Improving Oral Health Literacy Brightens Children's Smiles

Improving Oral Health Literacy Brightens Children’s Smiles

Melissa Linn: On today's webinar, we're pleased to have Maria Del Rocio Galarza and Francisco Ramos-Gomez presenting. Rocio and Francisco will introduce themselves in just a moment. Next slide, please. 

Francisco Ramos-Gomez: Thank you so much, Melissa. Thank you. Appreciate all you do. Very grateful to all the wonderful, wonderful viewers today, especially to celebrate next month, starting this in a few days the month of February, Oral Health Month. We can celebrate together. Rocio, welcome. Thank you. 

Maria Del Rocio Galarza: Thank you. I'm happy to be here from Sesame Street in Communities to help share some of the resources that we know we have here as part of the collaboration with Head Start. 

Francisco: With that, the reason for our meeting today is to really discuss a bit about oral health literacy. What does it mean, Rocio? We've been talking much about health literacy. Why do we need to really understand these concepts here with all our wonderful Head Start staff in an easy way with very small, little key messages and small, incremental steps for families? Hopefully with our session today, we'll give you some tools, some ideas, and things that you can start doing tomorrow based on the work. Rocio let's start with you. What do you think? What does oral health literacy mean? 

Rocio: When we talk about health literacy, it's to the degree to which people can find and understand information and put them into use to make actions or to make decisions related to their own health and the health of others. When we think about us as an organization, as Head Start members, what we're doing is to facilitate how people are digesting some of this information and really helping them to get the resources that they need so that they can make those really good decisions, not only for themselves but for their children as well. 

Francisco: Absolutely. We're overwhelmed with information. How can we really capture small, little messages throughout? I guess you can tell us maybe something about the principles of health literacy. 

Rocio: We're going to be discussing the principles throughout the presentation because it's easier to see it with examples. The idea here is that we have a framework, a structure of what are some of the main concepts that when we're thinking about a comprehensive program on health literacy, these steps or these principles need to be part of those. We do a lot in the Head Start programs already. 

What this helps us is to evaluate. Am I doing too much on the content? Am I doing too much of the practice? How do I make a balanced approach within the Head Start programs? We're going to go through the seven principles. You see them there. Throughout, I'm going to highlight a few based on the resources that we're sharing. 

Francisco: This is a great idea. Let's talk a little bit how does it translate into good oral health. As you know, there's some very specific ideas to have. Really some recommendations we have for all of you for your parents and families, all they're looking after. The idea is to really emphasize on the regular dental visits when you come to the dentist at an early age. We're trying to make sure that every baby and infant is taken care of so we can really detect any issues we might have for later years. 

They will receive preventive oral health care interventions. You have heard about the fluoride varnish, how to teach the parents how to brush their child's teeth. Most importantly, the idea that parents have to really be very thoughtful and really to think about drinking tap water for their child throughout the day. Also limiting snacks and eating foods low in sugar. There's a huge mandate now by the World Health Organization to reduce the amount of sugary foods and drinks in children under five years of age. 

For us, which is really the most important intervention, if you can do one thing for your child at the end of the day is to brush their teeth at least twice with a fluoridated toothpaste. We're going to talk more about this, how we can use the principles of oral health literacy to really implement this in the daily habits and behaviors of the families you guys are taking care of in all the country. You guys remember You are the guardian angels of all these children. 

Rocio: We do this because we know that oral health is part of health. There's no really distinction. When you're healthy, when you have good oral health, it affects your whole body and also the child’s ability to learn in school. We have from positive self-esteem to be able to grow and develop normally. Also, something that we sometimes forget, we need our mouth to speak and our teeth. All of this is connected, Francisco? 

Francisco: Absolutely. I mean, you cannot really have good total health without good oral health. I remember a pediatrician, if you see this beautiful child here, look at his teeth. The teeth gives you the window to their souls, their lives. It tells you so much of a story. We want to make sure that with these little simple messages that we send to parents but really. For you guys, the complex issue is to really make sure that parents follow these messages daily, especially at home, like limiting sugary foods and drinks to prevent tooth decay. It's very well known how the sugar really plays a huge role for cavity formation and for children to have early childhood caries. 

Rocio: One thing is though, because this is a very broad message, how do we make it — going back to the guiding principle of content — how do we make it easier to understand? 

Francisco: I know you've been asking me, how does tooth decay happens, Rocio? We've been talking about it. It seems simple, but it sounds very cumbersome. How can we transfer this information in lay terms for families to understand? 

What I tell my three-year-old patients with the permission of the parents, you have a lot of bugs in your mouth, which are normal to have. When they really you don't brush your teeth or they don't brush your teeth for, you they get so many bugs in your teeth. With the sugars you eat, they're going to eat it so much. They're going to grow and grow and grow to have more and more of them. They invite their families, their nephews, their relatives, and then they have a feast, and they have to go to the bathroom. They make pee pee in your tooth and that starts eroding your tooth away. 

