EXHIBIT B ORAL-HEALTH POLICIES.PDF

Exhibit B
MARICOPA COUNTY POLICY RESPONSIBILITY OF:
NUMBER Instructional Staff, Volunteers,
1.15 Head Start Nurse
ISSUE DATE: June 2008 Page 1 of 7
HUMAN SERVICES DEPARTMENT REVISED DATE: June 2014
Education Division
Head Start Zero-Five Program Authorized by: Margaret Trujillo, Assistant Director
Attachment(s): Dental Examination Form; EPSDT Tracking Forms;
Health Information Form; Health/Nutritional Referral; Home Base
Subject: Oral Health Lesson Plan; Initial Home Visit Lesson Plan; PIR Enrollment
Information Form; Service Delivery Log
1.15 PURPOSE
To promote safe and effective oral hygiene practices among children in conjunction with meals and to provide oral health
education to parents which promotes regular tooth brushing in the home.1
1.15.1 POLICY
1.15.1.1 Tooth brushing in the classroom will be done daily. Tooth brushing for the Home Based Program will be
done during weekly home visits.
1.15.1.2 Staff and volunteers will follow the procedures of section 1.14.2.2 to ensure the hygienic use and storage of
toothbrushes.
1.15.1.3 Staff will use developmentally appropriate methods for teaching tooth brushing activities.
1.15.1.4 Staff, volunteers, and parents will follow, and assist children in following, the program’s tooth brushing
procedures.
1.15.1.5 Staff, volunteers, and parents will model and teach children the appropriate tooth brushing technique.
1.15.1.6 The implementation of good oral hygiene habits in the home will be achieved by communicating with parents
the program’s oral health policy and educating parents at regular intervals on the importance and methods of
good oral health.
1.15.1.7 In addition to tooth brushing, program staff follows the guidelines of section 1.14.2.7 to promote the oral
health of children.
1.15.1.8 Program staff will monitor and track children’s dental exams and any necessary follow-up treatment in the
ChildPlus system.
1.15.2 OPERATIONAL PROCEDURES
1.15.2.1 Tooth Brushing Schedule
Policy: Tooth brushing in the classroom will be done daily. Tooth brushing for the Home Based Program will be done
during weekly home visits.
Tooth brushing will take place after breakfast for morning sessions and after lunch for afternoon sessions, depending on
the classroom or home base visit schedule.2 Gum wiping for infants will be done once daily after a feeding.3
1 Maricopa County Head Start Program. “Oral Health Policy and Procedures”., & Head Start Performance Standards. 1304.23(b)(3).
2 Maricopa County Head Start Program. “Oral Health Policy and Procedures”.
3 Office of Head Start. Program Instruction. “Oral Health – Revision: ACF-PI-HS-06-03”.
Reviewed August 2015

Maricopa County Human Services Department, Education Division Head Start Zero-Five Program Page 2 of 7
Attachment(s): Dental Examination Form; EPSDT Tracking Forms;
Subject: Oral Health Health Information Form; Health/Nutritional Referral; Home Base
Lesson Plan; Initial Home Visit Lesson Plan; PIR Enrollment
Information Form; Service Delivery Log
1.15.2.2 Hygienic Practices
Policy: Staff and volunteers will follow the procedures of this section to ensure the hygienic use and storage of
toothbrushes.
A. Child Provided Personal Toothbrush:
Each child will be provided his or her own toothbrush, and children will never share toothbrushes. Toothbrushes
with soft, rounded, polished bristles are recommended.
B. Labeling of Toothbrushes:
To prevent the use of a toothbrush by another child, toothbrushes will be clearly marked with the child’s name using
a permanent marker.
C. Discarding Toothbrushes:
Toothbrushes will be discarded after three months, or whenever the bristles appear worn or splayed. If a toothbrush
has been contaminated, or has been used by another child, it should be discarded. Additionally, if a child is absent
from the classroom due to illness, the old toothbrush should be discarded and a new one issued upon the child’s
return to the classroom.
D. Toothbrush Storage:
Toothbrushes should be stored in an upright position in the holders that prevent the contact of the child’s toothbrush
with other toothbrushes. In the classroom, staff will use a well-ventilated toothbrush holder and mesh cover to
allow for proper airing and separation.
E. Disinfecting:
Toothbrushes will be disinfected once a week using Peridex solution. Toothbrushes will be sprayed with a light
mist of Peridex solution and allowed to air dry. Toothbrush holders will be disinfected weekly with disinfectant and
allowed to air dry once weekly. The Center for Disease Control does not recommend disinfecting toothbrushes
between uses.4
1.15.2.3 Developmental Considerations
Policy: Staff will use developmentally appropriate methods for teaching tooth brushing activities.
