Nutrition and Oral A Resource Guide

Prepared by Ruth Barzel, M.A. Katrina Holt, M.P.H., M.S., R.D., FAND Cite as Holt K, Barzel R, eds. 2020. and Oral Permission is given to photocopy this publication Health: A Resource Guide. Washington, DC: or to forward it, in its entirety, to others. Requests National Maternal and Child Oral Health for permission to use all or part of the information Resource Center. contained in this publication in other ways should be sent to the address below. Nutrition and Oral Health: A Resource Guide © 2020 by National Maternal and Child Oral National Maternal and Child Oral Health Health Resource Center, Georgetown University Resource Center Georgetown University This publication was supported by the Health Box 571272 Resources and Services Administration (HRSA) of Washington, DC 20057-1272 the U.S. Department of Health and (202) 784-9771 (HHS) as part of an award totaling $1,000,000 with E-mail: [email protected] no funding from nongovernmental sources. This Website: www.mchoralhealth.org information or content and conclusions are those of the author and should not be construed as the official policy of HRSA, HHS, or the U.S. govern- ment, nor should any endorsements be inferred. Contents

Introduction...... 3 Acknowledgments...... 4 Materials...... 5 Data and Surveillance...... 6 Policy...... 6 Professional Education and Training. . . . .8 Public Education...... 10 Organizations...... 17 Introduction

The National Maternal and Child Oral Health Guidelines for Americans emphasize consuming Resource Center (OHRC) developed Nutrition less than 10 percent of calories per day from and Oral Health: A Resource Guide to provide added sugars.2 In addition, the World Health information to assist health professionals, pro­ Organization recommends reducing the intake gram administrators, educators, parents, and of sugar to less than 10 percent of total energy others in promoting good eating and oral health intake and, to reduce children’s risk for weight practices to help prevent oral in pregnant gain and dental caries, limiting the intake of women, infants, children, and adolescents. sugar to less than 5 percent of total energy intake per day (less than 16 grams of sugar for Nutrition and oral health are interrelated. children ages 4–8).3 Additionally, the American Nutrition and diet can affect overall health and Heart Association recommends reducing sugar well-being as well as the development and consumption in children and adolescents to less integrity of the oral cavity and the progression of than 25 grams of added sugar per day.4 oral . Likewise, oral disease impacts the ability to eat and nutrition status. Caries-causing The resource guide is divided into two sections. bacteria in the mouth use sugar in food to make The first section describes materials, such as acid that can break down tooth surfaces and brochures, fact sheets, guidelines, curricula, and create (dental caries). Establishment reports published from 2016 through 2019 as well of a dental home promotes individualized as seminal resources published before 2016. The caries-preventive strategies, including dietary second section lists federal agencies, national recommendations and appropriate oral professional associations, resource centers, and instruction, as the primary teeth begin to erupt.1 national coalitions that may serve as resources.

The U.S. Department of Health and Human Our intent is to share resources that are useful Services and the U.S. Department of Agriculture and that represent current science and practice. develop dietary guidelines every 5 years to help For further information, we encourage you to Americans ages 2 and older make healthy food contact the organizations listed. Your state and choices to help prevent chronic disease and local departments of health, state and local oral- enjoy a . The 2015 –2020 Dietary health-related associations and societies, state or

NUTRITION AND ORAL HEALTH: A RESOURCE GUIDE 3 local oral health coalitions, and university-based 3. World Health Organization. 2015. Guideline: Sugars libraries are additional sources of information. Intake for Adults and Children. Geneva, Switzerland: OHRC will update the resource guide periodi­ World Health Organization. http://apps.who.int/iris/ cally, and we would appreciate hearing from bitstream/10665/149782/1/9789241549028_eng.pdf?ua=1 you if you know of any relevant resources that 4. Vos MB, Kaar JL, Welsh JA, Van Horn LV, Feig DI, are not included in this edition. Anderson CAM, Patel MJ, Cruz Munos J, Krebs NF, Xanthakos SA, Johnson RK; American Heart Associa- tion Nutrition Committee of the Council on Lifestyle References and Cardiometabolic Health; Council on Clinical Cardiology; Council on in 1. American Academy of Pediatric . 2018. Policy the Young; Council on Cardiovascular and Stroke on the dental home. . www.aapd. Nursing; Council on and Prevention; org/media/Policies_Guidelines/P_DentalHome.pdf Council on Functional Genomics and Translational 2. Centers for Disease Control and Prevention. 2010. Biology; and Council on Hypertension. 2017. Added The CDC Guide to Strategies for Reducing the Con- sugars and cardiovascular disease risk in children: sumption of Sugar-Sweetened Beverages. Atlanta, GA: A scientific statement from the American Heart Asso- Centers for Disease Control and Prevention. https:// ciation. Circulation 135(19):e1017–e1034. www.aha stacks.cdc.gov/view/cdc/51532 journals.org/doi/full/10.1161/CIR.0000000000000439 Acknowledgments

The following National Maternal and Child Oral we are grateful to the following individuals Health Resource Center staff members assisted for reviewing the resource guide: Lori Cofano, in the development of this publication: Beth Lauren Neufeld, Sandy Tesch, Pamella Vodicka, Lowe, Sarah Kolo, and Olivia Pickett. In addition, and Julia Wacloff.