It is something that we have to really address how some of these lactic acid is something that is formed by that bacteria that will start eroding your tooth away, causing the white spot lesions and the brown and then the really dark cavities in the children's mouth, affecting them for pain and really a lot of issues with this. It's a frequency as well, Rocio. You've been asking me about this before. 

Rocio: Yeah. Well, it's hard to understand. I think that this was very important when we were creating the materials. It was hard to understand that it's the eating patterns that is making it much worse. 

Francisco: It is. It’s just the amount of sugary snacks and drinks that you eat on the day. Unfortunately, a lot of parents are using food to really address the child's behavior. They use it for incentives, and they keep really giving way too much food to children throughout the day and the night. This is the thing that we want to limit. That you should really give them regular meals, controlled regular meals, and try to give some respite to the mouth during these intakes of snacks. The most important is to drink water between meals as well. 

Rocio: We'll talk so much more about that. We have a video that actually goes through some of this information as well. 

Francisco: Absolutely. The idea is, how can we really bring the message to parents? All the Head Start staff that are listening to us today, I know that you really, really work with us so nicely to make sure that parents understand about these everyday foods. That Drinking water and milk without any flavoring, that besides milk and water should really nothing be accessible to children's bodies, especially soda. Sodas are so bad for obesity, dental caries, and pre-diabetes as well. You really have to make sure that these messages are understood by families at large. There are some resources, Rocio? 

Rocio: Some of the resources that we have on ECLKC are related to Head Start staff. They are to really have those talking points that you gave in terms of the patterns, the amount of sugar. One of the ones that I found really helpful is also the hidden sugar, finding that hidden sugar. Because in many of our snacks and drinks, there is sugar, and we don't even realize. One of the things that I've also loved about these tip sheets for Head Start staff is that it gives language that you can also share with families. 

In addition to this material for the staff, we have materials that are directly for the family. Those are really concise. What you see here is not only the importance of healthy snacks and healthy drinks but recipes. I mention the recipes because, again, the guiding principles, the one number four, which is dissemination, sharing accurate, accessible, and actionable information to guide health decisions, should be in different types of formats. The recipes is one of those incredible formats that you can have that makes it very actionable. 

Francisco: I love the recipes. I even do some for myself as well. They're really, really cool to see them. I just want to come back really briefly to this finding hidden sugar. Especially I want to really do a shout-out to those pouches. We call them junk in a pouch. Some of them have sugar with coloring water. Which mother in their right mind or father will be giving 20 spoons of sugar with artificial water? Please teach the parents to read the labels. It's such an important thing for them to know what they're feeding their children. 

Rocio: Those labels sometimes can be misleading. What to look out for is what is important. Those handouts do a really good job and giving you the language in very simple terms. 

Francisco Ramos-Gomez: Absolutely. 

Rocio: Yeah, go ahead. 

Francisco: Even our bean organic baby food or healthy baby, I mean, it's so deceiving. 

Rocio: It is very, very deceiving. 

Francisco: [Inaudible] We have some great videos that we want to showcase today. 

Rocio: Well, the first one you have here is Grover. 

Francisco: Sorry, yes. 

Rocio: No problem. The first one here you have is Grover. Grover is talking to little tooth I should say. The tooth is telling Grover the things that he needs to stay healthy and strong. This is a good video to use as an introduction in a family engagement activity. It is a good one to also use for kids. They love Grover, of course. Then afterwards, we do certain activities to really motivate them to know how to keep their teeth strong. 

Francisco: That's so nice. I love that there's a tooth there. Because as you know, we had many issues because the puppets have no teeth. How could we make them? 

Rocio: Yeah, it is so true. 

Francisco: There is a good oral health message out there from Sesame Street puppet. 

Rocio: Yes, we have tried to put teeth on some of the most recognizable characters, and it's just not the same. This is helpful to have the tooth outside letting us know what the tooth needs. 

Franciso: The toothbrush right there with fluoride toothpaste. 

Rocio: We'll get to that. We'll get to that. 

Francisco: I'm not going to be able to show the whole video, but just a little bit. This one also is a very cool video on very good nutritious and wonderful food that parents will eat. Oops, sorry. 

Rocio: No problem. 

Francisco: There you go. 

[Video begins] 

[Crunching] 

Abby: Hi Elmo. 

Elmo: Oh, hi Abby. 

[Crunching] 

Abby: That sounds delicious. 

Elmo: Oh, they are. Oh, you want some? 

Abby: Mm-hmm. 

Elmo: Well, go for it. 

Abby: OK. 

[Crunching] 

Elmo: Wait, Abby, Elmo loves eating fruits and vegetables. And so do Elmo's teeth. 

[Laughter] 

[Crunching] 

Elmo: Boy, that sounds cool. 

Abby: What does? 