A. Children Between Age One and Two:
Tooth brushing with toddlers will always be done on a one-to-one basis in order to allow for adequate supervision,
individual attention and instruction, and prevention of communicable diseases. Generally, children at this age do
not have the gross motor skills to adequately brush their teeth on their own, which is why one-to-one attention must
be provided. Staff, volunteers, or parents will brush children’s teeth with a soft bristled toothbrush, using a small
smear of toothpaste that contains fluoride.
B. Children Age Two and Over:
With preschool children, ages to two to five, tooth brushing in child care settings can best be accomplished as a
group activity, with adults supervising, coaching, and modeling appropriate techniques. Tooth brushing activities in
the classroom are best with small groups of six to eight children per supervising adult. Supervising adults will
4 The University of Iowa. “Recommendations for Oral Health”. P. 2., & Head Start Performance Standards. 1304.23(b)(3). “Guidance”., & ADHS
Licensing, A.A.C. R9-5-501(A)(19).
Reviewed August 2015

Maricopa County Human Services Department, Education Division Head Start Zero-Five Program Page 3 of 7
Attachment(s): Dental Examination Form; EPSDT Tracking Forms;
Subject: Oral Health Health Information Form; Health/Nutritional Referral; Home Base
Lesson Plan; Initial Home Visit Lesson Plan; PIR Enrollment
Information Form; Service Delivery Log
ensure that toothbrushes are not shared, and that they are handled appropriately to prevent the transmission of
communicable diseases. One adult for every six to eight children allows for adequate supervision, individual
attention and instruction. This ratio reduces inappropriate activities such as sword playing, toothbrush guns,
combing hair with toothbrushes, and poking.5
1.15.2.4 Tooth Brushing Procedures
Policy: Staff, volunteers, and parents will follow, and assist children in following, the program’s tooth brushing
procedures.
A. Tooth Brushing Procedures Based On Age:
1. Infants Under Age One:
Once daily after a meal or feeding, staff, volunteers, or parents will wash their hands, cover a finger with a
gauze pad or soft cloth and gently wipe infant’s gums. Only water, not toothpaste, will be used to clean the
gums since an infant will likely swallow the toothpaste.6
2. Children Less Than Two Years And Greater Than One Year:
The tooth brushing procedure is lead by an adult staff member, volunteer, or parent, and includes the following:
a. The adult washes their hands.
b. The adult wets the child’s soft-bristled toothbrush under running water.
c. The adult dispenses a smear amount of toothpaste in a paper towel or inside the lip of a small paper cup.
d. The adult brushes the child’s teeth.
e. Thorough tooth brushing will usually take one to two minutes. Playing music can encourage the child to
continue until the song has ended.
f. When the brushing is completed, the adult will wipe the excess toothpaste from around the outside of the
mouth for children that are unable to spit.
g. The adult will rinse the toothbrush thoroughly with tap water after each use.
h. The toothbrush will be returned to the child’s designated toothbrush holder and allowed to dry.
3. Children Age Two and Over:
The tooth brushing procedure is led by an adult staff member, volunteer, or parent, and includes the following:
a. The adult washes their hands.
b. The adult dispenses a pea-sized amount of toothpaste inside the lip of a small paper cup.
c. The adult wets each child’s toothbrush under running water.
d. The adult hands the wet toothbrush and paper cup with toothpaste to each child.
e. The adult allows each child to scoop the toothpaste from inside the cup using the child’s toothbrush.
f. The adult will supervise, coach, and model the appropriate tooth brushing technique.
g. Thorough tooth brushing will usually take two to three minutes. Playing music can encourage the child to
brush until the song has ended.
h. Children will dispose of the paper cups in the trash.
i. The adult will rinse the toothbrushes thoroughly with tap water after each use. The adult may allow the
children to rinse their toothbrushes with tap water under close supervision.
j. The toothbrush will be returned the child’s designated toothbrush holder and allowed to dry.7
5 Maricopa County Head Start Program. “Oral Health Policy & Procedures”., & The University of Iowa. “Recommendations for Oral Health”. P. 1.
6 Head Start Performance Standards. 1304.23(b)(3). “Guidance”., & Office of Head Start. Program Instruction. “Oral Health – Revision: ACF-PI-
HS-06-03”.
7 Maricopa County Head Start Program. “Oral Health Policy & Procedures”, & Office of Head Start. Program Instruction. “Oral Health – Revision:
ACF-PI-HS-06-03”.