NUTRITION AND ORAL HEALTH: A RESOURCE GUIDE 4 Materials Materials

FEEDING INFANTS AND YOUNG Data and Surveillance TODDLERS: USING THE LATEST EVIDENCE IN WIC SETTINGS DENTAL HEALTH MATTERS This brief summarizes feeding guidelines for This infographic focuses on the oral health status pregnant women and infants and children from of children and adolescents in South Dakota. birth to age 2 that are relevant to the Special Sup- Topics include untreated tooth decay in children plemental Nutrition Program for Women, Infants, ages 6–8 in South Dakota compared to the U.S. and Children (WIC). Topics include WIC services population and ways to prevent tooth decay, the and an overview of the feeding guidelines. The number of high school students who have missed applications of the feeding guidelines in the WIC school because of problems with their teeth or setting, including staff training on the guidelines, mouths, the percentage of students in third grade participant education, and breastfeeding support, who have not visited the in the past 12 are also discussed. months, and the percentage of children who do not have dental sealants. Information about Whaley S, Perez-Escamilla R, Segura-Perez S, healthy behaviors and using products containing Lott M. 2017. Feeding Infants and Young Todd­ is also provided. lers: Using the Latest Evidence in WIC Settings. Durham, NC: Healthy Eating Research. 19 pp. South Dakota Department of Health. 2016. Dental http://healthyeatingresearch.org/wp-content/ Health Matters. Pierre, SD: South Dakota Depart- uploads/2017/05/her_wic_051817-FINAL.pdf ment of Health. 1 p. http://doh.sd.gov/documents/ statistics/YRBS_Oral_Health.pdf HEALTHY BEVERAGE CONSUMPTION IN EARLY CHILDHOOD: Policy RECOMMENDATIONS FROM KEY NATIONAL HEALTH AND NUTRITION FEEDING INFANTS AND YOUNG ORGANIZATIONS—CONSENSUS TODDLERS: USING THE LATEST STATEMENT EVIDENCE IN CHILD-CARE SETTINGS This consensus statement provides evidence-based recommendations on beverage consumption for This brief summarizes evidence for promoting infants and children from birth to age 5. The doc- healthy nutrition in early care and education set- ument includes definitions of beverage types and tings. Topics include breastfeeding, shaping food describes the process for developing the recom- preferences among infants and toddlers, the role mendations. It offers information about beverages of the feeding environment and responsive feed- that are best for infants and children, beverages ing, introducing infants to complementary foods, to limit, and beverages to avoid. For each bever- and recognizing infants’ and toddlers’ hunger and age, recommended amounts to give infants and fullness cues. Feeding strategies to reduce the children of different ages are provided. likelihood that children will develop tooth decay are provided. Policy and practice implications are Healthy Eating Research. 2019. Healthy Bever- included. age Consumption in Early Childhood: Recom- mendations from Key National Health and Robert Wood Johnson Foundation. 2017. Feed- Nutrition Organizations —Consensus Statement. ing Infants and Young Toddlers: Using the Latest Durham, NC: Healthy Eating Research. 15 pp. Evidence in Child-Care Settings. Princeton, https://healthyeatingresearch.org/wp-content/ NJ: Robert Wood Johnson Foundation. 21 pp. uploads/2019/09/HER-HealthyBeverage-Consen- http://healthyeatingresearch.org/wp-content/ susStatement.pdf uploads/2017/05/her_ece_051817-FINAL.pdf

NUTRITION AND ORAL HEALTH: A RESOURCE GUIDE 6 HEALTHY FUTURES: ENGAGING KIDS AND DRINKING WATER: A GLASS THE ORAL HEALTH COMMUNITY IN HALF FULL OR HALF EMPTY?

CHILDHOOD OBESITY PREVENTION This paper discusses the importance of children This special supplement includes articles pre- drinking water. Topics include information about pared for the Healthy Futures: Engaging the Oral the importance of water consumption in prevent- Health Community in Childhood Obesity Preven- ing chronic disease; obstacles to ensuring that tion National Conference. The articles discuss students have access to clean, safe drinking water the science related to preventing childhood in schools; drinking water challenges in commu- obesity and reducing children’s consumption of nities; and opportunities for funders to increase sugar-sweetened beverages and strategies that children’s access to and consumption of free, safe oral health professionals and organizations can drinking water. Improving access, prioritizing employ to prevent childhood obesity. The articles education, funding data collection and research, examine (1) the science related to preventing promoting multisectoral partnerships, and advo- childhood obesity, (2) the science related to cating for supportive policies are also discussed. reducing children’s consumption of sugar- In addition, the paper presents a policy frame- sweetened beverages or sugar-containing bever- work to support healthy development in children ages, and (3) strategies that could be employed by investing in accessible, safe drinking water. by oral health professionals and organizations Braff-Guajardo E, Hecht K. 2015. Kids and Drink- and others to prevent childhood obesity. ing Water: A Glass Half Full or Half Empty?. Tinanoff N. 2017. Healthy Futures: Engaging Washington, DC: Grantmakers In Health. 3 pp. the oral health community in childhood obesity www.gih.org/files/FileDownloads/Kids%5Fand% prevention. Journal of Dentistry 5FDrinking%5FWater%5FKellogg%5FUC%5FMay 77(S1):S5–S140. http://onlinelibrary.wiley.com/ %5F2015.pdf doi/10.1111/jphd.2017.77.issue-S1/issuetoc NUTRITION COUNSELING FOR HEALTHY FUTURES: ENGAGING OBESITY PREVENTION IN CHILDREN: THE ORAL HEALTH COMMUNITY IN A HANDBOOK FOR THE DENTAL CHILDHOOD OBESITY PREVENTION COMMUNITY

NATIONAL CONFERENCE—EXECUTIVE This handbook is intended to increase the SUMMARY knowledge of dental students, residents, and fel- lows and dental hygiene students about obesity This executive summary provides an overview prevention, nutrition, and nutrition counseling for of the Healthy Futures: Engaging the Oral Health children. The handbook provides an overview of Community in Childhood Obesity Prevention childhood obesity and its consequences, recom- National Conference and key findings. It also mendations that support optimal oral health and presents a list of proposed strategies for prevent- healthy weight in children, and tools that oral ing childhood obesity in the following areas: health professionals can use to support child- research, dental students’ education and training, hood-obesity-prevention efforts. oral health professionals’ continuing education and training, advocacy/policy, consumer-based Bhoopathi V, Tripicchio G, Sarwer DB, Cordero- education interventions, interprofessional collabo- Ricardo M, Tellez M, Langenau E, Hill J. 2019. ration, and reimbursement. Nutrition Counseling for Obesity Prevention in Children: A Handbook for the Dental Community. Holt K, Tinaoff N, Garcia RI, Battrell A, Casamas- Philadelphia, PA: Temple University Maurice H. simo P, Grover J. 2017. Healthy Futures: Engaging Kornberg School of Dentistry. 22 pp. https:// the Oral Health Community in Childhood Obesity dentistry.temple.edu/NCOP_Handbook Prevention National Conference —Executive Sum- mary. Washington, DC: National Maternal and Child Oral Health Resource Center. www.mchoral health.org/PDFs/RWJF-HF-ExecSumm.pdf

