Oral Health, Overall Health, and Learning

Did You Know?
  • Nearly three out of every 10 children ages 2 to 5 have had tooth decay.
  • Almost seven out of every 10 children with tooth decay or another oral health problem have missed school because of the problem.

Brush Up on Oral Health

Oral health is an important part of a child’s overall health and well-being. Children with good oral health tend to eat well, sleep well, and develop as they should. A child’s oral health also makes a big difference in their ability to learn. Children with tooth pain often have a hard time finishing tasks or activities in the classroom. They may act out, be withdrawn, or seem tired or depressed.

This issue of Brush Up on Oral Health describes one part of the Head Start Program Performance Standard (HSPPS), Ensuring up-to-date child health status, 45 CFR §1302.42(b)(1)(i), and how it relates to oral health. The issue discusses how Head Start programs can find and use the dental periodicity schedule for their state. It also offers a recipe for a healthy snack to make in the Head Start classroom or at home.

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A boy reading a picture bookEnsuring Children Are Up to Date on Health Care Services

The HSPPS, Ensuring up-to-date child health status, was set to help keep children healthy and ready to learn. This standard requires that program staff obtain determinations from medical professionals and oral health professionals as to whether the child is up to date on a schedule of age-appropriate preventive and primary medical care and oral health care. These schedules are based on well-child visits and dental periodicity schedules defined by the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit of each state’s Medicaid program. The EPSDT benefit provides comprehensive and preventive health care services for children enrolled in Medicaid. EPSDT includes the following services:

  • Early: Assessing and identifying problems early
  • Periodic: Checking children’s health at periodic, age-appropriate intervals
  • Screening: Providing physical, mental, developmental, dental, hearing, vision, and other screening tests to detect potential problems
  • Diagnostic: Performing diagnostic tests to follow up when a risk is identified
  • Treatment: Controlling, correcting, or reducing health problems found

An established schedule based on a child’s age determines when EPSDT visits occur and what services are provided. This is known as a periodicity schedule. Each state is required to develop a periodicity schedule for EPSDT well-child services as well as dental services.

Some states use a nationally recognized periodicity schedule for well-child visits such as the American Academy of Pediatrics’ Bright Futures guidelines. Other states have consulted with medical organizations involved in children’s health care to develop their own periodicity schedule.

Dental Periodicity Schedule

The dental periodicity schedule that the program performance standard (45 CFR §1302.42(b)(1)) mentions is also set by each state and must meet standards of dental practice. Most states follow the dental periodicity schedule recommended by the American Academy of Pediatric Dentistry (AAPD). Other states have worked with dental organizations involved in children’s oral health care to develop their own dental periodicity schedules. At a minimum, oral health services include relief of pain and infections, restoration of teeth, and maintenance of oral health.

AAPD maintains a webpage with a link to each state’s dental periodicity schedule. To find your state’s dental periodicity schedule, select your state from the list.

Head Start programs can get information on a child’s oral health status and care using oral health forms developed by the National Center on Early Childhood Health and Wellness. The forms are filled out during a child’s dental visit. They have information on the child’s current oral health status and what oral health services were done during the visit.

The forms can be customized with the Head Start program’s name, mailing address, phone and fax numbers, and email address. A sample letter to the child’s oral health professional is also available that explains how to complete and submit the form to the Head Start program’s health manager.

Cook's Corner: Apple Ring Sandwiches

Applie slices from recipeHere is a delicious and healthy snack that children can make in a Head Start classroom or at home with their families.


  • 1 apple
  • 1 tablespoon low-fat peanut butter, low-fat cream cheese, or hummus
  • ¼ teaspoon ground cinnamon (optional)


  1. Core the apple and cut into rounds.
  2. Spread half of the slices with peanut butter, cream cheese, or hummus.
  3. Cover (sandwich) with remaining apple slices.
  4. Sprinkle with ground cinnamon (optional).

Makes three to four servings

Safety tip: An adult should core and slice the ingredients.

Contact Us

The National Center on Early Childhood Health and Wellness welcomes your feedback on this issue, as well as your suggestions for topics for future issues. Please forward your comments to health at ecetta dot info or call 866-763-6481.

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Last Updated: September 30, 2019