Dentists and Head Start

What You Should Know and How You Can Help

What Is Head Start?

Head Start was established in 1965 to improve the school 

readiness of children ages 3 to 5 from families with low 

incomes. In 1994, Early Head Start was established to serve 

low-income pregnant women, with a focus on positive birth 

outcomes, and to promote healthy physical and cognitive 

development in children from birth to age 3 from families 

with low incomes. Both Early Head Start and Head Start 

provide education and health services in the context of 

family and community.1

Head Starta is a federal program administered through 

grants to approximately 1,600 community-based organizations. The federal government provides 80 percent of Head 

Start program funding through the Office of Head Start, 

Administration for Children and Families. Head Start 

grantees are required to raise the remaining 20 percent of 

their funding to help build partnerships and ensure that 

each program reflects the culture of the local community.2

Who Participates in 

Head Start?

Head Start programs serve approximately 900,000 pregnant 

women, infants, and children each year in all 50 states, the 

District of Columbia, and most U.S. territories. Some programs are designed specifically to serve American 

Indian/Alaska Native and 

migrant and seasonal farm 

worker families.1

At least 90 percent of 

children enrolled in each 

Head Start program must 

be from families with 

low incomes, and up to 

10 percent can be from 

families with incomes that 

exceed the low-income 

guidelines who would 

benefit from Head Start 

services.3

 Up to 35 percent of each Head Start program’s 

enrollment may also be children whose families’ incomes are 

between 100 percent and 130 percent of the federal poverty 

level. Children are automatically eligible, regardless of family income, if they are homeless or in foster care or if their 

families receive Temporary Assistance for Needy Families 

or Supplemental Security Income.4

The Head Start population reflects a higher percentage of 

racial and ethnic minorities than the general U.S. population.5

 The racial composition of the Head Start population 

is as follows: 39.9 percent white, 30.0 percent black/African American, 16.7 percent unspecified/other, 7.8 percent 

Early Head Start and Head Start 

provide education and health 

services in the context of family 

and community.
2

biracial or multiracial, 4.0 percent American Indian/Alaska 

Native, 1.7 percent Asian, and 0.6 percent Hawaiian/Pacific 

Islander. Of the Head Start population, 35.9 percent are of 

Hispanic/Latino ethnicity.2

Ten percent of each Head Start program’s enrollment 

opportunities are reserved for children with disabilities and 

special health care needs.6

Of the 94 percent of children enrolled in Head Start who 

have health insurance, 82 percent are enrolled in Medicaid 

or in the Children’s Health Insurance Program (CHIP).2

Why Are Head Start Children 

at Higher Risk for Oral Disease?

Head Start staff and parents report that the number one 

health issue affecting children enrolled in Head Start 

nationwide is lack of access to oral health services.7

Despite improvements in oral health status nationally, profound oral health disparities remain in certain population 

groups, including children 

enrolled in Head Start. 

These children, like other 

children from families with 

low incomes, experience 

more tooth decay and resultant pain and suffering than 

children from families with 

higher incomes.8

While oral health is 

emphasized in Head Start 

program performance 

standards, many infants 

and children enrolled in Head Start continue to encounter 

barriers to care. For example, there is a shortage of dentists 

serving the Medicaid/CHIP population. Furthermore, many 

dentists do not feel comfortable providing services to infants 

and young children, despite agreement within the oral 

health community (Academy of General Dentistry, American Academy of Pediatric Dentistry, and American Dental 

Association [ADA]) that children should see a dentist by 

age 1.9–12

What Oral Health Services 

Does Head Start Offer?

Head Start health services are based on the premise that a 

child must be healthy to be ready to learn. Good oral health 

is essential to a child’s behavioral, speech, language, and 

overall growth and development.7,13

Head Start program performance standards require that staff 

track the provision of oral health care (i.e., that an infant 

or child has a dental home and is up to date according to 

the state’s dental Early 

and Periodic Screening, 

Diagnostic, and Treatment Program schedule) 

and help parents obtain 

oral examinations and 

follow-up care for their 

child. These activities 

must take place within 

90 days of an infant’s 

or child’s entry into the 

program. Information 

about examination 

results, plans for followup care, treatment 

completed, and oral disease prevention activities (e.g., fluoride varnish, fluoride supplementation) are kept in a child’s 

health record.14

Head Start program activities also promote good dental 

hygiene in the classroom. Each day, staff wipe infants’ gums 

and assist children in brushing their teeth with fluoridated 

toothpaste. In most cases, toothbrushing is conducted in 

conjunction with a meal or snack.14

The number one health issue 

affecting children enrolled in Head 

Start nationwide is lack of access 

to oral health services.
3

Parent engagement is a key component of Head Start. 