NUTRITION AND ORAL HEALTH: A RESOURCE GUIDE 7 intended to complement the materials that home Professional Education visitors use with families and can be incorporated into topics that home visitors address with fami- and Training lies. Topics include the importance of primary teeth, brushing and flossing, eating healthy foods, drinking water, and visiting the dentist. Setting BRIGHT FUTURES: GUIDELINES FOR and reaching oral health goals and addressing HEALTH SUPERVISION OF INFANTS, oral health problems or emergencies are also CHILDREN, AND ADOLESCENTS (4TH ED.) discussed.

These guidelines provide background informa- Washington Dental Service Foundation. 2015– tion and recommendations for promoting the 2016. Cavity Free Kids: Home Visiting Resource. healthy development of infants, children, and Seattle, WA: Washington Dental Service Founda- adolescents from birth to age 21, as well as stan- tion. Multiple items. http://cavityfreekids.org/ dards for health supervision visits. Topics include resources/home-visiting-resource lifelong health for families and communities, fam- ily support, health for children and adolescents with special health care needs, development, CHECKLIST FOR CHILD CARE STAFF: , weight, nutrition, physical activity, BEST PRACTICES FOR GOOD ORAL oral health, use of social media, and safety and HEALTH . A companion pocket guide is also available. [Funded by the Maternal and Child This checklist provides items that child care Health Bureau] program staff can check to reflect what they are doing to promote good oral health for infants, Hagan JF, Shaw JS, Duncan PM, eds. 2017. Bright toddlers, and young children. Items not checked Futures: Guidelines for Health Supervision of can serve as goals to help staff work toward Infants, Children, and Adolescents (4th ed.). Elk improving their practices related to food and Grove Village, IL: American Academy of Pediatrics. drinks and oral hygiene. The checklist is divided 123 pp. https://brightfutures.aap.org/materials-and- into three main categories: infants from birth to tools/guidelines-and-pocket-guide/Pages/default. age 1, toddlers ages 1–3, and young children aspx ages 3–5. Within each category, items to check are listed in two subcategories: foods and drinks and oral hygiene. The checklist is written in BRUSH UP ON ORAL HEALTH simple language and is available in English and This series of tip sheets provides Head Start staff in Spanish. with information on current practice, practical Holt K, Lowe B. 2019. Checklist for Child Care tips to promote good oral health, and recipes for Staff: Best Practices for Good Oral Health. Itasca, healthy snacks. Topics include teething, fluori- IL: National Center for Early Childhood Health dated community water, healthy drink choices, and Wellness. 4 pp. www.mchoralhealth.org/ healthy bedtime habits, oral health during preg- PDFs/ChecklistChildCareStaff.pdf (English) and nancy, and preventing oral disease. www.mchoralhealth.org/PDFs/ChecklistChild- National Center on Early Childhood Health and CareStaff_Spanish.pdf (Spanish). Wellness. 2012–. Brush Up on Oral Health. Itasca, IL: National Center on Early Childhood Health and Wellness. 3 pp each. www.mchoralhealth. CHILDREN’S DRINK FACTS 2019: SALES, org/headstart/brush-up.php NUTRITION, AND MARKETING OF CHILDREN’S DRINKS

CAVITY FREE KIDS: HOME VISITING This report focuses on the sales, nutrition, and RESOURCE marketing of children’s drinks, defined as drinks that companies promote as products intended These resources for home visitors are designed for children ages 2–11 to consume. The report to help families establish good oral health hab- identifies and analyzes sweetened drinks, fla- its and obtain oral health care. The items are vored water, and drink mix categories as well as

