA’s Visit to the Dentist. I used to use that all the time when I would go into the classrooms.

And I would put on my scrubs and my overgarment and my glasses and my mask, and all of the things ‒ and the gloves ‒ and we’d talk about what it was all for, in an effort to desensitize some of these kids before they even went to the office. And then, we would talk about the chair, and how it would ride up and down and lean back. We’d talk about the mirror and the tooth counter, and we’d talk about them getting to wear a bib because they get a little juicy sometimes.

And we’d talk about how the X-ray was like a big camera, and all of the things, and they’d be so excited. And at the end, when I get to do my screening, they’d all get a dentist mask, and they’d be a dentist for the rest of the day. So, it’s just a nice way to engage the kids in the classroom.

And here’s another opportunity for you to be able to share some of your ideas. We’d like to take a couple of minutes to have you share some of your creative ideas to help keep ‒ how you are helping to keep oral health alive in the classroom and some of the strategies that have worked really well to help engage parents in setting up necessary follow-up care for their children.

Please use that chat box over on the left and share some of these great ideas that you’re using in your classrooms to keep oral health alive, but also those challenging situations that you deal with with parents and follow-up care. What’s working really well in your programs? Take a couple of minutes and make some notes over there, please.

At this time, I’d like to turn the remainder of this presentation over to my colleague, Gina. Take it away.

Gina Sharps: Thank you, Heather. Good afternoon, everyone. It’s so great to be with you and spend some time talking about oral health. I’m going to spend the remainder of our time focusing on the two standards on oral health hygiene practices and child nutrition, and then we promise we’ll take a few questions at the end.

And I’m sure one of the things that you’re thinking right now is, well, clearly, that picture was taken pre-COVID-19. And indeed, it was. But just because we are in the middle of a pandemic does not negate the fact that we shouldn’t be promoting good oral health hygiene.

Unfortunately, we know oral disease hasn’t stopped because of COVID-19. In fact, we know stressing good oral health hygiene practices while children are at home is more important now than ever due to the potential of inconsistencies with home routines, school routines, and wide variations in nutritional practices. So, the good news is Head Start is allowing flexibility pertaining to the Program Performance Standard on oral health hygiene.

With that, it is recommended that toothbrushing in classrooms be suspended until it is considered safe again and for programs to keep working hard, as we know you do, to promote effective oral health hygiene for all children enrolled in Head Start. So, the rationale for suspending toothbrushing is that the virus can be spread through droplets. Brushing, spitting can increase the risk of transmission by spreading these droplets.

So, again, that’s the rationale for suspending toothbrushing, that the virus can be spread through droplets. And so, the Centers for Disease Control and Prevention, the Office of Head Start, have recommended temporarily suspending activities that could increase the risk of spreading the virus, and recommend toothbrushing at home, but not in group care. So, again, we’re recommending toothbrushing at home but not in group care.

All right. As we were putting this session together, we wanted to be ‒ oh, my goodness. Sorry about that. Let me get back there.

We wanted to be very considerate of each of you as Head Start staff in weaving in practical activities and strategy. So, basically, where were the natural points of intersection in families’ everyday lives that we can make the most impact on their oral health? And with that, we’d like to suggest four strategies specifically related to good oral health hygiene practices.

And they are: The first is to encourage parents to brush their child’s teeth with fluoride toothpaste in the morning and before bedtime. And remember, fluoride is the natural mineral that reduces dental decay, aka cavity. And it’s important that children do not rinse with water after brushing, as we want the fluoride to bathe the teeth throughout the day and as they sleep.

And the second strategy centers upon the opportunity to share toothbrushing supplies and resources with parents. And I love this strategy, because you can get really creative around this. I know here in Region III, our dental hygienist liaisons, our DHLs, have partnered with Head Start to secure and share toothbrushes with various centers. And of course, Head Start Centers have dollars that you can tap into to purchase toothbrushing supplies.

And the third strategy is to record songs and videos for parents to use while their child brushes at home. So, talk about fun. This is really a great way to do what you all do best, in terms of modeling good oral health habits. It’s super easy to video yourself brushing teeth or even singing one of your favorite toothbrushing songs.