Parents, as their child’s primary caregivers, play the most 

important role in ensuring that their child’s health and 

development needs are met. Head Start staff help parents 

understand the benefits of prevention and proper oral health 

care, along with the importance of establishing a dental 

home early in life.14

What Can Dentists Do to Help?

Accept referrals of children enrolled in Head Start, and 

make blocks of appointments available in the summer and 

at the beginning of the school year to help ensure that all 

children receive needed 

oral health care. Have a 

member of your office 

team make reminder 

calls the day before 

scheduled appointments, and explain your 

cancellation policy and 

expectations regarding 

on-time arrival to parents, Head Start staff, 

or both.

Designate a staff 

member to learn about 

Medicaid and CHIP 

billing. Reimbursement rates and procedures vary from 

state to state.

Provide care to children enrolled in Head Start on ADA’s 

Give Kids a Smile Day. This one-day event, held during 

National Children’s Dental Health Month each February, 

helps children from families with low incomes get needed 

oral health care and raises awareness of the need.

Join a Head Start health services advisory committee 

composed of parents, Head Start staff, health and human 

service professionals, and other community members. As 

participants in such committees, dentists can assist in the 

development of oral health policies and procedures and 

can support Head Start’s objective to increase access to and 

identify continuous sources of oral health care for Head 

Start participants.

• Partner with the Head Start state collaboration office in 

your state to create opportunities to learn about Head 

Start programs and the oral health needs of Head Start 

participants. For example, a Tennessee Head Start oral 

health forum was co-located with the Tennessee Dental 

Association annual session. Continuing education credits 

were offered to dentists who attended 

the forum.

• Partner with medical professionals 

(e.g., physicians, 

nurse practitioners, 

nurses, physician 

assistants) to incorporate oral health 

screenings, risk assessment, fluoride varnish applications, 

anticipatory guidance, and referrals for treatment into 

well-child visits.

Leverage your professional organization’s or state dental 

association’s resources to raise awareness among colleagues 

and to address the oral health care needs of children enrolled 

in Head Start. Following are suggestions for and examples 

of ongoing activities:

• Utilize communication tools such as professional organizations’ websites, newsletters, and discussion lists to highlight the oral health needs of children enrolled in Head 

Start and to facilitate member involvement with Head 

Start programs.

• Educate legislators about the oral health needs of children 

from families with low incomes, and suggest approaches 

for overcoming barriers to access, including increased 

Medicaid reimbursement and expanded funding for pediatric dentistry residencies and training. States that have 

raised reimbursement rates have seen significant increases 

in the number of dentists participating in Medicaid.15

Good oral health is essential 

to a child’s behavioral, speech, 

language, and overall growth and 

development.

• Advocate for increased training in community and pediatric dentistry in dental schools. The opportunity for 

students to work with Head Start as part of their dental 

education increases cultural sensitivity, exposes students 

to oral diseases they may not see elsewhere, and instills a 

sense of community responsibility.

Finding a dental home for Head Start participants continues 

to be a high priority for the Office of Head Start. To learn 

more about how you can help, contact your state’s Head 

Start collaboration office.
Resources

•	 Academy of General Dentistry

http://www.agd.org

•	 American Academy of Pediatric Dentistry

http://www.aapd.org

•	 American Dental Association

http://www.ada.org

•	 American Dental Association’s Give Kids a Smile

http://www.ada.org/givekidsasmile.aspx

•	 Head Start Locator (searchable database of Head Start programs)

http://eclkc.ohs.acf.hhs.gov/hslc/HeadStartOffices

References

1. Office of Head Start. 2010. About the Office of Head Start. http://www.

acf.hhs.gov/programs/ohs/about/index.html.

2. Office of Head Start. 2010. Head Start Program Fact Sheet: Fiscal Year 

2010. http://www.acf.hhs.gov/programs/ohs/about/fy2010.html.

3. U.S. Department of Health and Human Services, Office of Human 

Development Services. 1998. Title 45—Public Welfare, Chapter XIII, 

Part 1305—Eligibility, Recruitment, Selection, Enrollment, and 

Attendance in Head Start. 1305.4: Age of children and family income 

eligibility. Code of Federal Regulations. http://www.access.gpo.gov/nara/

cfr/waisidx_08/45cfr1305_08.html.