Elmo: Well, just keep crunching, Abby. 

Abby: All right. 

[Crunching] 

[Music playing] 

Francisco: Love this song, Rocio. This was wonderful. 

Rocio: Yes. Crunchy fruit and vegetables. 

[Music playing] 

Elmo & Abby: [Singing] Eating crunchy fruits and vegetables, you can't go wrong, can't go wrong, can't go wrong. Eating crunchy fruits and vegetables, you can't go wrong, 'cause they help you keep your teeth nice and healthy and strong. If you're thirsty drink water. 

[Slurps] 

All: If you're thirsty drink water, water. If you're thirsty, drink water. If you're thirsty, drink water, water. Eating crunchy fruits and vegetables, you can't go wrong, can't go wrong, can't go wrong. Eating crunchy fruits and vegetables, you can't go wrong, 'cause they help you keep your teeth nice and healthy and strong. And if you're thirsty, drink water. Ooh can't go wrong. Drink water. Can't go wrong. Drink water. Can't go wrong. If you're thirsty, drink water. Can't go wrong. 'Cause they help you keep your teeth nice and healthy and strong. 

[Crunching] 

[Video ends] 

Francisco: Whoa, bravo. 

Rocio: It's a great segue to the next tip, huh? 

Francisco: Yes, to drink water throughout the day as well, not just crunchy stuff. Make it fun. That's the whole idea, to create habits by making them fun, especially with this. I was really salivating on those wonderful broccolis and carrots. 

Rocio: I want apples. 

Francisco: Yes. The benefits of drinking water. Do you know that improves your brain function, increases energy? It really promotes healthy weight, strengthens the teeth, keeps mouth clean. We have a lot of issues with families that they're very, very reluctant to drink tap water. Important that we know that it's safe, it's better for them, and really promotes good oral health as well. 

Rocio: Well, people assume that bottled water is better. 

Francisco: No. Not at all. It's most costly. It causes pollution to the environment where floating with a huge amount of an island of plastics in the Pacific Island. We need to really ensure that parents get this very good message that drinking tap water is good. It's safe. If you are concerned about drinking it, there's filters out there that are sold, very, very inexpensive of them. I don't want to say brands, but also if you can just use the refrigerator drinking water, that's already filtered as well. 

Make it fun for the babies, the children. Keep it portable. You can flavor it with a little bit of lemon or orange in there. You can ice it. The most important, Rocio, is that the parents themselves, they really are the role models for the children. The children follow what they do. If they see the teachers or the staff or the parents drinking sodas. I mean, and they're trying to give them water. It doesn't make the match. 

Rocio: Yeah, absolutely. 

Francisco: They really have to follow the habit formation at an early age. 

Rocio: Absolutely. For some ideas on how to follow that habit formation, not only for the families, but even in the Head Start program, this resource is really interesting because it does have a link with strategies for everyone in the Head Start program to make sure to drink water. Of course, it also has the information that Francisco has been talking about here around the importance of drinking water. 

Important to hear, when we're talking about modeling, that is not only the parents. That is all of us. We're talking about capacity building, which is the number one principle for our guiding principles for health literacy. Important that we are all practicing and creating these changes from a program perspective as well. 

Then for support that we have for families, we have the poster, which I love the poster, because we can put it everywhere in our program physically. It's right there as a reminder to drink water. I also like the other resources, because to your point, Francisco, the parents also need to change some of these habits, and it's hard to communicate with them how to avoid some of these sugars that are sneaking in. What these other resources give are those tips that the adults can take to reduce their sugar intake in the beverages. 

Francisco: Yes. I really have to do a shout-out to all the oral health staff from Head Start that you guys have done amazing, amazing work in gathering all this information for all of us to share. There's also some videos out there, a very cute video of the otter, Potter the Otter, about Tale of the Water. Please, if anything, we need to demystify this fear of drinking tap water and make parents that they are they're really, really easy to use. 

The next one is the brush with fluoridated toothpaste. Rocio, as you know, there's a lot of concerns about fluoride and confusion and parents keep asking us about the fluoride. We want to really ensure that fluoride is safe. Fluoride in the water has been for the last 78 years the most successful prevention strategy to really reduce the burden of caries or dental disease in this country and many places in the world. We want to add to that brushing the child's teeth with fluoridated toothpaste. There were many, many different recommendations. 

Based on scientific evidence, the American Academy of Pediatrics, the American Academy of Pediatric Dentistry, the CDC, all of the big institutions got together to come with just one universal recommendation, which is the use of fluoridated toothpaste for life from as soon as the first tooth is in the mouth. The only changes are that you're going to be doing for less than three years of age a little smear amount, a tiny amount that they don't need to spit. Above three years of age, they have a pea size or pea size when they can speed. 

It's a universal recommendation of the use of fluoridated toothpaste almost from first tooth in the mouth until you're 110 years of age. The idea is that you can preserve your permanent teeth by really this constant small amount of exposure of this fluoridated toothpaste in this child's teeth and dentition. 