And of course, being here in West Virginia, the home of Choosy, IMIL, “I Am Moving, I Am Learning.” One of my favorite toothbrushing songs is “Brush My Smile” ‒ [Singing] Just a little on the middle of my brush, so brush, help me brush. And I’m sure you all have your own faves, and if you need some inspiration, feel free to call on your state DHLs, as some of them have done some really outstanding and fun videos to promote good oral health habits.

Now, I can’t promise you they’re all going to sing to you, but they will be a great source of inspiration. And so, the fourth strategy is to encourage and ask parents to set a good example and to let their children see them brushing their own teeth. We’ve all seen young children mimic their fathers and mothers in everyday tasks. So, why not encourage parents to show their children the same with their toothbrushing routine?

We want to make sure to encourage parents to make a point to brush their tongue, to reach the teeth and the further back of their mouth. They can use exaggerated gestures to show children very clearly each critical step of the toothbrushing process. And at the end, parents can flash their pearly whites in the mirror to show that they’ve done a quality job, and to be proud of their efforts to show their children the reward of a brushing job well done.

And so, to encourage parents the correct technique, you could host a virtual education session with parents to review step-by-step proper brushing. Sorry about that. Trying to get this to advance to the next one.

Being a little tricky. There we go. As for resources, our World Health friends in the new National Center on Health, Behavioral Health, and Safety have done an outstanding job at creating publications such as Brush Up on Oral Health to promote a whole host of oral health topics.

And there are a few specifically related to this particular standard that we feel that you might find of benefit. And they are, How to Structure Your Child’s Nighttime Routine, Fluoride, and Preventing Tooth Decay. And I know within our DHL community, one of our very favorite resources is Brush, Book, Bed. And if you haven’t had a chance to check it out, it is really a fantastic tool that aims to improve oral health outcomes by sharing messages about early literacy, sleep, and establishing a regular nighttime routine.

The Brush, Book, Bed was developed by our friends and colleagues at the American Academy of Pediatrics to share simple and clear messages with parents. The messages are: Each night, help your children brush their teeth, read a favorite book or two, get to bed at a regular time each night. So, what’s really awesome about this program is the interprofessional approach that it offers.

Head Start staff can share these messages. We as DHLs can share these messages. The child’s pediatrician or primary care provider can share these messages. So, it really provides for a sense of continuity in terms of anticipatory guidance offered by all those supporting the child and the families that we serve.

So, now, let’s take a look at a few of the resources that you can share with parents, and there were many, but we pulled three to highlight with you today. And the first is, the Coronavirus Disease and Oral Health handout, which stresses the importance of eating healthy foods and drinks and practicing good oral health hygiene habits, including when to replace the toothbrush if a family member is sick.

And this resource is available in multiple languages, including Spanish, Chinese, Tagalog, and Vietnamese. There’s also the Healthy Habits for Healthy Smiles, Brushing your Child’s Teeth. And this is a very nice one-pager that includes tips on toothbrushing, such as the proper amount of toothpaste per age group and the importance of parents brushing the child’s teeth to ensure that they are adequately cleaned.

And as a reminder, Healthy Habits is available in both English and Spanish. And lastly, Heather mentioned this a little earlier, is a web-based resource from Sesame Street in Communities, titled Brushy Book, Nighty Night, featuring dentist Grover. And of course, who doesn’t love Grover?

And if you’re familiar with Brushy Book, Nighty Night, you know the messages are congruent with those found in the Brush, Book, Bed program. It’s all about literacy, sleep, and establishing a regular nighttime routine. So, we’d encourage Head Start Centers to link these resources to your center’s Facebook page. The messages can be incorporated into electronic monthly newsletters that you send out to your parents.

Again, the goal is to consistently promote the importance of good oral health, as it directly relates to the child’s overall health. OK, so we’re going to pause right here and, just as Heather did, encourage you to share. She would like you to share and chat in some of your successful strategies that you’ve used to promote oral health hygiene practices in the chat box.

