Local Public Health Spreads Importance of Good Oral Health during Children’s Dental Health Month

By Umair A. Shah, MD, MPH, NACCHO President and Executive Director of Harris County Public Health in Houston, Texas

The oral cavity, including the teeth and surrounding structures, are necessary for adequate nutrition, proper speech and a positive self-image.  Although tooth decay is largely preventable, it continues to be the most common chronic disease of early childhood.1  Dental health can impact school performance when a child has untreated tooth decay with resulting pain that affects their ability to concentrate, sleep at night or even attend school, “more than 51 million school hours are lost each year to dental related illness.”2 Taxpayers share approximately 11% of the $113.5 billion spent nationally on dental care expenditures, a percentage that has increased over the years as dental care utilization continues to increase among children.3  Children with cavities in their primary (baby) teeth are three times more likely to develop cavities in their permanent (adult) teeth which could contribute to broader health problems including diabetes and cardiovascular disease.4

All year long, many local health departments work to ensure children have access to quality oral health care. February is Children’s Dental Health Month, a time to spread awareness of good oral health habits and highlight the importance of beginning and maintaining oral hygiene in the early childhood years as soon as the first tooth appears.

Start Oral Care Early

In children, maintaining oral health is critical, even before adult teeth begin to form. The way in which primary or “baby” teeth are cared for shapes the way permanent teeth develop, making it important for children to learn effective oral health habits early. The type of care primary teeth receive can affect a child’s speech development, how they chew, and their confidence. Cavities are very common among children in the U.S. Untreated cavities lead to infections that can cause difficulties with eating, speaking, and even learning. A more serious and painful consequence of improper maintenance of primary teeth is formation of an abscess. When an abscess occurs, pus accumulates in a cavity to block an infection from spreading. This accumulation typically causes swelling and can be very painful.5

Making Oral Health a Priority for Children with Special Healthcare Needs

Over ten million children in the U.S. have special healthcare needs.6 Oral healthcare has been identified as one of the most common unfulfilled requirements among children with special healthcare needs (CSHN). Over the years, healthcare and public health professionals, lawmakers, and other advocates have been working to improve access to oral healthcare for CSHN.

NACCHO hosted a webinar titled, “Oral Health Considerations for Children and Youth with Special Health Care Needs,” which focused on oral health problems in CSHN, identified barriers to care, and brainstormed ways to address needs. The webinar also highlighted state and local examples that are working to improve the oral health of CSHN.

Local Health Departments Bridge Access to Dental Care

Luckily, cavities and other oral diseases are preventable through daily brushing with fluoride toothpaste, dental sealants, fluoride varnishing, and fluoridated tap water. Local health departments across the nation are playing their part in promoting good oral health through dental care services and programs.

In 2017, the Clinton County Health Department (CCHD) in New York won NACCHO’s Model Practices Award for their initiative to implement a fluoride varnish program in 100% of pediatric primary care practices in the county for children under the age of five. Their goal was to decrease the number of early childhood cavities and prevent developmental delays, diseases, self-esteem issues, and the prevalence of tooth decay in adulthood. CCHD staff worked with the New York State Association of County Health Officials to learn an overview of implementing a fluoride varnish program including application and billing. Once CCHD staff was trained, 100% of the pediatric provider offices were trained on screening, assessment, proper application, possible barriers, billing, and research, and all agreed to implement fluoride varnish application in their practice.

In Tioga County, NY, the Tioga County Health Department established a school-based mobile dental services program, designed to provide preventive and restorative dental care for underserved children and adults who lack insurance and access to a dental provider. Throughout the school year, the mobile unit travels to schools throughout the county and in the summer, it is stationed at a community center. Mobile unit dental staff perform exams, cleanings, fillings, x-rays, sealants, extractions, and fluoride treatments. Since the program’s inception, thousands of clients have received dental care through this program, many of whom had Medicaid, CHIP, or no insurance at all.

Throughout Harris County, TX the Harris County Public Health (HCPH) Dental Health and Prevention Services utilizes a multifaceted programming approach to improve the oral health of children. The dental programming includes:  dental clinical services for children, adolescents and expectant mothers; a population based oral health education and promotion program that reaches 15 school districts and over 300 schools each year and a school-based early prevention program which provides oral health education, oral assessments, fluoride varnish treatments, referrals and case management to thousands of children in underserved populations throughout Harris County. Recently HCPH embarked on this mission of “taking public health to the public” and acquired several mobile units that can provide a variety of public health services and education where people live, learn work, worship and play. Our Mobile Dental Unit will allow increased opportunities to provide access to dental care for children and promote the importance of oral health at community events.

