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					                                                        Approved by the Health Advisory on 1/30/08
                                                           Approved by the Policy Council __3/8/08
                                                                     Approved by Board __4/17/08

Child Health and Development Services Child Nutrition

Subject:     Dental Exams, Treatment & Homes; and Dental Hygiene (tooth cleaning)

Source:    Performance Standards
Reference: 1304.20 (c) (3) (i) & (ii) 1304.23 (b) (3)

Performance Objective: Head Start (HS) and Early Head Start (EHS) health services
focus on prevention and early intervention and are based on the premise that a child
must be healthy in order to learn.

Good oral health is essential for a child’s behavioral, speech, language and overall
growth and development.

The goals of the SPCAA Head Start and Early Head Start dental services policy,
procedures and practices are to ensure that:

      children do not have pain or infection related to or caused by dental problems or
       issues and free of dental disease.

      children learn and practice good oral health habits at home and during the daily
      children receive appropriate dental exams and care as needed,
      children and families have a dental home, and
      children are free of dental disease.

   1. The Head Start and Early Head Start performance standards require
      children to have a dental examination by a licensed dentist within the first
      90 calendar days of the program year (enrollment). If a child comes into the
      program and they have had a dental exam within the previous 12 months, then
      the HS/EHS Family Support Worker (FSW) will request parents provide or help
      the staff obtain verification of the examination and any treatment received.

   2. All children in Head Start and Early Head Start will follow the THSteps Medical
      Checkups Periodicity Schedule for infants, children. (EPSDT State Schedule).
      SPCAA HS and EHS have A qualified health professional who will make the
      determination as to whether a child is up to date on a schedule of age
      appropriate preventive and primary health care.

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3. HS/EHS Family Support Workers (FSW) are responsible for and must be
   available to help parents identify, schedule, access and obtain dental services for
   their child(ren).

4. If the child does not have a dental home, the FSW will also assist parents identify
   and establish a dental home. SPCAA defines as “dental home” as defined by the
   American Academy of Pediatric Dentistry – a source of continuous, accessible,
   comprehensive, family-centered, coordinated, compassionate and culturally
   effective oral health care delivered or directed by a professional dentist.

5. The FSWs can request and obtain assistance from the HS/EHS Health and
   Family Services Managers and other personnel to aid them in providing prompt
   and appropriate assistance to families regarding dental services. FSWs should
   contact these Managers and support personnel to obtain the necessary technical
   assistance as soon as possible and thus avoid unnecessary delays or gaps in

6. Dental providers require parental consent prior to dental exams or treatments,
   therefore a parent must take or accompany a child or designate a near relative
   (18 years or older) to take or accompany the child for dental exams or treatment

    HS/EHS staff cannot provide the required parental consent for dental
    exams or treatment. HS/EHS can provide assistance with referrals and
    transportation for the child and parent or child and designated near relative, if no
    other source of transportation is available.

7. Paying for dental services comes from various sources:

   Parents of Medicaid eligible children may contact 1-877-thsteps (1-877-847-
    8377) for a list of dental providers in their area who participate in an approved
    Medicaid plan. Transportation services for Medicaid eligible children are
    available by calling 1-877-medtrip (1-877-633-8747). Medtrip providers will need
    to know the date, time and address of the provider prior to scheduling

   Parents of children covered by CHIP should contact 1-800-647-6558 for a list of
    dental providers.

   Parents of children not covered by Medicaid or CHIP must use their own private

   Parents of children who are not covered by Medicaid, CHIP or private
    insurance must contact the HS/EHS FSW assigned to their center/partner
    site to request assistance with dental exams or follow-up treatment.

    Head Start/Early Head Start funds may be only used for dental services
    when no other source of funding is available. FSWs must document in the
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       child’s brown folder what efforts are made to find other funding sources.
       Copies of the records noting efforts to find other funding and information
       on why HS or EHS programs are necessary to provide the service must be
       forwarded to the Health Service Manager to obtain approval to use HS or
       EHS funds for dental exams or treatment. Based on the information
       received, the Health Manager will either confer with the Family Services
       Manager and guide the FSW to check out additional sources of assistance,
       or herself make inquires to funded providers or state agencies, or approve
       the request to use program funds.

       Approval to use program funds is the responsibility of the Health Manager.
       Health Manager must return written notice of approval or denial of the
       requested use of program funds to the FSW within 2 weeks of receipt of
       request . In the event of pain or other urgent situation, the Health Manager
       can and will approve the program expense in the most expedient manner to
       avoid long periods of pain or progression of infection.

8. A dental exam for HS/EHS children consists of an oral evaluation to identify any
areas of concern [teeth coming out crooked, on top of each other, coming out in the
wrong spot].

Application of fluoride is recommended by dental professionals when communities do
not fluoridate their water. Daily brushing with fluoride toothpaste is the best way to get
topical fluoride.

9. As per Head Start Performance Standards, SPCAA Head Start and Texas
Department of State Health Services (THSteps) fluoride, sealants and cleanings are
considered preventive care. For SPCAA Head Start/Early Head Start fluoride, cleaning
and sealants are preventive measures that are only done if the dentist marks them as a
need on the dental exam form. These are not considered treatment.