So, I will pause and give you a few moments to share. And I’m not sure if we mentioned this or not, but we’ll compile all of your great ideas and send these out at the conclusion of the webinar. So, I’m seeing some of them come through.

Singing ‒ [Laughter] … Singing songs, modeling ‒ excellent. Someone liked the idea of videos. Oh my goodness, Heather’s right. You all are fast with this. This is fantastic.

All right, thank you very much for that. So, we’ll move on to the last standard, and now, lastly let’s briefly talk about Standard 1302.42 related to child nutrition. And I’m sure most of you have this one memorized.

And it states, a program must make safe drinking water available to children during the program day. So, as oral health professionals, we were really interested, are really interested, in your work around this standard. We know drinking tap water with fluoride reduces cavities by 25% in both children and adults, and provides children and their families with an extra layer of protection against cavities.

We also know from the science that water plays such an important role in maintaining a child’s overall health. Drinking water supports children’s muscles, their joints, their tissues. It improves their digestive system, keeps their bodies hydrated, and it also has a positive impact on a child’s cognitive performance, particularly short-term memory.

And we know that drinking water can also improve children’s visual attention and fine motor skills. So, the second strategy that we are really excited to share with you is holding a weekly virtual cooking show for parents, featuring one of the recipes from Cooks Corner, Recipes for Healthy Snacks. Now, you might be thinking, “Well, that sounds fun, Gina, but how many ways are there to prepare tap water?”

But the goal here is to focus on healthy drinks and food selection by using tap water, so this is one of those strategies you can tailor in multiple ways. You can have a family come into the center and film the cooking show. You could film yourself with a nifty chef hat on, or you could pull in your family service coordinator.

Again, the goal is to have fun while promoting healthy drinks and food choices. All right. So, as for resources for Head Start staff, we’d again call your attention to the Brush Up publications on choosing healthy drinks, community water fluoridation, and water and help.

And one of my new favorite ‒ new, meaning, in the last couple of years ‒ is the colorful blue poster shown here on the slide. And this poster can be used as a teaching aid or with parent events. And then, really, another important message with fluoridated water is around health equity.

We know that community water fluoridation is a safe and effective, and it benefits everyone, no matter race, age, or income level. And while we don’t have to wait for any special time to promote oral health messages, we know that there are some really unique opportunities to team up and work with community partners to promote the messages of drinking water with fluoride to keep teeth healthy and strong. One of the first opportunities that comes to mind is during Drinking Water Week, which is celebrated the first full week in May each year. And this year, Drinking Water Week will be held May 2nd through the 8th. Again, that’s 2nd through the 8th, with Drinking Water Week.

And so right there is some potential to help get the word out to families advocating the importance of drinking water with fluoride. So, let me see if I can advance it. Sorry, folks, my little clicker is giving me sass today.

OK, so, now, let’s once again take a look-see at a few of the resources you can share with parents. There were many, but there are five here that we pooled for your consideration. And they are Cooks Corner Recipes for Healthy Snacks.

And if you haven’t, I really encourage you to explore this resource. None of the recipes have added sugar. They do, however, include ingredients that are fresh, low in fat, and high in fiber.

The recipes are really fun, and they present the opportunity to incorporate many of the various Head Start domains that you’re familiar with ‒ mathematics knowledge and skills, science knowledge and skills, and physical development and health. And two of my favorite recipes are watermelon pizza and tomato salsa, and they are yummy.

So, we also have two of the Healthy Habits for Healthy Smile handouts, including encouraging your child to drink water and giving your child healthy snacks. And I’m saving my personal two favorites for the last, and they are Potter the Otter: A Tale About Water and West Virginia University Water Recipes.

The Potter the Otter is available online through California’s Santa Clara County First Five Program. And when you click on the link, the book is narrated. So, this is one of those resources you can link to your center’s page or maybe even partner with your local library to share this particular book.

I know here in West Virginia, because of COVID-19’s influence on gathering at public spaces, such as our libraries, our librarians have set up an outreach where children and families can call in and read along with the librarians. So, it’s really pretty clever and a wonderful way to help combat learning regression.

