Oral health content of early education and child care regulations and standards.
OBJECTIVE
Almost two out of every three US children younger than five receive child care from someone other than their parents. Health promotion in early education and child care (EECC) programs can improve the general health of children and families, but little is known about the role of these programs in oral health. We identified U.S. EECC program guidelines and assessed their oral health recommendations for infants and toddlers.


METHODS
State licensing regulations were obtained from the National Resource Center for Health and Safety in Child Care's online database. Professional standards were identified through a search of PubMed, early childhood organizations' websites, and early childhood literature. All EECC guidelines were reviewed for key terms related to oral health promotion in children and summarized by domains.


RESULTS
Thirty-six states include oral health in their licensing regulations, but recommendations are limited and most often address the storage of toothbrushes. Eleven sets of standards were identified, four of which make recommendations about oral health. Standards from the American Academy of Pediatrics/American Public Health Association (AAP/APHA) and the Office of Head Start (OHS) provide the most comprehensive oral health recommendations regarding screening and referral, classroom activities, and education.


CONCLUSIONS
Detailed guidelines for oral health practices exist but they exhibit large variation in number and content. States can use the comprehensive standards from the AAP/APHA and OHS to inform and strengthen the oral health content of their licensing regulations. Research is needed to determine compliance with regulations and standards, and their effect on oral health.
Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC 27599, USA. akranz@unc.edu
Ashley M
AM
Kranz
R Gary
RG
Rozier
D001903:Bottle Feeding; D002327:Cariostatic Agents / Q000627:therapeutic use; D002654:Child Care / Q000331:legislation & jurisprudence* / Q000592:standards; D002656:Child Day Care Centers / Q000331:legislation & jurisprudence / Q000592:standards; D002669:Child Welfare / Q000331:legislation & jurisprudence*; D002675:Child, Preschool; D018479:Early Intervention, Educational / Q000331:legislation & jurisprudence / Q000592:standards; D005459:Fluorides / Q000627:therapeutic use; D017408:Guidelines as Topic; D006267:Health Education, Dental; D006293:Health Promotion; D006801:Humans; D007223:Infant; D008004:Licensure; D008403:Mass Screening; D009909:Oral Health; D010372:Pediatrics / Q000592:standards; D011634:Public Health / Q000592:standards; D012017:Referral and Consultation; D012955:Societies, Medical; D013663:Teaching / Q000379:methods; D014099:Toothbrushing; D014481:United States
D002327:Cariostatic Agents; D005459:Fluorides