Reviewed August 2015

Maricopa County Human Services Department, Education Division Head Start Zero-Five Program Page 4 of 7
Attachment(s): Dental Examination Form; EPSDT Tracking Forms;
Subject: Oral Health Health Information Form; Health/Nutritional Referral; Home Base
Lesson Plan; Initial Home Visit Lesson Plan; PIR Enrollment
Information Form; Service Delivery Log
B. Rinsing With Water:
Children should be allowed to spit out excess toothpaste following brushing, but rinsing should be limited, or not
take place. Studies have shown that rinsing washes away some of the benefits of the fluoride.8
1.15.2.5 Early Head Start and Head Start Tooth Brushing Technique
Policy: Staff, volunteers, and parents will model and teach children the appropriate tooth brushing technique.
A. Appropriate Tooth Brushing Technique:
The following technique is recommended by the professional dental community and is the only method modeled
and taught to children in the classroom or by staff and volunteers:
1. Horizontal Scrub:
Children should use a horizontal scrub technique. With this technique, the brush is placed horizontally on the
tooth along the gum line and moved back and forth with a scrubbing motion.
2. Brush All Sides of Teeth:
Children should be encouraged by a supervising adult to brush all three sides of their teeth – the outsides,
insides, and chewing surfaces. A systematic approach should be followed to help ensure that all areas of the
mouth are cleaned.
3. Brush Tongue:
It is important to teach children to brush their tongue.
4. Use of Child Friendly Language:
Using child-friendly language like “upstairs” for top teeth and “downstairs” for bottom teeth is developmentally
appropriate.9
1.15.2.6 Parent Education
Policy: The implementation of good oral hygiene habits in the home will be achieved by communicating with parents the
program’s oral health policy and educating parents at regular intervals on the importance and methods of good oral health.
A. Explain Oral Health Policy:
Parents will have the oral health policy explained to them during the initial home visit. Parents will also be advised
that children must have an initial dental exam as part of their regularly scheduled health screenings.
B. Provide Oral Hygiene Information:
Parents will be provided with oral hygiene information and/or handouts at the following times:
1. At parent orientation.
2. At parent conferences and meetings.
8 The University of Iowa. “Recommendations for Oral Health”. P. 3., & U.S. Department of Health and Human Services. “Oral Health Assessment
and Dental Prevention.
9 The University of Iowa. “Recommendations for Oral Health”. P. 3.
Reviewed August 2015

Maricopa County Human Services Department, Education Division Head Start Zero-Five Program Page 5 of 7
Attachment(s): Dental Examination Form; EPSDT Tracking Forms;
Subject: Oral Health Health Information Form; Health/Nutritional Referral; Home Base
Lesson Plan; Initial Home Visit Lesson Plan; PIR Enrollment
Information Form; Service Delivery Log
1.15.2.7 General Guidelines for Promoting Oral Health
Policy: In addition to tooth brushing, program staff follows the guidelines of this section to promote the oral health of
children.
A. Guidelines:
1. Staff Training:
All staff will receive education about children’s oral health, including information on identifying children who
need dental care.
2. Child Education:
Each year children are educated about the care of their teeth in an age-appropriate
manner. This may include a visit from a community helper such as a nurse, dentist, or dental school or other
dental health professional agencies.
3. Nutrition:
a. The program provides meals according to the Head Start nutritional philosophy and that are low in sugar.
b. Sweet fluids like juice or soda are never placed in infant bottles without written instruction from the infant’s
health care provider.
c. Pacifiers are kept clean and never dipped in honey or other sweet liquid.
4. Teething Rings:
Teething infants are given cooled teething rings to comfort painful gums. Teething rings are sanitized after
each use.
5. Use of Bottles and Sippy Cups:
Bottles and sippy cups are used for meals and snacks while the child is being held or seated.10 Bottles are never
permitted in an infant’s crib without written instruction from the infant’s health care provider.11
6. Pacifiers:
Pacifiers are stored in individual pacifier holders for storage.
1.15.2.8 Early Head Start and Head Start On-Going Monitoring:
Policy: Program staff will monitor and track children’s dental exams and any necessary follow-up treatment in the
ChildPlus system and children’s files.12
A. Tracking Dental Care:
The responsibility for determining that children have a dental home, are up-to-date on the EPSDT schedule of
dental care, and for tracking children’s oral health varies by program component. Table 1 displays responsible staff
by program component.