Rocio: I do have to ask Francisco, because this is a confusing one. Because I remember in the past the idea of fluoridated toothpaste before age of three was a no. 

Francisco: Yes. 

Rocio: The back and forth is getting confusing. 

Francisco: Well, that's the thing that a lot of pediatricians have to read the recommendations from the American Academy of Pediatrics or look at ECLKC where we really showcase the very specific resources about the appropriate use of fluoridated toothpaste. We found that you need to really start protecting these teeth from day one as soon as they're there, their first birthday, first tooth in the mouth. That's part of the age one visit to the dentist. You can have a provider, even a pediatrician, to understand to make sure that they really recommend this for each child, regardless of where they are at. 

Rocio: There are not risks in doing this.

Francisco: There's a lot of fear for fluorosis. Fluorosis is when you have some staining in your teeth when you're an adult. Let me tell you, for one case of fluorosis that I see, in a year I see a thousand cases of early childhood caries. You do the math. You do the balancing act of why is this fear is going to really put your child at risk for a lot of cavities at an early age. It's not easy to treat them. That's really the issue. 

The American Academy of Pediatrics came with a great suggestion of brush, book, bed to make this brushing experience a very bonding experience and a positive experience with that child where you're going to really take this opportunity to really bond. You can sing a little song, read a little bit of the book and brush your teeth, make it fun, make the experience something that you really create a habit in the child that is so important. 

That's why the amazing staff of Head Start are listening to us today. They've been good because they've been brushing their child's teeth for many, many years. They've been really some of the best habit formation staff that we can never think or see because they were really, really brushing their teeth and teaching them at an early age. 

We really are so grateful and appreciative of all of you out there that you still continue with your brushing programs, especially after your lunch, that you really emphasize because of all the benefits of tooth brushing. These children at this early age will be the ones to tell the parents, mommy, my teacher brush me today. You have to brush me tonight. That was amazing. 

Rocio: They're amazing. That is a guiding principle as well, actually. It's the guiding principle of practice. Adopting and implementing with guidance the practice of tooth brushing is one that is important. 

Francisco: Absolutely. 

Rocio: Not only at the Head Start program. It's an amazing practice. 

Francisco: That's why we encourage them to really follow this tradition of brushing your child's teeth in the Head Start classroom. As you know, there's really great benefits of child toothbrushing. This issue of habit formation is essential. Parents do not really know that they have to assist or help that child until they're seven or eight years of age when they have the appropriate motor capacity, when they can actually tie their shoelaces, to be able to brush by themselves. 

Rocio: Yeah. This was an aha moment for me as a parent. It's good that it happened with my first. It's taking care of my second. It's good that it happened when my first was very little so that I could really take over and help her brush her teeth instead of her trying to do it by herself, which definitely doesn't work. The teeth were still as dirty as ever. 

Francisco: Thanks, Rocio. Thanks for sharing. We have parents in my practice at two or three years. Dr. Ramos, he brushes his teeth every night. Like hello, you mean he plays with a toothbrush. He's a three-year-old. How could a three-year-old know how to do it right.

Rocio: Yes, we need those aha moments sometimes though, Francisco. 

Francisco: Yes. Thank you for sharing. I know there's some great resources that helps our staff. 

Rocio: Yes. We have resources for Head Start staff. Because how to brush children's teeth sometimes is something that has come up, particularly for young kids. They don't like their mouths touched. They don't know that what you're doing, particularly at the beginning before they establish their routine. These resources will help you establish that routine and help give you ideas on how to do it. 

The routine from the Academy of Pediatrics is amazing, because it's not only about brushing teeth, but it's about making that moment really count, that routine really count during bedtime. That it really is, like you were saying, it's an engaging routine. What these resources give you are ways of making it engaging for parents as well some ideas on how you can motivate parents to find the right books for their kids, to make this routine very special for their children. 

Francisco: Yeah, make it fun. It's so funny, because parents are used to wash the baby's hands, change the diaper, go every single place in the baby's body, but when they come to the mouth, they freeze. 

Rocio: True. Some of the programs that actually prepare you to do these type of things with children, with babies, they don't always talk about the mouth, which is so important to clean. Because of that, it is up to us to really be the educators on this. We created these materials in ECLKC that for families that you have that language, you are able to have the resources to talk to parents about the baby, the oral health of that little baby, and how to brush their teeth even at that age and how to make that bedtime routine as soon as possible with children. 

Francisco: Absolutely. We really want to commend Head Start and Sesame Street to join together. They've done many videos. They released these oral health videos because the puppets have no teeth. As you know, we struggled much with that. For me, this is my favorite. I just want to ask you, how many billions of people? Because this video has been seen by billions of people around the world. 