NUTRITION AND ORAL HEALTH: A RESOURCE GUIDE 8 those without added sweeteners (added sugars or patient-facing pages are conversation guidelines low-calorie sweeteners) in the 100-percent juice, for health professionals. The flip book also juice/water blend, and plain water/seltzer catego- includes a chart to help health professionals ries. Topic include the children’s drink market, establish self-management goals for families to children’s drink nutrition, on-package marketing, work on at home. and advertising. TeethFirst! 2016. Good Dental Health: A Partner- Harris JL, Romo-Palafox M, Choi YY, Kibwana ship Between You & Me. Providence, RI: Teeth- A. 2019. Children’s Drink FACTS 2019: Sales, First! 8 pp. www.teethfirstri.org/sites/default/files/ Nutrition, and Marketing of Children’s Drinks. site-content/Flip%20Book%20Order%20Form%20 Hartford, CT: Rudd Center for Food Policy and 9.2015.pdf Obesity. 78 pp. http://uconnruddcenter.org/files/ Pdfs/FACTS2019.pdf HEALTHY SMILES FOR MOM AND BABY: IMPLEMENTATION GUIDE COOK’S CORNER: RECIPES FOR HEALTHY SNACKS—COMPILED FROM BRUSH UP This guide describes an approach to increasing pregnant women’s and infants’ utilization of oral ON ORAL HEALTH (2ND ED.) health services by implementing two models This cookbook includes recipes to support for obtaining oral health care: (1) maintaining a children’s healthy growth and development with closed referral system and (2) integrating pre- ingredients that are fresh, low in fat, and high in ventive oral health services into Special Supple- fiber. None of the recipes include added sugar. mental Nutrition Program for Women, Infants The recipes can be used by early care and educa- and Children (WIC) services. The guide also tion programs to help meet updated nutrition highlights education activities for health profes- standards from the federal Child and Adult Care sionals and social services professionals who Food Program. The cookbook is divided into reci- provide care to pregnant women and parents pes for dairy, , vegetables, and more. Each with infants. [Funded by the Maternal and Child recipe includes a list of ingredients, directions, Health Bureau] a picture of the prepared recipe, and, where Children’s Health Alliance of Wisconsin. 2019. needed, safety tips. It is available in English and Healthy Smiles for Mom and Baby: Implementa- in Spanish. tion Guide. Milwaukee, WI: Children’s Health National Center on Early Childhood Health and Alliance of Wisconsin. 4 pp. www.mchoralhealth. Wellness. 2017. Cook’s Corner: Recipes for Healthy org/PDFs/hsmb-implementation-guide.pdf Snacks —Compiled from Brush Up on Oral Health (2nd ed.). Itasca, IL: National Center on Early ORAL HEALTH CARE DURING Childhood Health and Wellness. 32 pp. https:// eclkc.ohs.acf.hhs.gov/publication/cooks-corner- : PRACTICE GUIDANCE recipes-healthy-snacks-oral-health (English), FOR TEXAS PRENATAL AND DENTAL https://eclkc.ohs.acf.hhs.gov/es/publicacion/ PROVIDERS el-rincon-de-la-cocina-recetas-para-refrigerios- saludables-salud-oral (Spanish) This document provides guidance on oral health care during pregnancy for prenatal care health professionals and oral health professionals in GOOD DENTAL HEALTH: Texas. Topics include myths vs. facts, guidance A PARTNERSHIP BETWEEN YOU & ME for health professionals, oral conditions dur- ing pregnancy, and oral health pharmacologi- This flip book for health professionals to share cal considerations for pregnant women. It also with parents covers the basics of good oral includes resources for consumers, available in health in infants and young children. Each page English and in Spanish, about good oral health is double-sided and designed as a teaching tool. during pregnancy and during infancy as well as The patient-facing pages feature simple text (in a dental referral form for pregnant women. The English and in Spanish) and pictures and illus- document was adapted from Oral Health Care trations to educate families. On the back of the

NUTRITION AND ORAL HEALTH: A RESOURCE GUIDE 9 During Pregnancy: A National Consensus State- conditions. The client handouts are available in ment. [Funded by the Maternal and Child Health English and in Spanish. Bureau] Hunt K, Manter M. 2016. Teeth for Tots: Oral Oral Health Improvement Program. 2019. Oral for Parents & Caregivers of Health Care During Pregnancy: Practice Guid- Infants and Toddlers —An Oral Health Resource ance for Texas Prenatal and Dental Providers. Guide. Lawrence, KS: Kansas Head Start Associa- Austin, TX: Department of State Health Services, tion. Multiple items. www.saavsus.com/store/ Oral Health Improvement Program. 24 pp. www. teeth-for-tots-oral-health-resource-guide dshs.state.tx.us/dental/pdf/TX-DSHS-OHIP- Perinatal-Guide-Final-AccessibleForm.pdf THANKS FOR PROTECTING US 2 SETTING GOALS FOR ORAL HEALTH This video discusses the importance of healthy primary teeth to children’s overall health and DURING PREGNANCY how health professionals can play a role in pre- This checklist for home visitors and their clients venting oral disease in infants and young chil- in Maryland is designed to help them establish dren by administering fluoride varnish as soon as goals for oral health during pregnancy. Topics the first tooth emerges. The video also discusses include making a dentist appointment, going to other ways that health professionals can encour- the dentist, brushing with fluoridated , age good oral health at well-child visits, includ- flossing, drinking tap water, drinking less soda ing providing information about toothbrushing, and other sugar-sweetened beverages, and eating proper use of bottles, good nutrition, how to and vegetables. The checklist is available in establish a dental home, and the importance of English and in Spanish. [Funded by the Maternal establishing a dental home. and Child Health Bureau] Maine Health Educational Services. 2018. Thanks Maryland Dental Action Coalition. 2016. Set- for Protecting Us 2. Portland, ME: Maine Health ting Goals for Oral Health During Pregnancy. Educational Services. 1 video (3 min., 24 sec.). Columbia, MD: Maryland Dental Action Coali- www.youtube.com/watch?v=NlbIy_2M3Dk&featu tion. 1 p. http://phpa.dhmh.maryland.gov/ re=youtu.be oralhealth/Pages/Oral_Health_and_Pregnancy. aspx (English), https://phpa.health.maryland.gov/ oralhealth/Documents/GoalSettingSpanish.pdf (Spanish) Public Education

5-2-1-0 HEALTHY CHOICES COUNT! TEETH FOR TOTS: ORAL HEALTH ACTION GUIDE—EARLY CARE, EDUCATION FOR PARENTS & EDUCATION, AFTER-SCHOOL CAREGIVERS OF INFANTS AND TODDLERS—AN ORAL HEALTH This guide is part of the 5-2-1-0 Healthy Choices RESOURCE GUIDE Count Program, an evidenced-based prevention framework to promote healthy habits. The guide This curriculum for health professionals provides discusses how early care and education sites oral health education to parents of infants and can adopt a whole child approach to wellness children from birth through age 3. The cur- and education by providing healthy foods in the riculum is composed of 10 modules, and each classroom and cafeteria and creatively increasing module provides background information and physical activity throughout the day. The guide a sample agenda. Topics include oral health explains why the 5-2-1-0 method works and pres- and infancy, teething, primary teeth, the age 1 ents 10 strategies for success. It also discusses dental visit, oral health screenings, tooth decay, how to implement the program in an early care fluoride, toothbrushing and flossing, weaning, or education site in five steps: engage, register, nutrition and feeding habits, oral habits, dental implement, share, and check in. first aid, medications and oral health, and special

