Early Childhood Caries Prevention and Management Programs in the US

Objectives: Early Childhood Caries (ECC) is a significant public health concern, affecting nearly half of all US children. Recognizing that ECC is consequential and can be prevented or managed once established, many ECC programs have been established across the US. This study characterizes these programs in order to identify opportunities for improvement.
Methods: ECC programs were identified utilizing web and literature searches, listserve solicitations, key informant interviews, and secondary recommendations from identified programs. Under Columbia University Medical Center’s Institutional Review Board, a 39-question survey was developed, focus-group tested, and fielded in Qualtrics©. Responses from 105 completed surveys were entered into SPSS for analysis.
Results: 97 programs describe themselves as currently active for periods ranging from < 1 to 40 years. All address prevention while 68 address “risk factor or disease activity suppression” and 47 seek “caries arrest.” One-third train health providers while most target families through IHS, Head Start, WIC, Early Intervention, day-care or other services (80). Seven are multi-state. Nearly all target low-income populations and extend to rural or frontier areas. 67 utilize fluoride varnish or silver nitrate. 61 educate non-dental personnel. For information and evidence sources, fewer than half engage cariologists (55), health educators (44), behavioral scientists (29) or nutritionists (29). Programs are heavily reliant on non-permanent funding from philanthropy and/or government. 82 programs report using evaluation metrics but none quantifies cost effectiveness. 98 believe their program is feasible to replicate.
Conclusions: There are a myriad of independent ECC efforts underway in the US. For many programs, enhancements may include institutionalizing funding, expanding approaches to include disease control and suppression as well as prevention, greater involvement of cariology and health behavior experts, and risk-targeting. Future case studies are necessary to fully understand successful activities and ultimately establish policies promoting best practices.