Rocio: Yes, it's almost 2 billion people that have seen this video. Just one hint on using this video. Many people have used have seen this video again and again while the kids are brushing their teeth. This is almost like a little signal. This is time to brush teeth. While they brush their children's teeth, they play the song. That's why we have billions of views with this video, but it's a good use. 

Francisco: Can we play it, Rocio? I love the song. Love this song. 

[Video begins] 

Elmo: OK, everybody. It's time to brush your teeth. Go get your toothbrush. 

Elmo: [Singing] Brush, brushy brush, brushy, brush brush. Brush brushy brush, brushy brush, brush. Brushy brush them up and down. Brush brushy brush. Brushy brush them round and round. Brush, brushy, brush. To keep teeth healthy, here's the truth. Brush brushy brush. 

You gotta brush each and every tooth. Brush brushy brush. The keep in the front get a lot of care. Brush brushy brush. But don't forget the ones back there. Brush your teeth. Keep them looking clean and bright. Brush brushy brush. B-b-brush. Brush your teeth every day and every night. Brush brushy brush. B-b-brush, brush, brush. 

Now your toothpaste may taste good. Brush brushy brush. When you got it in your mouth. Brush brushy brush. But you should never swallow it. Brush brushy brush. You've got, got, got to spit it out. Go on and spit. We'll wait for it. 

Brush your teeth. Keep them looking clean and bright. Brush brushy brush. B-b-brush, brush. Brush your teeth every day and every night. Brush brushy brush. B-brush, brush, brush. Now if your parents heard, here's what you gotta do. Let them have your toothbrush so that brushy brush your teeth. Great job. You're almost done. Five, four, three, two, one. Now spit. 

[Laughter] 

[Video ends] 

Francisco: I love it. I love it. I wish all the teachers and the staff are singing with us. 

Rocio: Yes. It is catchy. Whether you want to sing with us or not, they might not have a choice. [Laughs] 

Francisco: No, but there's some other great resource on videos like this one on brushing teeth to give parents some confidence, to give them tools, to give them ideas. This amazing launch of all these videos since last year. Thank you. 

Rocio: They're a good reminder of what the main messages are. When you think about disseminating these videos, you can think about doing it not only for the kids themselves but also if you have social media outlets or if you have any ways of communicating with families, sending the link is really easy and it helps motivate them to keep going into creating their routines. 

Francisco: Absolutely. I really love that you really emphasize on the need of the caregiver of the parent to really be the one responsible for the final tooth brushing until they eight years of age. We cannot really say enough about that. The parent experience is important. Moving along, let's talk a little bit about the age one visit. Why are we all excited about this policy? 

Also, it's a policy of many, many scientific institutions in the country and the world to really emphasize and promote the age one visit. By first tooth in the mouth, first birthday, we should all have these infants and toddlers have this exposure for a risk assessment for [Inaudible] to tell the parents what to do. The application of a fluoride varnish, which are vitamins for these baby's teeth at an early, early age. 

Rocio: You were saying to me, though, when you first mentioned the first visit that this was also an equity issue. I mention it again, because it's a guiding principle for everything that we should be thinking about about health literacy in our programs. 

Francisco: I'm glad that you mentioned that, because we were chairing an Oral Health Equity Committee here in California, and everyone came from all different walks of life about all the promotions of how we can really position or help, and the consensus was that the age one visit is equal to equity. 

Every child, regardless of their socioeconomic status, their geographic location, their race, ethnicity, wherever they are, parental education, they all should have access to these age one visit, which is essential for many things. To really emphasize to the advocates of really going and preventing cavities in baby teeth. Because baby teeth are essential. Many parents ask us, "But Dr. Ramos, they are baby teeth. Who cares?" 

Rocio: They're going to fall out anyway. 

Francisco: Yes. We have to change that myth because the baby teeth are the basis for everything to chewing food. They help on developing the speech. They hold the space for the permanent teeth. You don't need braces later on. Most importantly, promoting self-esteem. 

Mental issues in the school room is really essential to make sure we really have these good teeth in these children. I mentioned to you earlier, the whole idea that if you have infection in your baby teeth, it's going to pass to your [Inaudible] tissue and then to your permanent tissue. That's why we should care. That's why it's important that we all here in this classroom today we really become advocates of baby teeth, of how essential they are. 

Do you know, Rocio, unfortunately after COVID, we see not cavities, but "co-vities" now because a lot of these children are coming back with vengeance. Children have no cavities are coming back with lots of pain, discomfort. They have infection, have poor eating and sleeping habits. They cannot really be school ready. How could we think about this child to be focused in the Head Start classroom or in any classroom? 

Rocio: Well, and the issue here is that it's totally preventable. Why are we putting children through this when we can prevent with simple practices? 

Francisco: 100% preventable. It's hard to get them treated. Cost, the resource amount to take, because these children have to be sedated. They have to be put to sleep under anesthesia. They're not going to sit down for you to have root canals or extractions or fillings just in the dental chair. They require much specialization. 