And lastly, the Water Recipe Card was created by my friends and colleagues at West Virginia University, my alma mater. So, go Mountaineers, for all the Mountaineers out there. The goal of the recipes are to encourage children to stay hydrated by drinking tap water infused with fresh fruits and herbs.

So, if you like the idea of hosting a virtual cooking show, you can always start with one of the recipes from the WVU, the West Virginia University Recipe Card, as they are really easy with minimal steps. And it also allows for the opportunity for you to encourage parents to prepare fruit-infused water in the morning. That way, children have access throughout the course of the day to a healthy drink option.

So, once again, we would love for you to chat some of your ideas, or hear some of your ideas in the chat box over to the left-hand side, just to highlight a few of the successful strategies that you’ve used in your centers to promote healthy child nutrition. So, I will give you a moment to type away there.

All right, so I see enjoying the resources, Cookie Cutters for Picky Eaters, all right. Oh someone says, Potter the Otter is famous in their classrooms, so they’re already using some of these resources. Oh, this is fantastic.

Someone likes the water challenge. OK. Oh, someone else likes Choosy, fantastic. OK. So, I’m going to just move on. I do want to share ‒ before we take your questions, we’d like to mention one last resource that can be found on the Office of Head Start’s Twitter and Facebook accounts, and the resource promotes several oral health messages many of which you heard today via Twitter and Facebook.

So, for all you tweeters out there, feel free to retweet and repost the oral health messages to get these out to our families. And I just wanted to share that the Twitter account is @HeadStartGov. Again, that is @HeadStartGov. And I believe that’s going to be typed into the chat box, that you can reference that.

And the last post on the Twitter . . . I’m not extremely proficient with Twitter, but my colleague, Beth Lowe, shared with me that the last post on Twitter was on February 15th, so you might have to do a bit of scrolling. And the last post on the Office of Head Start Facebook account was on February 18th.

So, with that, I will pause and we’d love to field some of your questions. Heather, you’ve had a moment to look at a few if you want to jump in and get us started there.

Heather: I have. The first one was, “Is it safe to take children to the dentist during COVID-19?” And it absolutely is. And I encourage you to use some of the resources that we’ve shared today, have parents call the office, ask the questions that they’re concerned about. And it’ll just help them to feel more comfortable when they make the appointment and attend it.

Another question here was about parents being concerned about children being strapped down or not being allowed in a room when there’s work being done. And you know, I mentioned at the beginning as I was going through, parents need to find an office that’s a good fit for their child. And so, if there are practices that they’re not comfortable with, I encourage them to talk to their providers about that or find an office that is a better fit for their families. There are amazing dentists in every state, and we just sometimes need to find them. And I think ‒  

Gina: Heather, while you’re scrolling, I can jump in.

Heather: OK. Go ahead.

Gina: The one that’s assigned to me says, “Regarding toothbrushing and center-based programs, do we wait for the OK from the Office of Head Start for when it is safe to restart toothbrushing, or do we make the decision for ourselves?” So, my response to that would be, we’re going to wait for the Office of Head Start to give us the all-clear.

We’re going to look at the science, so we’re going to look to see what’s coming out from the Centers for Disease Control and Prevention, too, in terms of guidance. But Steve Shuman, I’d love to tag you in on this one to ensure that I answered that most accurately.

Steve: Thanks, Gina. And I will say, the Office of Head Start, the National Center, and the CDC are working very closely, so our recommendations are aligned. But of course, these are recommendations.

So, if you are working with your local or state or tribal health department or territorial health department, your licensing agency, your health services advisory committee, and your management team, you may make decisions that are appropriate for your program based on community rates of transmission. I hope that helps.

Gina: OK. No, that’s clear. Go ahead. Go ahead.

Heather: This is Heather. I’ve got another question here. After COVID-19 life, “Are there any agencies I can contact for dental in-person trainings?” Contact your state dental hygiene liaison, and they will help you.