Table1: Tracking Oral Health – Staff Responsible by Program Component
Program Component Responsible Staff
Head Start – Center Based Family Support Specialists and Supervisors,
Head Start Nurse
Early Head Start – Center Based Early Head Start Teachers, Site Supervisors,
Head Start Nurse
Early Head Start and Head Start – Home Based Visitors and Supervisors, Head
Home Based Start Nurse
10 AZ Health & Safety Policy Manual for Child Care Centers. “Oral Health”. P. 58.
11 ADHS Licensing, A.A.C. R9-5-502(C)(3)(b)(iii).
12 Maricopa County Head Start Program. “Oral Health Policy & Procedures”.
Reviewed August 2015

Maricopa County Human Services Department, Education Division Head Start Zero-Five Program Page 6 of 7
Attachment(s): Dental Examination Form; EPSDT Tracking Forms;
Subject: Oral Health Health Information Form; Health/Nutritional Referral; Home Base
Lesson Plan; Initial Home Visit Lesson Plan; PIR Enrollment
Information Form; Service Delivery Log
B. Follow-Up and Arranging Treatment:
Staff will provide referrals and follow-up for the evaluation and treatment of dental abnormalities identified by staff
or parents, or as indicated on the child’s physical or dental exams. The Head Start Nurse will track dental referrals
and administer health fund requests for oral health services if needed. Staff will provide assistance to parents, as
needed, to enable them to learn how to obtain any prescribed medication, aids, or equipment for dental conditions.
C. Communicating With Parents:
Parents will be provided with written and verbal reminders about tooth brushing at home. All such communications
will be documented on the “Service Delivery Log”. Parents will be consulted immediately when child dental
problems are suspected or identified.
D. Classroom Monitoring:
Supervisors or designated staff will monitor classrooms at various times to ensure the oral health plan is followed.13
1.15.3 RELATED FORMS
1.15.3.1 List of Related Forms
 Dental Examination Form
 EPSDT Tracking Forms
 Health Information Form
 HS/EHS Referral Form
 Home Base Lesson Plan
 Initial Home Visit Lesson Plan
 PIR Enrollment Information Form
 Service Delivery Log
1.15.4 RELATED LAWS, REGULATIONS, AND PERFORMANCE STANDARDS
1.15.4.1 Arizona Department of Health Services, Child Care Licensing
 Arizona Administrative Code R9-5-501(A)(19)
 Arizona Administrative Code R9-5-502(C)(4)(b)(iii)
1.15.4.2 U.S. Department of Health and Human Services – Head Start Performance Standards
 45 CFR 1304.20(a)(1)(i)
 45 CFR 1304.20(a)(1)(ii)
 45 CFR 1304.20(a)(1)(ii)(C)
 45 CFR 1304.20(a)(1)(iii)
 45 CFR 1304.20(a)(1)(iv)
 45 CFR 1304.20(c)(1)
 45 CFR 1304.20(c)(2)
 45 CFR 1304.20(c)(5)
 45 CFR 1304.20(d)
 45 CFR 1304.20(e)(1)
 45 CFR 1304.23(b)(3)
13 Maricopa County Head Start Program. “Oral Health Policy & Procedures”., & Head Start Performance Standards. 1304.20(a)(1)(iii) & (iv)., &
1304.20(c)(5)., & 1304.20(c)(1) & (2)., & 1304.20(e)(1)., & 1304.20(d).
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Maricopa County Human Services Department, Education Division Head Start Zero-Five Program Page 7 of 7
Attachment(s): Dental Examination Form; EPSDT Tracking Forms;
Subject: Oral Health Health Information Form; Health/Nutritional Referral; Home Base
Lesson Plan; Initial Home Visit Lesson Plan; PIR Enrollment
Information Form; Service Delivery Log
1.15.5 SOURCES
Arizona Administrative Code. Title 9 Health Services, Chapter 5 Department of Health Services Child Care Facilities.
Available online at: http://www.azsos.gov/public_services/Title_09/9-05.htm
Arizona State School Readiness Board. Arizona Health and Safety Policy Manual for Child Care Centers. Spring 2006.
Available online at: http://gocyf.az.gov/SR/Policy/manual/CCHCmanual_WEBFULL.pdf
Maricopa County Human Services Department, Education Division. Head Start Zero-Five Program. Maricopa County
Head Start Zero – Five: Health Services Content Area Plan. 2007.
Maricopa County Human Services Department, Education Division. Head Start Zero-Five Program. Maricopa County
Head Start Zero – Five: Oral Health Policy and Procedures. Updated February 2007.
University of Iowa, College of Dentistry, Department of Pediatric Dentistry. Recommendations for Oral Health:
Toothbrushing Protocol for Preschool and Child Care Settings Serving Children 3-5 Years of Age. February, 2004.
Available online at: http://www.mchoralhealth.org/PDFs/ToothbrushingProtocol.pdf
U.S. Department of Health And Human Services. Administration for Children and Families. Office of Head Start. Head
Start Program Performance Standards and Other Regulations. Feb 2001.
U.S. Department of Health And Human Services. Administration for Children and Families. Oral Health Assessment and
Dental Prevention. Available online at:
http://eclkc.ohs.acf.hhs.gov/hslc/ecdh/Health/Reference%20Center/Publications%20and%20Multimedia/Articles/health_a
rt_00407_080805.html
Reviewed August 2015