These parents go in this conundrum of trying to find the appropriate pediatric dentist to take care of these children appropriately. It's easy to prevent this and that's why we are promoting the age one visit. A lot of the parents might think, but what are you going to do in the age one visit? Rocio, I'm sure that you were wondering, why do you want us to bring them so early on? 

Rocio: Well, particularly when you only see three teeth or two even. What are they going to do? 

Francisco: I'm glad you say that, because the visit is for the parents themselves, for the caregivers. It's the magical moment we're going to provide information. We're going to do a knee to knee, like you see the baby here. We're going to do the knee-to-knee with the parent they're holding the baby, and we're going to show them how to brush their teeth, how to take care of them, how to do anything about preventing any of the white spot lesions, to check if there's any precursors of disease promotion. That you have to really work around the molars to really use the toothbrush to massage the gums even where there are no teeth. But to get into the habit, Rocio, of really do this every night appropriately. 

Most importantly, that we have also this amazing tool. It's a fluoride varnish. Think about the vitamins for the teeth. Some of the pediatricians that are doing it now, which they're doing it very successfully, they think it's almost part of the immunization or the vaccination against cavities using this fluoride varnish. It's a wonderful tool. Not alone, because you have to really make sure that the parent doesn't put any soda in the bottle at night or doesn't really do any of the bad habits that we're going to be checking on the risk assessment tool. 

These are the benefits. We're going to answer all the questions that parents might have. It's more like creating a team approach. Rocio, can I say what is your daughter's name? 

Rocio: Oh, my daughter now is 13. 

Francisco: I was just going to say that you have a one-year-old now. 

Rocio: Yes, no, no, no. My daughter, no, but this all started actually when she was a baby. Because we were doing this project this long. I've been doing for this long, Francisco. 

Francisco: That's so nice. That's why you're an expert. 

Rocio: Things have changed, because when she was very little and we had started this project, there was some debate about fluoride. Then it was kind of at that point particularly, it was not something that everyone knew that the parent needed to brush the teeth of the child. 

To this day, I see the same questions. It's been long. How to brush teeth is another question that has come up quite a bit. What happens during visits in general and how many times we have to go. All of these questions have been going on for a long time. Unfortunately, it is not something that we can find without the help of others that have the resources and the information that is based on research. 

Francisco: Absolutely. That's why the Head Start staff are essential to pass this information around. Part of the oral health literacy is to take these pieces of information we're giving them like we are and bring them to the families' households. I was telling you that I want to become there as your health coach instead of a dentist. We're going to be there together with you and your child to make sure that your child is staying wellness and keep their healthy teeth healthier and not in disease. That's the beauty of the age one visit. There are some resources out there that I know you want to bring it up too. 

Rocio: Yes. These are for Head Start staff. The resources describe what happens in that first visit. Because part of it, again, is not knowing. For me it was just like, why are you asking me to do one extra thing when I'm so sleep deprived? When I understood that there's a reason for this, that these are some of the things that I'm going to be taught almost and during this visit and what the child is going to experience. It motivated me to do it for my first child and then for the second child, of course. 

These are the materials that do it. One thing that I wanted to emphasize is that all of these materials have been created with feedback and feedback is a guiding principle. It’s with feedback from parents, from health providers, from providers such as yourself to actually really summarize what needs to be given to families. What are the messages that families need to actually make sure that they understand the importance of all of these and move them to action? Here are some information for families around the visit to the dentist at age one as well. 

Francisco: We have a great video. I don't think we have time to show it all. It’s a great video that we're going to be having available for you to really promote the age one visit. Remember, we can all say together two is too late. Two is too late. By age two, let's all work together to keep our wonderful, wonderful children a cavity free generation. We can do it together for cavity free generations. There's some very nice health and oral health literacy tools for the staff that you mentioned earlier before. 

Rocio: Yes, you're going to be provided all the links later. The ECLKC website is full of these materials. Again, they are based on research. That's why it should be your first point of contact for any resources that you want to disseminate. I also wanted to get back to we've been discussing actually most of the I mentioned most of the guiding principles, but I didn't mention one of them, Francisco. I wonder if you've noticed which one I haven't mentioned. 

Francisco: Let me see. 

Rocio: Well, but I want to mention it now. The one that we're mentioning is the one related to evaluation. We want to make sure that all of these things that we're sharing with families that we have unpackaged for families to understand that information how to make it actionable that we also are evaluating what is most effective for our programs. 

As a guiding principle, what I would encourage you is download the program, the information, the tools, look at the main messages, but also think about how do I evaluate within the context of my program. Which are the messages, or which are the not the messages, I should say. Which are the resources or the approaches to disseminating these messages that are most helpful for us as a program? 

Francisco: Excellent. I know there's several questions in here. I'm going to stop and see if there's any questions that you guys have. 