NACCHO and CDC Launch Joint Local Water Fluoridation Project

The Centers for Disease Control and Prevention (CDC) says, “Children living in communities with fluoridated tap water have fewer cavities than children whose water is not fluoridated.”1 Water fluoridation can be delivered to whole communities regardless of income level or access to oral care. In January 2017, NACCHO, together with the CDC, launched a program called, “Building Capacity for Oral Health: Fluoridation Equipment in Local Communities,” which offers funding and technical assistance to support the replacement of aging water fluoridation equipment or the installation of new equipment. Nearly 30 organizations across 13 states applied, signifying the need for the project. Ultimately, six applicants were awarded based on their community’s need. In all, the oral health of nearly 450,000 people will be positively affected. In October 2017, NACCHO and CDC opened another round of funding for community water fluoridation systems. A total of 17 organizations were awarded funding, furthering efforts in providing communities with fluoridated water, thus improving and maintaining oral health.

Preventing Oral Health Problems

While public health professionals and policymakers work to address barriers in access to dental care, parents and caregivers can prevent oral health problems in their children by ensuring they drink fluoridated water, applying fluoride varnish and dental sealants to teeth, and simply brushing with fluoridated toothpaste. This National Children’s Dental Health Month, let’s champion optimal oral health among all children and promote healthy dental habits, so that America’s children have equal opportunities for success.



  1. Centers for Disease Control and Prevention. 2015. Oral Health Basics. Retrieved from https://www.cdc.gov/oralhealth/basics/index.html.
  2. S. Dept of Health and Human Services. Oral Health in America: A Report of the Surgeon General. Rockville, Md. U.S. Dept of Health and Human Services, National Institute of Dental and Craniofacial Research, National Institutes of Health; 2000:12.
  3. https://www.ada.org/en/publications/ada-news/2016-archive/february/dental-spending-remains-stagnant
  4. https://www.cdhp.org/state-of-dental-health/pregnancy-early-childhood
  5. Children’s Dental Health. The Importance of Caring for Baby Teeth. Retrieved from https://childrensdentalhealth.com/prevention-education/for-parents/the-importance-of-caring-for-baby-teeth.
  6. Maternal and Child Health Bureau. 2007. The National Survey of Children with Special Health Care Needs Chartbook 2005– 2006. Rockville, MD: Maternal and Child Health Bureau. http://mchb.hrsa.gov/cshcn05.

Member Spotlight: Health and Human Services Director Chris Dobbins Shares His Nontraditional Path into Public Health and Highlights the Success of the Gaston Youth Connected Program

Interview by Taylarr Lopez, Communications Specialist, NACCHO

NACCHO’s Member Spotlight series features interviews with local health department leaders and staff about their careers in public health. This interview features Christopher C. Dobbins, MPH, Director, Gaston County Department of Health and Human Services, in Gastonia, NC. He is also a member of NACCHO’s Board of Directors. Below he shares the challenges of navigating the health landscape during the uncertain future of the Affordable Care Act and the importance of public health awareness. Continue reading

Influenza Season: Resources and Information for Local Health Departments

This story originally ran in NACCHO’s Preparedness Brief.

Flu season is upon us. The Centers for Disease Control and Prevention (CDC) reports increasing and widespread flu activity across the United States. According to CDC surveillance, influenza-like illness activity is higher than it was during the peak of the 2014-2015 flu season and so far hospitalization rates are similar to that same time period. Continue reading

Public Health Advocacy: Informing Lawmakers about What Matters Most in Our Communities

By Umair A. Shah, MD, MPH, NACCHO President and Executive Director of Harris County Public Health in Houston, Texas

The Journal of School Health defines health advocacy as “The processes by which the actions of individuals or groups attempt to bring about social and/or organization change on behalf of a particular health goal, program, interest, or population.” 1 It is also one of the main pillars of public health. Local health departments depend on policymakers to enact laws that make our communities safe and promote healthy living. Every day, federal, state, and local decision-makers discuss a myriad of issues, including those related to public health. Through the power of advocacy, we have seat belt, tobacco prevention, safe drinking water, and nutrition labeling laws, just to name a few. For the betterment of our communities, it is imperative that public health professionals who possess expertise and experience in the field, educate lawmakers through evidence-based research. Continue reading

Cincinnati Health Department: Smoke-free Housing Implementation Success Story

By Tonia Smith, Tobacco Free Living Coordinator, Cincinnati Health Department

By engaging residents at each step in the process, Cincinnati Health Department’s (CHD’s) Creating Healthy Communities Coalition helped to implement a smoke-free multi-unit housing (SFMUH) policy for Cincinnati Metropolitan Housing Authority’s (CMHA’s) 13,000 public housing residents.