NUTRITION AND ORAL HEALTH: A RESOURCE GUIDE 10 Iowa Department of Public Health. 2019. 5-2-1-0 BABY STEPS FOR TINY TEETH Healthy Choices Count! Action Guide —Early Care, Education, After-School. Des Moines, This video shows a conversation between a new IA: Iowa Department of Public Health. 15 pp. mother and her friend. Topics include the impor- www.iowahealthieststate.com/webres/File/ tance of not cleaning an infant’s pacifier with Healthy-Hometown/5210/2019_ChampionTool , not putting a child to sleep with a bottle, kit_Update_FINALONLINE.pdf and not giving infants juice. The video provides a dentist’s perspective on why it is important for infants to visit the dentist. It shows the dentist 5-2-1-0 HEALTHY CHOICES COUNT! examining an infant while explaining each step ACTION GUIDE—HEALTH CARE of the process. Tips on how to check an infant’s mouth for tooth decay and how to clean an This guide for health professionals is part of infant’s and teeth are provided. The video the 5-2-1-0 Healthy Choices Count Program, an is available in English and in Spanish. evidence-based prevention framework to pro- mote healthy habits. The guide discusses how Texas Department of Health Services. 2019. Baby health professionals can use the 5-2-1-0 method Steps for Tiny Teeth. Austin, TX: Texas Depart- to help children stay healthy. It explains how ment of Health Services. 1 video (6:37 minutes health professionals can implement the program English, 7:26 minutes Spanish) https://youtu.be/ in five steps: engage, register, implement, share, nyEbrW2oCzw (English), https://youtu.be/uUR and check in. vt0UCX5U (Spanish)

Iowa Department of Public Health. 2019. 5-2-1-0 Healthy Choices Count! Action Guide —Health BRUSHING FOR TWO: A HEALTHY START Care. Des Moines, IA: Iowa Department of Public FOR YOUR BABY Health. 15 pp. www.iowahealthieststate.com/ webres/File/Healthy-Hometown/5210/Health This tip sheet for pregnant women explains why care/5-2-1-0%20Action%20Guide_HealthCare.pdf oral health is important and how to maintain good oral health during pregnancy. Contents include information about oral hygiene, nutrition, 5-2-1-0 HEALTHY CHOICES COUNT! and the safety of receiving oral health care during ACTION GUIDE—WORKPLACES pregnancy. The tip sheet is printed in English on one side and in Spanish on the other. This guide is part of the 5-2-1-0 Healthy Choices Count Program, an evidence-based preven- Virginia Department of Health, Division of Dental tion framework to promote healthy habits. The Health. 2016. Brushing for Two: A Healthy Start guide explains how to become a 5-2-1-0 Healthy for Your Baby. Richmond, VA: Virginia Depart- Choices Count! registered workplace. It also ment of Health, Division of Dental Health. 2 pp. discusses how to implement the program in a www.vdh.virginia.gov/content/uploads/sites/30/ workplace in five steps: engage, register, imple- 2016/10/HL03-7-2016_BrushingforTwocardES.pdf ment, share, and check in.

Iowa Department of Public Health. 2019. 5-2-1-0 FIRST SMILES Healthy Choices Count! Action Guide —Workplaces. Des Moines, IA: Iowa Department of Public Health. This video for parents provides information about 15 pp. www.iowahealthieststate.com/webres/File/ the importance of oral health in infants and young Healthy-Hometown/5210/Workplace/2019_5210_ children. Topics include preventing dental caries; Workplace_ActionGuide.pdf early examination, detection, and treatment; and education. The video shows an oral health profes- sional performing a lap-to-lap examination, apply- ing fluoride varnish, and encouraging a mother to give her child milk and water rather than juice.

Kids Smiles. 2016. First Smiles. Philadelphia, PA: Kids Smiles. 1 video (3 min., 20 sec.). www.you tube.com/watch?v=myFGpBw36_c

NUTRITION AND ORAL HEALTH: A RESOURCE GUIDE 11 FOODS FOR HEALTHY TEETH (REV.) oral health for pregnant women, and taking care of an infant’s oral health. The series is available This brochure for consumers focuses on nutrition in English and in Spanish. and oral health. Topics include healthy foods, foods and drinks to avoid, juice recommenda- National Center on Early Childhood Health tions, xylitol, and prevention of tooth decay. and Wellness. 2014–. Healthy Habits for Happy The brochure is available in Amharic, Arabic, Smiles. Itasca, IL: National Center on Early Burmese, Dari (Afghan Persian), English, Haitian Childhood Health and Wellness. 2 pp each. Creole, Karen, Kinyarwanda, Levantine (Arabic), https://eclkc.ohs.acf.hhs.gov/oral-health/article/ Pashto, Spanish, and Sudanese (Arabic). healthy-habits-happy-smiles

Maryland Department of Health and Mental Hygiene, Office of Oral Health. 2015.Foods for A HEALTHY MOUTH FOR YOUR BABY Healthy Teeth (rev.). Baltimore, MD: Maryland Department of Health and Mental Hygiene, Office This document is intended to help parents keep of Oral Health. 6 pp. https://healthreach.nlm.nih. their infant’s mouth healthy. It lists five steps that gov/document/98/Foods%20For%20Healthy%20 parents can take: Protect the infant’s teeth with Teeth fluoride, check and clean the infant’s teeth, feed the infant healthy food, don’t put the infant to bed with a bottle, and take the infant to the den- FROM DROOL TO SCHOOL: CARING FOR tist before age 1. The text is accompanied with YOUR CHILD’S ORAL HEALTH FROM THE colorful illustrations. A conversation between two mothers in which one learns from the other DROOL YEARS THROUGH THE SCHOOL about how to keep a baby’s teeth healthy is YEARS (UPD.) included. The document is available in English and in Spanish. This booklet for parents provides information on how to care for an infant’s or child’s oral health National Institute of Dental and Craniofacial from birth through the elementary school years. Research. 2019. A Healthy Mouth for Your Baby. The booklet also includes information about how Bethesda, MD: National Institute of Dental to find and pay for oral health care and activities and Craniofacial Research. 12 pp. www.nidcr. that parents can do with their child to help them nih.gov/sites/default/files/2019-08/a-healthy- learn together about the importance of good oral mouth.pdf (English) www.nidcr.nih.gov/sites/ health. The booklet is available in Arabic, Eng- default/files/2019-08/healthy-mouth-spanish.pdf lish, and Spanish. A brochure and a video are (Spanish) also available.

