Dental and Oral Health for Young People in Foster Care

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The health of your mouth, teeth, and gums is linked to your general health and well-being at every stage of life. “A healthy mouth enables not only nutrition of the physical body, but also enhances social interaction and promotes self-esteem and feelings of well-being” (Dental Health Foundation, 2016).

The opposite can also be true. Dental and oral health problems can be painful and may contribute to low self-esteem at any age. There’s evidence that in children they may also be linked to poor school performance (Seirawan, Faust, & Mulligan, 2012).

A Challenge for Kids in Foster Care

Up to the time they enter foster care, children and teens have often  had only fragmentary and sporadic dental and oral health care. Many—more than one in three, according to one study—have acute and/or chronic dental and oral health problems (AAP, 2016a).

Often these problems are undiagnosed or under-treated. Common dental and oral health problems among children and teens in foster care include “bottle tooth decay” in very young children, multiple dental cavities in older children, and malocclusion (imperfect positioning of teeth when jaws are closed).

Entering foster care is no automatic fix. According to the American Academy of Pediatrics (2016a), dental and oral health care are some of the most difficult health services to access for children and teens in foster care.

Practice and Policy in NC

The American Academy of Pediatrics (2016a) recommends every child and teen entering foster care have a dental evaluation within 30 days of placement. North Carolina child welfare policy and practice support this recommendation.

North Carolina policy dictates that within 7 days of entering foster care every child should have an Initial Visit with a medical provider (typically a physician) to quickly assess their condition, make referrals, and fill needed prescriptions. If appropriate, a referral to a dentist could occur at this time. Within 30 days of entering foster care every young person should have a Comprehensive Visit in which a medical provider gives them a more thorough assessment, including a dental evaluation and, if needed, a referral to a dentist (NC DSS, 2016).

Young Girl Brushing Teeth

What Dental Care Services Do Kids in Foster Care Need?

Comprehensive dental care for children in foster care includes follow-up care for all conditions identified in the initial dental assessment. According to NYS Office of Children and Family Services (2009) dental care services for children in foster care may include:

  • Initial exam, preventive services, and sealants on permanent molar teeth upon entry into foster care
  • Begin routine dental visits by age one
  • Preventive care every 6 months
  • Examination by dentist annually
  • Sealants on newly erupted molars at preventive visits
  • Ongoing restorative care to promptly address every problem identified, including: timely access to restorative care; fillings; root canals; replace missing and damaged teeth; periodontal care for gum disease; immediate access to dentist or oral surgeon for pain or dental trauma; immediate access to effective medication to relieve pain; orthodontics for severe handicapping dental conditions
What Can I Do?

As a foster or adoptive parent or kinship caregiver, you are in a good position to ensure the children in your care get timely assessments, receive the dental care they need, and learn habits to safeguard their oral, dental, and overall health for years to come. Below you’ll find information and suggestions to help you with this important mission.

Dental Care Can Be a Trauma Trigger

For children who have been sexually, physically, or emotionally abused, getting dental care can be a trauma trigger.

If children are anxious about dental care, find out what’s most concerning to them by asking questions such as “Are there particular parts of the dental treatment that are difficult for you?” or “Is there anything we can do to make you feel more comfortable?”

Other tips to make dental treatment easier for those with trauma histories include:

 

  • Choose a dentist based on their gender, if that will help reduce your anxiety.
  • Ask to bring a friend or family member to the appointment with you or have another staff member present during exams. Tell the dentist you are anxious. You need not explain why.
  • Agree with the dentist on a non-verbal signal to indicate increased anxiety and a message in case you want to stop treatment.
  • Use relaxation aids such as headphones with soothing music.
  • Ask that you be the one to handle the suction instrument whenever possible.
  • If the smell of latex is a problem, ask the dentist to use vinyl gloves

Sources: dentalfear.com, n.d.; Dougall & Fiske, 2008

Oral Health Tips & Resources for Parents

At Placement

If a child already has a dentist when they are placed in your home, continue using that dentist unless the child has had a bad experience with that dentist.

Young Children

Choosing a brush. Use a soft-bristled brush designed for an infant’s or child’s teeth.

Holding a toothbrush. If the child has trouble holding a toothbrush, try making the handle thicker by putting it inside a tennis ball. The handle can also be strapped to the child’s hand with a wide rubber band, a hair band, or Velcro. Or, buy a toothbrush with a thick handle.

Teaching the child to brush. Break the process into small steps the child can understand and practice. Ask a dentist, dental hygienist, or early childhood specialist for help, if needed. Another way is to place a hand over the child’s hand to guide the toothbrush as the child brushes.

Using toothpaste with fluoride. Use toothpaste with fluoride that the child likes and that feels good in his or her mouth. An adult should always place toothpaste on the toothbrush. Under age 3: Use a small smear (about the size of a grain of rice).  Ages 3–6: Use a pea-size amount.

Positioning the child. Make sure the child is comfortable while you brush their teeth.
Keeping the child engaged in brushing. Use a timer, a short song, or counting as a game to encourage brushing for 2 minutes.

Source: American Academy of Pediatrics, 2016b

Children and Teens

Brush twice a day with an ADA-accepted fluoride toothpaste. Clean between the teeth daily with floss or another interdental cleaner. Eat a balanced diet and limit snacks. Visit your dentist regularly.

Youth Aging Out of Foster Care

If possible, schedule a complete dental checkup and take care of any dental issues before a youth leaves care. The youth should identify a dentist they will continue to use and determine whether coverage is available or what the cost will be (NYS Office of Children and Family Services, 2009).

Sealants

Children should get sealants on their permanent molars as soon as the teeth come in — before decay attacks the teeth. The first permanent molars come in between age 5 and 7. The second permanent molars come in between age 11 and 14. Other teeth with pits and grooves also might need to be sealed. Teens prone to decay may also need sealants. Talk to a dentist about sealants for your child (NIH, 2015).

Resources for Learning More

American Academy of Pediatrics Resource Library. http://www2.aap.org/fostercare/resourcelibrary.html. Search by the topic “Dental Health.”