They’ll either come in and do a training for you, or they can direct you to a resource in your area, a dentist or an office that could come in and do a training with your students. So, utilize your dental hygiene liaison in your state. And I believe in, either the web links or the file share here, that there is a list that you can download, so you’ll know who the DHL is in your state.

Gina: All right. Thank you, Heather. I’m going to go ahead and field one here. I see Kerry Drennen posted an excellent question. “At what age should you start using toothpaste with fluoride?”

So, the recommendations from the American Academy of Pediatrics Dentistry ‒ as soon as the first tooth erupts, we’re going to start using toothpaste with fluoride. So, from the first tooth eruption up to age 3, we’re going to use a rice-sized amount or a small smear. From ages 3 to 6, we’re going to use a pea-sized amount of fluoridated toothpaste.

And everyone from that social media oral health messages that are on the Office of Head Start’s Facebook page and Twitter has these very specific questions in them in regard to toothbrushing amount. So, this was a perfect question. Thank you, Kerry, for that.

Heather: All right. The next one that I see is, “Is it mandated that children of the ages from 3 to 5 need to get a dental screening every six months?” And I would refer you back to your state’s dental periodicity schedule. So, look that up for your state and see what the recommendation is.

And often, it’s not just a screening that’s recommended, but an exam. So, it needs to be an exam by a diagnostic provider. So, look at that dental periodicity schedule for your state, and that is how we direct families when we are telling them or sharing with them what the recommendations are.

Steve: Heather, could I just jump in there for one second? I did want to say that in the Head Start Program Performance Standards, it is required to follow the state oral health periodicity schedule, a dental periodicity schedule, that you just mentioned. So, that part is the requirement, and then you’ll find the specifics of that in your state schedule. Thanks.

Gina: I’ll go ahead and field another one here, and I’m trying to lump some of these together. And this one is regards to rinsing mouths after toothbrushing. So, Claire Wilson posed an excellent question.

“Once we return to teethbrushing at Head Start centers, should we stop having kids rinse their mouth after brushing to leave the fluoride on the teeth?” So, we really want that to be the standard at all times, whether that’s in the classroom or at home. Adults or children, for that matter, so after we brush teeth, we just want to spit the toothpaste out, and we do not want to rinse.

So, that gives all of us the benefit of fluoride bathing the teeth, either after we brush in the morning, at night, or throughout the course of the day. Great question, Claire.

Steve: I think we just have a couple more questions.

Gina: OK. Thank you, Steve. I’m continuing to scroll here. Oh, I see one that I have not addressed yet. “Is training toothpaste for children 0 to 12 months effective?”

So, again, as soon as the first tooth erupts, up until age 3, we want to make sure that we’re using toothpaste with fluoride. And Heather and Beth, you jump in here, but I believe most training toothpastes do not contain any fluoride.

Heather: No, they don’t.

Gina: Uh-huh. Correct. Yes, thank you, Heather, for verifying.

Heather: Just use that smear of the fluoridated toothpaste, and it will be good.

Steve: That smear is the teeniest, tiniest amount, and there are photographs of what a smear looks like on the ECLKC Oral Health page. So, it looks like you may have answered all of the questions. Gina or Heather, do you see anything you haven’t answered?

Heather: I don’t.

Gina: Nor do I.

Steve: OK. Well, while we have this up, I know that there were some questions about specific resources, including Otter the Potter ‒ or, Potter the Otter, rather. Excuse me, Potter the Otter.”

And all of the resources that both Heather and Gina mentioned today are in one or both of the resource sections of this window that you’re looking at, either in the web link pod, where you’ll get to the ECLKC Oral Health page, or the resources in the file share pod. And there are the slides. There is the Promoting Children’s Oral Health Resource List, which basically has links to everything that was mentioned today, and those water recipes from the West Virginia University that Gina mentioned.

What could be easier than cooking with water? Hmm? And to obtain the web link pod, including the evaluation and the certificate, you’re going to select the item, then drop down and go to browse to, and then a new window will open on your device. Whether you’re on an iPad, a tablet, a computer, a laptop, or a telephone, it should appear.