Delta Dental Foundation, Michigan Dental Asso- A HEALTHY MOUTH FOR YOUR BABY ciation Foundation. 2015. From Drool to School: (FOR AMERICAN INDIANS AND ALASKA Caring for Your Child’s Oral Health from the Drool Years Through the School Years (upd.). Lan- NATIVES) sing, MI: Delta Dental Plan of Michigan. 56 pp. This document is intended to help American www.deltadentalmi.com/MediaLibraries/Global/ Indian and Alaska Native parents keep their documents/From-Drool-to-School-Book-DIGITAL. infant’s mouth healthy. It lists five steps that pdf parents can take: protect the infant’s teeth with fluoride, check and clean the infant’s teeth, feed the infant healthy food, don’t put the infant to HEALTHY HABITS FOR HAPPY SMILES bed with a bottle, and take the infant to the den- This series of handouts for pregnant women and tist before age 1. The text is accompanied with parents of infants and young children provides colorful illustrations. A conversation between two simple tips on nutrition and oral health issues. sisters in which one learns from the other about Topics include brushing a young child’s teeth, how to keep a baby’s teeth healthy is included. choosing healthy drinks for young children, National Institute of Dental and Craniofacial encouraging young children to drink water, giv- Research. 2019 A Healthy Mouth for Your Baby ing young children healthy snacks, taking care of (for American Indians and Alaska Natives).

NUTRITION AND ORAL HEALTH: A RESOURCE GUIDE 12 Bethesda, MD: National Institute of Dental and Virginia Department of Health. 2018. Infant Craniofacial Research. 12 pp. www.nidcr.nih.gov/ Nutrition and Oral Health. Richmond, VA: sites/default/files/2019-08/healthy-mouth-baby- Virginia Department of Health. 1 p. www.vdh. aian.pdf virginia.gov/content/uploads/sites/30/2018/11/ Nutrition_ENG_HL35-10-2018-EDITED.pdf (Eng- lish), www.vdh.virginia.gov/content/uploads/ HEALTHY MOUTHS FOR YOU AND sites/30/2018/11/Nutrition_SPAN_HL36-10-2018. YOUR BABY pdf (Spanish)

This video provides information about what mothers can do to promote good oral health in KEEP YOUR BABY CAVITY FREE their infant or young child and why it is impor- tant to do so. The video shows an oral health This video provides information for parents professional demonstrating how to clean the about how to keep their infant’s mouth healthy. infant’s mouth and observing while the mother It discusses the importance of eating healthy cleans the infant’s mouth. foods and practicing good oral hygiene before and during pregnancy and the relationship University of Maryland School of Public Health, between infant feeding practices and oral health Herschel S. Horowitz Center for . and overall health. The video also explains why 2017. Healthy Mouths for You and Your Baby. it is important to avoid putting an infant to bed College Park, MD: University of Maryland School with a bottle and why beverages with natural or of Public Health, Herschel S. Horowitz Center for added sugar should never be put in a bottle. The Health Literacy. 1 video (2 min.). https://go.umd. proper way to clean an infant’s gums and teeth edu/healthymouths is demonstrated, and the importance of the age 1 dental visit is discussed. The video is available in English and in Spanish. I LIKE MY TEETH (ORAL HEALTH POSTERS) Vann W Jr. 2016. Keep Your Baby Cavity Free. Chapel Hill, NC: University of North Carolina These posters for consumers share simple, posi- School of Dentistry, Prenatal Oral Health Pro- tive messages about brushing children’s teeth with gram. 2 videos (3 min., 18 sec.; 3 min., 51 sec.). fluoridated toothpaste, drinking fluoridated water, www.prenataloralhealth.org/index.php/about/ eating a healthy diet, and talking to the dentist or page/32/Mothers+Videos doctor about fluoride treatments for children. The posters are available in English and in Spanish. LESSONS IN A LUNCH BOX: HEALTHY National Center on Early Childhood Health and TEETH ESSENTIALS & FACTS ABOUT Wellness. 2017. I Like My Teeth (oral health post- SNACKS™ ers). Elk Grove Village, IL: National Center on Early Childhood Health and Wellness. 8 items. This lunch box provides parents with information https://eclkc.ohs.acf.hhs.gov/oral-health/article/ about oral health and healthy eating choices and oral-health-resources-staff (English), https://eclkc. practices. The lunch box is illustrated with draw- ohs.acf.hhs.gov/es/salud-oral/articulo/recursos- ings that promote good oral health and good de-salud-oral-para-el-personal (Spanish) nutrition and contains a “Dental Care in a Carrot” case made to include a , toothpaste, , and a rinse cup. Ordering informa- INFANT NUTRITION AND ORAL HEALTH tion; downloadable files, including a description This handout for parents provides information of the program, a 5-day lesson guide for teachers, about nutrition to promote children’s oral health. and an outline of the lessons; a video about the Topics include what sugar does to teeth, feeding program; and other supplemental materials are with a bottle and a cup, healthy foods for young available on the website. The lunch box is also children, and the best times to give children available in Braille. foods containing sugar. The document is avail- The Children’s Oral Health Institute. No date. able in English and in Spanish. [Funded by the Lessons in a Lunch Box: Healthy Teeth Essentials Maternal and Child Health Bureau] & Facts About Snacks™. Owings Mills, MD: The

NUTRITION AND ORAL HEALTH: A RESOURCE GUIDE 13 Children’s Oral Health Institute. Multiple items. ORAL HEALTH DURING PREGNANCY/ www.mycohi.org/lunchbox.html BABY’S FIRST DENTAL VISIT