Beth Lowe: I was a little slow on the unmuting. My name is Beth Lowe. I'm from the National Center and I'm fielding some of the questions for Francisco and Rocio. If you're wondering who I am, that's who I am. We've had a lot of good questions coming in. There's one in particular that I thought was quite interesting. That was from somebody who wanted to know about resources to help those who are not literate to improve oral health literacy. I think maybe Rocio, you can take the first stab at that. Then Francisco, if you have anything else to add. 

Francisco: Yes. I also would like to do a poll before we continue with our questions. Let's answer this one, and then we go to the poll that I just found. 

Rocio: For the ones that are not literate, we do have quite a bit of videos. We have shown just a few of them. We have a bit of videos that are introducing to some of the messages that we have introduced today. That is a very good place to start. In addition to those videos, you'll find activities that you can do with children in the website. 

You can find also take-home sheets that they can do. I know that in Head Start programs, we cannot do activity sheets. This is not for the Head Start program itself, but it is much more for those families that are not literate for them to see in terms of the message what the message is in a visual. We have those accessible as well. 

Francsico: Thank you. I just went back to the poll. I hope that you guys help us. We really want to know about your program. We're really excited to know all of you that you have been able to get back to the brushing again in the classroom. Are you doing it in the table with all the children together? Are you doing it individually when you send the children to the sinks? Can you tell us a little bit about your program? If you are not brushing, why not? We'd love to hear from you. I think we can maybe put the poll for folks to answer. 

Rocio: While they answer the poll, I think, again, going back to some of the information that you gave on fluoride and how young is youngest is something that keeps coming up. 

Francisco: Well, you mean the fluoride toothpaste as the first tooth is in the mouth, and then the varnish is after one year. I mean, that first year of life. It's not really nothing to be really concerned about. We want to demystify. The pediatricians are doing it. Everyone is doing it. It should be no issues. I'm not sure if Kate has the poll. If you guys can maybe write on the chat, share some of your thoughts of what has been working to promoting your tooth brushing in your program. That'd be helpful. 

I'm not sure if people are putting any comments in the chat. Oh, there they are. How is your program currently conducting tooth brushing? 48% of them the children are brushing their teeth together at the table. Children are brushing their teeth individually at the sink. 42%. 10% of them are not brushing. I love to hear some of the great experiences of people that are brushing. 

What's working really well for them that they can share to the folks that are not brushing so we can get them all excited to get back to brushing the classroom? Do you know, Rocio, that this was the best intervention that we had for the last 38 years with Head Start programs? They were the first ones to really help us to teach the children. 

[Interposing voices] 

Rocio: Getting some feedback. 

Francisco: I'm sorry. Can you hear me, OK? 

Rocio: Yes, yes. It comes and goes a little bit. Yes. I didn't know, but to answer your question, Francisco, I did not know that it was such a big intervention. It's really interesting to learn about it, because it is through the modeling of the educators from Head Start that children really start and go back home. [Inaudible] "You have to brush my teeth." That is super important. Do we have more questions? 

Beth: Actually there was another really good question that came in about just kind of navigating through all the information that's out there on oral health. They wanted to know how can you tell if the oral health information that they're receiving or they're looking at is trustworthy. 

Francisco: That's such an important question because we're inundated with fake news. Please go to ECLKC. Look to the American Academy of Pediatrics, the American Academy of Pediatric Dentistry. Those should be your sources, your main sources. Parents, now part of this oral health literacy example and the training today is to really ensure that they learn to really validate the sources that are getting the information from. 

What a beautiful tool and the best tool you have of the ECLKC that you can really go there to the Head Start and really address any of these issues and bring them to the light to the families, right Rocio? That's why we have this incredible resources. Beth, you and your team have really worked hard to create them. 

Rocio: I do want to say that ECLKC is not only based on research, but many of the questions or those difficult conversations to have. How do I explain, for example, a parent that has a baby why this is important? How do I explain to parents that lack perhaps some of the resources around health? How do I explain some of these concepts? The ECLKC materials have been taking that in consideration and give you very specific almost talking points, I would say. The descriptions and the way that it's described in the actual material is the way that you can explain to families how to really apply some of these tips and practices. 

Beth: Then Sesame Street also does a very good job of using experts, oral health resource, oral health professionals to help you guide your messages that you're providing as well. Is that correct? 

Rocio: Yes absolutely. All of the materials were created in collaboration, actually, with some of your programs as well. It's important for you to know all of the materials that we presented here are in collaboration with experts so that we can give you what is best, what is most helpful research perspective. [Inaudible]. 

Francsico: Rocio, just to know that, I'm not sure, maybe it's an echo. Someone is with their mic perhaps with, Beth, if you put yours on mute, perhaps that's what the echo is causing. We can maybe ensure that these incredible resources that Head Start and the oral health program has really work with all these Academy of Pediatrics, they have really come with all the resources available. Rocio, do you want to add anything else to this? I'm sure there's other questions at all. I hope that there is some folks that might have told us about their experience in their programs. 

