Oral health policies and programs affecting the preschool child

Although many policies and programs address the oral health of children, those specifically dealing with the preschool child are few. Review of existing policy suggests a lack of coherence or emphasis on the preschooler as a separate focus for oral health efforts. The importance of locating preschool children within existing policies and programs lies in insuring their access to care and to the benefits of educational and other preventive efforts directed to oral health. The experience of dentists advocating for children in California illustrates the value of an awareness of policies and programs directed at the preschool population. In 1990, a lawsuit brought forth by a coalition of dentists and other child advocates resulted in changes in the Denti-Cal (Medicaid) program for the benefit of children served. These changes increased both access and use by increasing fees and attracting more providers. Two years later, California attempted to stem the costs of success and tried to switch to a mandated capitated program for all Medicaid recipients. Again, through legal action, child advocates were able to argue successfully that such a move would have a negative impact on the children of California. The outcome of the legal action in this situation is still to be decided at this writing, but the series of events and the success of the advocate-dentists speak to the value of a working knowledge of the programs available for children. An individual dentist can also benefit individual children by knowing approved and covered procedures for their care, programmatic characteristics for situations requiring referral, and resources for educational materials. In many cases, knowledge of policies and programs is as valuable as the care dentists render.