ORAL HEALTH AND PREGNANCY This bookmark for pregnant women provides information about nutrition and oral health dur- This brochure for consumers provides informa- ing pregnancy and infancy. The bookmark offers tion about the importance of good oral health tips on oral hygiene, nutrition, and dental visits habits during pregnancy for women and their during pregnancy on one side and during infancy infant. The brochure provides information about on the other. [Funded by the Maternal and Child oral health coverage for women in Maryland, the Health Bureau] safety of receiving oral health care while preg- Virginia Department of Health, Dental Health nant, and oral conditions that can occur during Program. 2017. Oral Health During Pregnancy/ pregnancy. Tips about how to keep the mouth Baby’s First Dental Visit. Richmond, VA: Virginia healthy during pregnancy are provided, and Department of Health, Dental Health Program. myths and facts about oral health during preg- 1 p. www.vdh.virginia.gov/content/uploads/sites/ nancy are presented. The resource is available in 30/2017/05/Oral-HealthPregnancyBookmark_HL English and in Spanish. [Funded by the Maternal 10-5-2017.pdf and Child Health Bureau]

Maryland Department of Health and Mental ORAL HEALTH FACT SHEETS Hygiene, Office of Oral Health. 2018.Oral Health and Pregnancy. Baltimore, MD: Mary­­land Depart­ ­ These fact sheets for consumers provide infor- ment of Health and Mental Hygiene, Office of mation on a variety of oral health topics. Topics Oral Health. 2 pp. https://phpa.health.maryland. include dental benefit coverage, dental caries, gov/oralhealth/Documents/OralHealthPregnancy fluoride, general anesthesia and oral sedation, English.pdf (English), https://phpa.health.maryland. gum disease, mouthguards, nutrition, oral can- gov/oralhealth/Documents/OralHealthPregnancy cer, oral piercing, pregnancy, sealants, smokeless Spanish.pdf (Spanish) tobacco, and xylitol. The fact sheets are available in English, Chinese, Hmong, Russian, Spanish, ORAL HEALTH BEFORE DURING AND and Vietnamese. AFTER PREGNANCY California Dental Association. 2017. Oral Health Fact Sheets. Sacramento, CA: California Dental This video for pregnant women focuses on Association. Multiple items (1 p. each). www.cda. maintaining good oral health before, during, and org/public-resources/patient-fact-sheets after pregnancy. Topics include the importance of pregnant women understanding the value of maintaining their oral health, changes during PREGNANCY AND DENTAL HEALTH: pregnancy that can affect a women’s oral health, WHAT YOU NEED TO KNOW how a woman’s oral health can affect the oral health of her unborn child, and the safety and This postcard provides information about what importance of getting oral health care during pregnant women need to know about oral health pregnancy. Tips on how to prepare for dental during pregnancy. Topics include morning sick- visits during pregnancy, as well as information ness, changes in the mouth, the importance of about nutrition during pregnancy and what to healthy eating, and oral health during pregnancy. do for women who experience nausea, are also The postcard is written in simple language. provided. The video is available in English and [Funded by the Maternal and Child Health Bureau] in Spanish. [Funded by the Maternal and Child Before the First Tooth. 2017. Pregnancy and Health Bureau] Dental Health: What You Need to Know. Portland, Hebert C. 2018. Oral Health Before During and ME: Before the First Tooth. 2 pp. www.mchoral After Pregnancy. No place: No publisher. 1 video health.org/pdfs/38356.pdf (2 min., 17 sec.). https://connectingsmilessc.org/ oral-health-and-pregnancy

NUTRITION AND ORAL HEALTH: A RESOURCE GUIDE 14 PREGNANCY AND ORAL HEALTH University of California, San Francisco, Center for Vulnerable Populations at San Francisco General This fact sheet for consumers provides informa- Hospital. 2015. Share the Love, Share the Water. tion about the importance of good oral health San Francisco, CA: University of California, San during pregnancy for pregnant women and their Francisco, Center for Vulnerable Populations at infant. Topics include the importance of oral San Francisco General Hospital. 1 video (3 min.). hygiene, getting oral health care, and good nutri- www.youtube.com/watch?v=aJjDoKlN7Lw tion during pregnancy. Tips for choosing healthy snacks and drinks, how to care for the mouth if a woman has morning sickness, and finding a SUGAR BITES dentist are included. These brochures, posters, videos, and web graph- Ohio Department of Health, Oral Health Pro- ics are part of a public-awareness campaign gram. 2018. Pregnancy and Oral Health. Colum- aimed at preventing the development of chronic bus, OH: Ohio Department of Health, Oral diseases by encouraging parents to choose water Health Program. 1 p. https://odh.ohio.gov/wps/ for young children instead of drinks that are wcm/connect/gov/02972d42-c8af-46eb-a712-0370 high in sugar. The resources focus on reducing 79e79e7a/Pregnancy+and+Oral+Health+Fact+ children’s risk for obesity, dental caries, and dia- Sheet.pdf?MOD=AJPERES&CONVERT_TO=url& betes by reducing their consumption of flavored CACHEID=ROOTWORKSPACE.Z18_M1HGGIK0N milk, juice drinks, soda, and sports drinks. The 0JO00QO9DDDDM3000-02972d42-c8af-46eb-a71 resources are available in English and in Spanish. 2-037079e79e7a-mzsIYKg First 5 Contra Costa Children and Families Com- mission, Healthy+Active Before 5. 2015–. Sugar RETHINK YOUR DRINK, CHOOSE WATER! Bites. Concord, CA: First 5 Contra Costa Children and Families Commission. Multiple items. http:// This infographic provides information about cutsugarydrinks.org/en/downloads sugar-sweetened beverages (SSBs) and tips on healthy alternatives. Topics include the poten- tial impact of SSB consumption on oral health; TAKE CARE OF YOUR CHILD’S the amount of sugar in different beverages; and BABY TEETH recommended daily limits on sugar for infants, children, adolescents, and adults. Information This video for parents explains why primary about reading nutrition labels, limiting juice, and teeth are important for children. Tips for sooth- choosing water is provided. ing infants who are teething, promoting healthy primary teeth, and taking infants and young chil- Delta Dental of Michigan, Ohio, and Indi- dren to the dentist are provided. The video dem- ana. 2016. Rethink Your Drink, Choose Water! onstrates how to brush an infant’s or child’s teeth Okemos, MI: Delta Dental Foundation. 7 pp. and the appropriate amount of fluoride tooth- www.deltadentalmi.com/MediaLibraries/Global/ paste. Also discussed are problems in the mouth documents/6255-Rethink-Your-Drink-Brochure. that need immediate attention from a dentist. In pdf addition, the video explains what kind of foods and drinks are best for infants’ and children’s oral SHARE THE LOVE, SHARE THE WATER health and overall health. University of California, Los Angeles, Behavioral This video is designed to encourage families to Economics for Oral Health Innovation Project. drink water. The video also provides informa- 2018. Take Care of Your Child’s Baby Teeth. Los tion about avoiding beverages containing sugar Angeles, CA: University of California, Los Ange- to prevent diseases such as diabetes and dental les, Behavioral Economics for Oral Health Inno- caries. vation Project. 1 video (3:36 min.). https://youtu. be/qiabuZLkZ-A

