Historically, the focus of children’s oral health has been on preventing and managing tooth decay. Despite achievements in lowering rates of tooth decay since the early 1970s, it remains the most common chronic disease of childhood in the United States. Children from families with low income are disproportionately affected by tooth decay.

If tooth decay is not treated, it will get worse over time and can significantly diminish children’s overall health and quality of life. Failure to prevent and treat tooth decay has long-term effects on children’s development. It may make eating and speaking difficult, reduce self-esteem, and make it harder for children to achieve an optimal weight. Oral health can also affect academic performance. Children with oral pain are more likely to be absent from school. They may also have trouble concentrating and managing their feelings and behavior. Children with disabilities are also at higher risk for developing tooth decay than other children. When children receive treatment and are no longer in pain, they are better able to focus on learning.

Health managers who are familiar with oral health considerations during pregnancy can better support pregnant women, pregnant people, and their families. Receiving oral health care is safe throughout pregnancy. Oral health care helps keep the pregnant person healthy during pregnancy, lowers the number of bacteria in their mouth that cause tooth decay, and makes it more difficult to pass those bacteria to their infant.

Head Start staff help pregnant women, pregnant people, and families understand the benefits of good oral health, how to prevent oral disease, and the importance of ongoing oral health care. Head Start staff also can share strategies in the classroom and during family meetings for eating healthy foods and practicing good oral hygiene.

Head Start Health Services Competencies

CFH-8 Know the importance of healthy oral development, risks, and protective factors.

CFH-13 Assist families to access medical and dental homes.

CFH-14 Identify whether children are up-to-date on their EPSDT and immunization requirements.

CFH-23 Support positive oral health practices during program hours.

CFH-24 Ensure that program staff can provide first aid and CPR and always have access to well-maintained first aid supplies in order to respond to medical and dental emergencies.

HSPPS Related to Oral Health

• Child health status and care, 45 CFR §1302.42
• Oral health practices, 45 CFR §1302.43
• Child nutrition, 45 CFR §1302.44
• Family support services for health, nutrition, and mental health, 45 CFR §1302.46
• Safety practices, 45 CFR §1302.47
• Community partnerships and coordination with other early childhood and education programs, 45 CFR §1302.53
• Enrolled pregnant women, 45 CFR §1302.80

Social Determinants of Health and Equity Considerations

Children ages 2–5 from families with low incomes are more likely to have untreated tooth decay than children from families with higher incomes. This is particularly the case for Mexican American and Black, non-Hispanic children, who are more than twice as likely to have untreated tooth decay as white, non-Hispanic children. Understanding causes of oral health inequities is essential to creating effective oral health programs and policies. Causes range from individual factors such as families’ financial stress, lack of knowledge about oral health, and inability to take time off from work to obtain oral health care to systemic factors such as state Medicaid and Children’s Health Insurance Program (CHIP) eligibility and renewal requirements, lack of comprehensive dental benefits, and low reimbursement rates.

Factors that limit families’ access to high-quality care also play a role in oral health inequities. Challenges related to reimbursement for oral health care can influence oral health professionals’ decisions about whether to participate in public insurance programs. Some oral health professionals who accept public insurance provide care to only a few such patients (e.g., 1 in 9 patients are on public insurance), whereas other oral health professionals provide care to a high volume of patients on public insurance (e.g., 100 or more children) in communities where few or no other oral health professionals accept them.

Geography also plays a role in obtaining oral health care. Millions of people living in rural areas and less prosperous urban and suburban communities lack access to oral health care due to geographic isolation and workforce maldistribution. Head Start staff can help families develop a plan to access oral health care.

Many adults in the United States do not have dental insurance. People without dental insurance are less likely to have a continuous source of oral health care, and they may not be able to afford the care they need. Nearly half of children receive dental benefits through Medicaid or CHIP. Unfortunately, fewer than half of dentists in the U.S. provide care to children and adolescents enrolled in Medicaid and CHIP and, of those, many limit the number they accept who are covered by these public insurance plans.

Where families live can significantly impact their access to resources necessary to maintain good oral health. Families living in food deserts (i.e., areas where affordable or good-quality fresh food is difficult to obtain) are more likely to experience poor nutrition. They are also more likely to frequently eat fast foods that are high in sugar, which increases the risk for developing tooth decay and other oral diseases. Having to drive long distances or lacking access to convenient public transportation make it difficult for families to make and keep dental appointments. The need to take time off from work, child care costs, and transportation costs also affect whether families make and keep dental appointments.

Social networks and support systems affect how people view oral health. Relationships and interactions with family members, friends, coworkers, and community members play a major role in how people value and understand oral health and how they maintain their oral hygiene and the oral hygiene of their children. Such social networks and support systems also affect people’s ability to make and keep dental appointments. Families who are part of a supportive social network see a dentist more often than families who are not.

Last Updated: June 23, 2023