Cavity Free at Three:
Improving the Health Care System

Many children endure serious dental problems simply because their parents don't know to take them to a dentist beginning at age one, and their other health care providers don't typically concern themselves with oral health. Yet dental caries (cavities in the primary teeth of children) is a preventable disease. The Cavity Free at Three program trains primary care providers to conduct infant oral health exams, apply fluoride varnish, educate parents and make the all-important referral to a dentist.

Since its inception in 2006, the program has quickly spread across the state, providing training to more than 600 primary care providers, health educators and public health practitioners. To date, more than 10,000 children have received Cavity Free at Three services, and 13,000 fluoride varnish kits have been distributed.

Karen Savoie, Director of Education with Cavity Free at Three, said the program underscores that children's oral health is a shared responsibility across medical disciplines, and it equips health care providers with the ability to provide total patient care. For example, Denver Health has integrated the Cavity Free at Three training into its eight primary care clinics, which serve 40% of the children in Denver, most of whom have public health insurance. Of Denver Health's 3- to 4-year-old patients, nearly 70% have cavities or pre-carious lesions, highlighting the need for such primary prevention services.

Associate Professor of Pediatrics, Dr. Patty Braun, talks with Daniela Tiscareno about proper dental practices for her 3-year-old daughter.

"We have dental providers at Denver Health, but many of our families didn't know that they could or should access a dental provider before their children are 3," said Patty Braun, MD, MPH, Associate Professor of Pediatrics at Denver Health, who also is the program evaluator. After its initial participation in Cavity Free at Three, Denver Health added policies and procedures that physicians should provide basic dental services, and made childhood caries a quality improvement indicator. "Just doing that helped remind providers and emphasized the importance.""We have dental providers at Denver Health, but many of our families didn't know that they could or should access a dental provider before their children are 3," said Patty Braun, MD, MPH, Associate Professor of Pediatrics at Denver Health, who also is the program evaluator. After its initial participation in Cavity Free at Three, Denver Health added policies and procedures that physicians should provide basic dental services, and made childhood caries a quality improvement indicator. "Just doing that helped remind providers and emphasized the importance."

Daniela Tiscareno's 6-year-old son and 3-year-old daughter have received oral exams and fluoride treatment from Dr. Braun, and they now brush their teeth twice a day and go to the dentist regularly. "My mom was one of those parents who didn't know that kids should go [to a dentist]. She thought that cavities would go away when the baby teeth fall out," said Daniela. Through Cavity Free at Three, Daniela knows how important early dental care is to the overall health of her children. "I'm very proud that my son and daughter don't have any cavities."

Dr. Braun said the program also has helped to increase providers' knowledge about and treatment of early childhood dental problems. Now, said Dr. Braun, "we intend to prevent cavities and in doing so, we will save a lot of emergency room visits, pain and costs. The providers have always been aware that our population has a lot of dental disease, but they didn't know what to do about it. Now they do, and I think it's satisfying to them to see they have an impact."

Cavity Free at Three has also been instrumental in helping to change the Colorado Department of Health Care Policy and Financing's rules so that physicians and public health practitioners can bill Medicaid for preventive oral health services in young children. This simple change resulted in a dramatic increase in dental services for children under age 3.

"We are actually establishing processes within the primary care provider network to expand outreach and bring oral health into the protocol for well child visits," Karen said. "Especially in parts of Colorado where there are no dental providers available, [kids] are getting oral health preventive services in the primary health setting. The health system really has a need there. These primary care providers want to do something and now they have the ability to help direct families to make the needed changes for better oral health."

Cavity Free at Three receives joint funding support from The Caring for Colorado Foundation, Colorado Health Foundation, Delta Dental Foundation of Colorado, Rose Community Foundation, Kaiser Permanente and The Colorado Trust.