NUTRITION AND ORAL HEALTH: A RESOURCE GUIDE 15 WHY EARLY DENTAL VISITS MATTER WHY FLUORIDE IN YOUR TAP WATER IS

This video for parents explains the importance of A GOOD THING the age 1 dental visit. Oral health professionals This video explains why adding fluoride to discuss good oral hygiene and nutrition and how community water systems is safe and effective early and regular professional oral health care at preventing tooth decay. The video features can help to establish a positive professional- commentary from oral health professionals and family relationship and healthy child develop- pediatric health professionals about the value of ment. The video is presented in English with community water fluoridation for children and Spanish subtitles. adults.

TeethFirst! 2015. Why Early Dental Visits Matter. American Dental Association. 2016. Why Fluoride Providence, RI: TeethFirst! 1 video (4 min., 17 sec.). in Your Tap Water Is a Good Thing. Chicago, IL: www.teethfirstri.org/content/why-early-dental- American Dental Association. 1 video (2 min., visits-matter 59 sec.). www.youtube.com/watch?v=wK4Fb1 CGEKE

NUTRITION AND ORAL HEALTH: A RESOURCE GUIDE 16 Organizations Organizations

ACADEMY OF NUTRITION AND AMERICAN DENTAL ASSOCIATION DIETETICS 211 East Chicago Avenue 120 South Riverside Plaza, Suite 2190 Chicago, IL 60611-2678 Chicago, IL 60606-6995 Telephone: (312) 440-2500 Telephone: (312) 899-0040 Website: www.ada.org Website: www.eatright.org The American Dental Association is committed The Academy of Nutrition and Dietetics works to to the public’s oral health and to ethics, science, improve the nation’s health and advance the pro- and professional advancement. Initiatives include fession of dietetics through research, education, those related to advocacy, education, research, and advocacy. The academy also provides expert and the development of standards. testimony at hearings, comments on proposed federal and state regulations, and develops posi- AMERICAN DENTAL HYGIENISTS’ tion statements on food and nutrition issues. ASSOCIATION 444 North Michigan Avenue, Suite 3400 AMERICAN ACADEMY OF PEDIATRIC Chicago, IL 60611 DENTISTRY Telephone: (312) 440-8900 211 East Chicago Avenue, Suite 1600 Website: www.adha.org Chicago, IL 60611-2637 The American Dental Hygienists’ Association Telephone: (312) 337-2169 works to advance the art and science of dental Website: www.aapd.org hygiene, promote standards of education and The American Academy of Pediatric Dentistry is practice in the profession, and provide profes- committed to promoting optimal oral health and sional support and educational programs. oral health care for infants, children, and adoles- cents, including those with special health care CENTERS FOR DISEASE CONTROL AND needs. PREVENTION Division of Oral Health AMERICAN ACADEMY OF PEDIATRICS 4770 Buford Highway, N.E., Mailstop F-10 Section on Oral Health Atlanta, GA 30341-3717 141 Northwest Point Boulevard Telephone: (770) 488-6054 Elk Grove Village, IL 60007-1098 E-mail: [email protected] Telephone: (800) 433-9016 Website: www.cdc.gov/OralHealth E-mail: [email protected] Website: www.aap.org/oralhealth The Centers for Disease Control and Prevention, Division of Oral Health, provides leadership in The American Academy of Pediatrics’ Section on preventing and controlling oral disease, promot- Oral Health focuses on improving communication ing oral health, and improving the quality of between pediatricians and pediatric and community water fluoridation. improving advocacy for oral health, nutrition, and early diagnosis and prevention of oral disease in children, including those with special health care needs.

NUTRITION AND ORAL HEALTH: A RESOURCE GUIDE 18 ROBERT WOOD JOHNSON U.S. DEPARTMENT OF AGRICULTURE, FOUNDATION FOOD AND NUTRITION SERVICE 50 College Road East 1400 Independence Avenue, S.W. Princeton, NJ 08540-6614 Washington, DC 20250 Telephone: (877) 843-7953 Telephone: (202) 720-2791 Website: www.rwjf.org/en/how-we-work/grants- Website: www.fns.usda.gov explorer/featured-programs/healthy-eating- research.html The U.S. Department of Agriculture, Food and Nutrition Service, provides leadership on food, The Robert Wood Johnson Foundation’s Healthy agriculture, natural resources, rural development, Eating Research: Building Evidence to Prevent nutrition, and related issues based on public Childhood Obesity supports research on environ- policy, science, and effective management. The mental and policy strategies that have the greatest department strives to provide all Americans access potential to improve healthy eating and weight to a safe, nutritious, and secure food supply. patterns among children to prevent childhood obesity, especially among groups at high risk for obesity: black, Latino, American Indian, and Asian/Pacific Islander children and children who live in communities where a high proportion of families have low incomes.

NUTRITION AND ORAL HEALTH: A RESOURCE GUIDE 19