Everyone deserves a safe and healthy home, free from exposure to environmental hazards, including secondhand smoke. For this reason, the Cincinnati Health Department’s Creating Healthy Communities program has identified the implementation of smoke-free multi-unit housing policies as one of its key healthy living strategies. Even for nonsmokers, secondhand smoke exposure causes heart disease, stroke, lung cancer, sudden infant death syndrome, and serves as a trigger for asthma. SFMUH policies improve and protect the health of all residents, guests, and employees (smokers and nonsmokers) and are particularly beneficial to vulnerable populations such as children, the elderly, and people with chronic illnesses. In July 2016, CMHA took a major step to improve the quality of life for its 13,000 residents by implementing a smoke-free policy which reduces exposure to secondhand smoke and minimizes fire risks at its 18 multi-unit housing sites and over 350 single-family dwellings. Public housing residents have higher rates of cigarette smoking than the general population, which is why resident engagement was vital to ensuring the success of the SFMUH policy.

Once CMHA’s Board of Trustees decided in favor of SFMUH policy adoption, CHD began providing technical assistance and engaging residents at each step in the process: planning, education, implementation, enforcement, and identifying tobacco cessation options. Notably, several CMHA residents were trained as Freedom From Smoking facilitators (American Lung Association) to lead group smoking cessation classes at CMHA sites. Designing, implementing, and promoting the smoke-free policy was a collaborative effort between CMHA, CHD’s Creating Healthy Communities Coalition (CHCC), the American Lung Association, Cincinnati Children’s Hospital Medical Center (CCHMC), Environmental Protection Agency, Hamilton County Public Health, the American Cancer Society, American Heart/Stroke Association, Cradle Cincinnati, and the Jurisdictional Wide Resident Advisory Board (J-RAB) which is comprised of CMHA residents. The Ohio Department of Health and Interact For Health provided funding and support to ensure the success of this project.

CMHA’s SFMUH policy was implemented at its 18 multi-unit housing locations and several hundred CMHA-managed single-family homes. Designated outdoor smoking areas have been installed at each site; signage and cigarette butt receptacles were provided by CHD and American Lung Association. Nicotine air sampling was conducted at six CMHA housing sites. Initial data will be compared to data collected one year after policy implementation (currently underway) to gauge the policy’s effect on indoor air quality. In February 2017, Cincinnati Health Department began recruiting CMHA youth (ages 11–17) to join Cincinnati STAND, a youth-led campaign which encourages kids to “stand up and speak out against tobacco”. The group aims to eliminate the cultural acceptance of tobacco use, counter tobacco advertising, and prevent youth smoking initiation. Many residents, both smokers, and nonsmokers have shown support and expressed pride in members’ activities. Residents have helped to serve food at meetings and assisted with transporting members to events. The first Freedom From Smoking cessation class began in May 2017. An average of seven residents attended meetings, which were co-facilitated by a CMHA resident.

Work with Cincinnati Metropolitan Housing Authority in implementing their 2016 SFMUH policy began in 2015. Engaging residents by asking their opinions, addressing their concerns, and keeping them informed about the process was critical. Training residents to facilitate group smoking cessation classes creating champions within the CMHA housing sites. Engaging youth at the beginning of the process would have been more beneficial and created even more community buy-in. Young people who are passionate about a cause can serve as great advocates for their friends and family. Cincinnati Health Department’s work with CMHA in successfully implementing a SFMUH policy by focusing on community/resident engagement, including youth, is replicable.

Member Spotlight: Chief Executive Officer George Roberts Discusses the Importance of Community Engagement and Public Health Value Messaging

Interview by Taylarr Lopez, Communications Specialist, NACCHO

NACCHO’s Member Spotlight series features interviews with local health department leaders and staff about their careers in public health. This interview features George Roberts, Jr., MHA, FACHE, Chief Executive Officer of the Northeast Texas Public Health District. He is also Vice President on NACCHO’s Board of Directors. Below he discusses the importance of building relationships at the national, state, and local levels and highlights the department’s successful weight loss initiative, Lighten Up East Texas. Continue reading

Leveraging Existing Resources to Achieve Breastfeeding Equity

By Emily Bernard, IBCLC, NACCHO Consultant; Barb Hawkins Palmer, KCHD, Executive Director of Healthy Kent; Bonita Agee, Strong Beginnings, Education Coordinator; Teresa Branson, KCHD, Deputy Administrative Health Officer; and Chelsey Saari, KCHD, Project Director for Population Health & Accreditation Coordinator


Recognizing there was significant racial inequity in breastfeeding among African American mothers, the Kent County Health Department (KCHD), in Grand Rapids, Michigan, deemed the disparity unacceptable and convened a group of stakeholders to discuss this issue and ways to address it. Only 53% of African American mothers initiated breastfeeding, compared to 79% for white clients. Although there is a WIC program operated by KCHD and various additional maternal and infant health support services in the community, stakeholders determined that mothers would benefit more from receiving one-on-one breastfeeding-specific care. Using the well-documented success of peer mentor models, and with funds from NACCHO, KCHD formed a committee who worked in collaboration with the Healthy Kent Breastfeeding Coalition and the EMPower Hospital (Mercy Health Saint Mary’s), to create the Mothers Helping Mothers Breastfeed project, peer mentor home visiting program, in an effort to close the breastfeeding continuity of care gap for African American women. Continue reading