10. Dental follow-up treatment consists of what the Dentist deems necessary for each
individual child. Examples of dental treatment include: [extractions, stainless steel
crowns, pulp therapy, amalgams, and composites].

11. All exams and necessary follow-up treatment (as indicated by dental examination)
will be started as soon as possible and completed prior to the end of the program year.

12. When a child has dental pain or infection, follow-up treatment must start
immediately. Parents of eligible children should use Medicaid, CHIP or private
insurance to pay for dental treatment required to relieve pain or infection. Parents of
children without coverage will work with the FSW to insure the necessary and
appropriate treatment is provided in a timely manner. (see # 7 above) Parents will be
asked to report any changes regarding Medicaid Eligibility as soon as possible to Head
Start and Early Head start staff and to provide current proof of Medicaid Eligibility for
children who require follow-up treatment.
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13. FSWs will obtain from parents or dental provider copies of dental exam and
treatment and put in ChildPlus Data Entry folder. Once the monitors go on site they will
input only completed information into ChildPlus.

   1. 14. When a health event expires within the last 60 days of the program year, the
      expired event does not have to be renewed. Any health event that expires before
      the last 60 days of the program year will need to be completed as usual. . In
      accordance with THSteps the child is considered as receiving a timely checkup if
      the checkup occurs anytime within the year after the child’s birthday allowing
      more flexibility for the family to schedule the checkup. Families are encouraged
      to get the Child’s checkup ASAP after the birthday as the child may lose
      eligibility, and would than miss out on this benefit.

15. For all expired health events that occur within the last 60 days of the program year,
the FSW will contact the parent and encourage the parent/guardian to have another
routine exam completed at their medical or dental home “provider.” This is to ensure
the child follows a schedule of preventative and routine care. The FSWs should assist
parents with scheduling, transportation, referrals, etc. The FSW will document the
contact in a family contact note (signed by the parent) and filed in Flap 6 of the brown
folder. The FSW will forward a copy of the contact note to the Health Manager who
retains the record and cross-references with the Child Plus data.

Procedures for Dental Hygiene

The HS and EHS program will schedule learning activities for children to acquire and
practice good preventative dental health habits. Parents will receive information and
training on oral health and are encouraged to support their child’s development of good
oral health practices. Teaching staff model appropriate dental hygiene by brushing their
teeth during specified times during the daily schedule. Staff will encourage children to
rinse out their own toothbrushes to prevent any cross contamination.

    1. Various materials and supplies will be provided at each center to support good
       oral health (posters, books, individual toothbrushes/gauze, tooth paste,
       manipulatives, etc.)

    2. Teachers must schedule at least once daily, after a meal, time for all HS and
       EHS children to clean their teeth and gums according to the age appropriate
       practices listed below. Center Directors can approve classroom staff rotate the
       cleaning/brushing, so that some children brush/clean teeth after breakfast and
       other children brush/clean teeth after lunch. Children will be offered drinking
       water after snacks, as rinsing with water helps to remove particles from teeth
       and prevent cavities. Staff will instruct and facilitate tooth brushing as long as is
       necessary and when developmentally appropriate, will observe the children
       when doing the procedure on their own.
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   3. Infant teeth will be cleaned beginning with the eruption of the first tooth at about
      five or six months of age. Staff will use gauze pad for infants less than age one
      and switch to a toothbrush at one year of age. Only water will be used until a
      toddler is able to spit out toothpaste without swallowing it. Staff will provide
      information to parents about the proper ways to prevent baby bottle tooth decay
      and other early childhood cavities. Teachers will not put children to bed with a
      bottle containing milk, formula, fruit juices, or sweetened liquids. Proper care of
      teething toys is considered part of dental hygiene. Toys will be properly cleaned
      and sanitized. Staff will serve as role models by brushing their teeth after meals.

       •For children age two and over

             Head Start staff (or qualified volunteers if available) should assist children
             two years old or older to brush their teeth using a small pea size of fluoride
             toothpaste. They will make sure children do not rinse their mouth nor
             swallow the toothpaste. (Children will spit out the toothpaste during
             brushing as needed.) Toothpaste will be distributed on a small individual
             piece of wax paper to be transferred to the toothbrush. Each child shall
             have a toothbrush labeled with first and last name.

      •For children between one and two years of age

             Once daily, after a meal, Head Start staff (or qualified volunteers if
             available) must brush children’s teeth with a soft bristled toothbrush, using
             a small smear of toothpaste that contains fluoride. Each child shall have a
             toothbrush labeled with first and last name.

      •For infants under the age of one,

             At least once during the program day, staff or qualified volunteers must
             wash their hands, wear exam gloves and then cover the index finger with
             a gauze pad or soft cloth and gently wipe the infant’s gums.


   1. Toothbrushes shall be stored in a toothbrush holder, so they do not drip on other
   2. Toothbrushes shall be separated from one another, bristles, up exposed to the
      air to dry and not in contact with any surface.
   3. The holder and toothbrushes will be covered with a meshed cover.
   4. Toothbrushes will be replaced when bristles have lost their firmness and/or every
      90 days.

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