You’re going to follow the directions for the . . . answer all those questions in the evaluation. When you submit it, you will get a new link to your certificate. You’re going to select that link, and then you’ll be able to download that certificate and save it or print it in whatever way you want.

It’s a certificate that has the name of today’s session, the date, and the one-hour duration. We don’t have more than that available for you. You can put in your own name.

Today’s slides are there in the file share pod. You can click. You can download any of those PDFs by selecting them and selecting Download Files. And they should appear wherever items are downloaded onto your device. Sometimes, it’s in a special folder that’s sometimes on your desktop.

The link to the evaluation and the certificate is on the web links pod immediately under the slide, to the right of the chat box and the Adobe technical app information segment. Evaluation and certificate ‒ you’re going to select that, Browse to, and then open it up. Everyone watching today, everyone that registered, will get a recording of today’s session with the same links and files ready to be downloaded or uploaded to your device.

Looks like a lot of people were extremely grateful. I know that I learned a lot from both Gina and Heather. I thank them very, very much and all of our oral health team, including Beth Lowe, Katrina Holt, and Sarah Kolo. They are wonderful members of the National Center on Health, Behavioral Health, and Safety. And all of, I could not forget all of the incredible DHLs across the country.

If you are interested in subscribing to our mailing list, there’s a link for it in the web link pod, or you can use this URL. If you have additional questions, you can call toll-free 888-227-5125, or write to us at Health@ECETTA.info. And all of our resources for the National Center on Health, Behavioral Health, and Safety are there on ECLKC at that URL.

We always prefer to get your email questions, because that’s the best way for us to respond to you. Looks like we’ve got a few more content-related questions. There are a lot of questions about rinsing, and we have just another minute or so. I don’t know if Gina or Heather, you want to take the rinsing question.

Heather: Absolutely. Rinsing isn’t recommended, because we really want the fluoride to remain in the mouth after brushing. So, the recommendation is to use the proper amount of toothpaste depending on the age of the child, brush, spit, and then don’t rinse. Allow that fluoride to do its work. When we rinse, we rinse the benefit of that away.

Steve: So, the rinsing has nothing to do with COVID. It really is about oral hygiene, keeping that fluoride as close to the teeth for as long as possible.

Heather: Absolutely.

Steve: Great. I see someone asking about teledental services, virtual dental services. They get documented in the same way in most states where they offer teledentistry. So, you want to get that documentation from the oral health care provider.

Heather: Steve, I also want to ‒

Steve: Go ahead.

Beth Lowe: Steve, I also want to chime in on that, too. Because someone asked about the dentist giving them information about a child receiving dental care and not using the oral health forms that are on the Head Start, on ECLKC. And you can use any kind of confirmation from a dentist to indicate that the child is up to date on their EPSDT schedule.

So, you know, those resources are available to you if you want to use them. Otherwise, you can use whatever means you have of verifying that a child has had a dental exam or has had dental work done.

Steve: Thank you, Beth. Those are just suggestive forms. Here’s a question. “Do we know if fluoride has pork in it?” And that’s very important for some people.

And I believe any of you can answer that question. Gina? Heather? Beth?

Gina: That would be no.

Steve: That would be no, right. It’s a test. There is no pork in fluoride. Fluoride is a naturally occurring mineral that, when used in small amounts, helps prevent oral decay, cavities.

Speaker: Thank you, Steve.

Steve: You’re welcome. Well, I think we’ve run out of time. The webinar platform is going to come down.

We will try to get to all of the unanswered questions that came in a little bit after we closed the question box, but we did get a few in, at a later date. And there is, Lauren, once again, there is no rinsing. There is no rinsing. You want to keep that fluoride on your teeth as much as possible, for as long as possible.

Kate is going to bring down the platform. And if you haven’t already selected the evaluation and certificate link, it should pop up on your screen. If not, don’t close out, because it’s going to pop up. Don’t close out.

And it will be in the recording as well. I think we got it all. Thank you again, Beth, Barbara, Anna, Kate, and, of course, Gina and Heather.

Gina: Thank you. It’s been great to be with you.

Steve: Yes, it has. Thanks.

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