Rocio: [Inaudible] questions. 

Francsico: I hope there is some folks that might have told us about their experience in the program. 

Rocio: Yes. You will receive the links to all of these materials in an email. You could go very much at your pace. Look at what are some of the materials that are most helpful to your program that answer perhaps some of the more specific questions that you have related to your kids. All of this you're going to be receiving in an email. 

Francsico: With that, I think that, Melissa, do you want to give the evaluation, the instructions for folks? 

Melissa: Let me just double check. We have a little bit of time. Did you want to take any more questions? 

Francsico: Yeah. Did anyone put anything I don't have access to the chat, but did anyone talk about their programs? I'd love to hear what's working with them and congratulate them and to really commend them for all the amazing work they're doing. They are the amazing guardian angels for all the children in the country, and we're so grateful to have you guys in their lives and in our lives as well. 

Beth: I mean, we had a number of questions that came in, but most of them have been answered. Actually, it'd be interesting to get your perspective on a couple of folks have asked us to comment and offer some suggestions on dentists who are not comfortable with seeing children under age three. If there's any kind of advice and information that you can give health managers and folks who are working with families who are enrolled in Head Start on how to address that issue. 

Francsico: The American Academy of Pediatric Dentistry has done a great effort because they instituted a policy over 38 years ago. We've been doing trainings, resources. Dentists should be really comfortable. Especially now our pediatric dental residency programs, we have mandatory training on infant oral health. All the new pediatric dentists of the future are very comfortable with infants and toddlers. 

I know finding dentists in the community can be challenging. You can just go to the website of the dental schools in your area. They should all feel very comfortable seeing these babies as well as there should be resources from the American Academy of Pediatric Dentistry and the American Academy of Pediatrics. As we mentioned you earlier, the pediatricians are very comfortable doing risk assessments and doing fluoride varnishes. 

The whole idea is that we start them early to create this dental home concept to ensure that all these babies have this access to dental care at age one as an issue of equity and to position children's oral health as social equity, social justice, and human rights also. That's very, very important. Make the link to dental school. The hygiene school is fantastic. We have a great example of hygiene school in Maine doing infant oral care with Head Start and with WIC as well. 

These models are more and more on this amazing partnership with dental providers that can really see these babies early on. Because you don't need to really be specialized to see infants. Hygienists are doing it. The dental providers are doing it the dental assistants are helping to these visits. It's a team effort with the dentist, the specialist, as well as the pediatricians. 

Rocio: Can I just highlight one thing? Because talking about teams, the webinar chat is full of ideas of how the Head Start programs are already applying curriculum, talking to parents, having dental screenings. This is really wonderful. I want to encourage everyone to look through actually the chat, because the best ideas on how to implement some of these tips and how to message to parents actually is coming from all of you and your practice. It's important for us to be sharing with one another these big achievements when it comes to our oral health of the kids that we're serving. 

Beth: You guys know better than us and we need to learn from you. I'm not kidding. You are the angels of all your communities. You're the ones that make the big agents of change for these children. We commend you. We're so grateful with full gratitude and we love to learn from you. Please make sure you send me the chat and all that they say there. I hope they shared to us all their amazing successes. We can really make them the amazing champions of oral health, especially this Oral Health Month next February that we're coming soon. We really want to thank you from the bottom of our hearts all the hard work you're doing.

Rocio: A big thanks. Yes, thank you for the shout out to February. Because next month is Oral Health Month, we are already prepped for it after this webinar.

Francsico: Absolutely. This is evaluation, Melissa, if you to tell them.

Melissa: Thank you much, Rocio and Francisco. Thanks to Beth for moderating and fielding our questions from the audience. Here on the screen, you will see the link to the evaluation. It's also in the chat. We would like your feedback. The evaluation survey is anonymous, and your feedback is important to help us improve future training and technical assistance offerings.

Francsico: Thank you again to all of you. Thank you so much.

Melissa: Just a reminder that after you submit the evaluation, you'll see a new URL that takes you to the certificate. We just want to thank you all for spending a part of your day with us. If you haven't already, you can subscribe [Inaudible]. Stay connected. Here are our social media accounts. Follow us on social media and join us on MyPeers to continue the conversations on today's topics with your colleagues across the country. Next slide, please. You can find our resources in the health section of the ECLKC or write to us at health at ecetta dot info.

Francisco: Thank you guys. Please go save some teeth. Rocio, wonderful to see you. Thank you to the Head Start staff and all our oral health amazing team in the national office. We appreciate all you do. For all of you out there, thank you, thank you, thank you for doing so much for our community, for our children, which are our future. God bless.

Rocio: Take good care. Thank you, everyone.

Melissa: Thank you all.

Francisco: Bye bye.