4. Office of Head Start. 2008. Head Start Reauthorization P.L. 110-134 

(ACF-IM-HS-08_01) Information Memorandum. http://www.acf.hhs.

gov/programs/ohs/policy/im2008/acfimhs_08_01.html.

5. Census Bureau. 2007. Race and Hispanic Origin in 2005. http://www.

census.gov/population/pop-profile/dynamic/RACEHO.pdf.

6. U.S. Department of Health and Human Services, Office of Human 

Development Services. 1998. Chapter XIII, Title 45—Public Welfare, 

Part 1305—Eligibility, Recruitment, Selection, Enrollment, and 

Attendance in Head Start. 1305.6: Selection process. Code of Federal 

Regulations. http://www.access.gpo.gov/nara/cfr/waisidx_08/45cfr

1305_08.html.

7. Brocato R. 2001. Head Start and Partners Forum on Oral Health. 

Head Start Bulletin 71:1–43. Washington, DC: Head Start Bureau. 

http://eclkc.ohs.acf.hhs.gov/hslc/resources/ECLKC_Bookstore/PDFs/

421CEF928C56391D1041DFCE1F0119AC.pdf.

8. Edelstein BL. 2000. Access to dental care for Head Start enrollees. 

Journal of Public Health Dentistry 60(3):221–229.

9. Academy of General Dentistry. 2010. Advocacy Policies 2009–2010.

Chicago, IL: Academy of General Dentistry. http://www.agd.org/files/

advocacy/9937advocacypolicies.doc.

•	 Head Start Oral Health Forums

http://www.mchoralhealth.org/HeadStart/hsforums.html

•	 Head Start State Collaboration Offices

http://eclkc.ohs.acf.hhs.gov/hslc/hsd/SCO

•	 Medicaid Provider Enrollment Information

http://www.mchoralhealth.org/ProviderEnrollment.html

•	 National Maternal and Child Oral Health Resource Center

http://www.mchoralhealth.org

•	 Office of Head Start

http://www.acf.hhs.gov/programs/ohs

10. American Academy of Pediatric Dentistry, Clinical Affairs Committee, 

Infant Oral Health Subcommittee. 2010. Guideline on infant oral 

health care. Pediatric Dentistry 32(6):114–118. http://www.aapd.org/

media/Policies_Guidelines/G_InfantOralHealthCare.pdf.

11. American Dental Association. 2010. Current Policies: Adopted 1954–

2009. Chicago, IL: American Dental Association. http://www.ada.org/

sections/about/pdfs/doc_policies.pdf.

12. Hale, KJ; American Academy of Pediatrics, Section on Pediatric 

Dentistry. 2003. Oral health risk assessment timing and establishment 

of the dental home. Pediatrics 111 (5 Pt 1):113–116.

13. Educational Services. 2002. Weaving Connections: The Health Services 

Advisory Committee. Washington, DC: Head Start Bureau. http://

eclkc.ohs.acf.hhs.gov/hslc/resources/ECLKC_Bookstore/Weaving%20

Connections%20%28Multimedia%20Kit%29.htm.

14. Office of Head Start. 2007. Child Health Services. http://eclkc.

ohs.acf.hhs.gov/hslc/resources/ECLKC_Bookstore/Weaving%20

Connections%20%28Multimedia%20Kit%29.htm.

15. Crall J, Schneider D, with the American Dental Association (ed.). 

2004. Medicaid Reimbursement: Using Marketplace Principles to Increase 

Access to Dental Services. Chicago, IL: American Dental Association. 

http://www.ada.org/sections/professionalResources/pdfs/medicaid_

reimbursement.pdf.

End Note

a

Head Start refers to Early Head Start and Head Start throughout the 

document.

Cite as

Holt K. 2011. Dentists and Head Start: What You Should Know and How You 

Can Help (2nd ed.). Washington, DC: National Maternal and Child Oral 

Health Resource Center.

Dentists and Head Start: What You Should Know and How You Can Help

(2nd ed.) © 2011 by National Maternal and Child Oral Health Resource 

Center, Georgetown University.

This publication was made possible by grant number H47MC00048 from 

the Maternal and Child Health Bureau (MCHB), Health Resources and 

Services Administration (HRSA), U.S. Department of Health and Human 

Services. This funding is part of an intraagency agreement between the 

Office of Head Start; Administration for Children and Families; and 

MCHB, HRSA. 

Permission is given to photocopy this publication. Requests for permission 

to use all or part of the information contained in this publication in other 

ways should be sent to

National Maternal and Child Oral Health Resource Center

Georgetown University

Box 571272

Washington, DC 20057-1272

Phone: (202) 784-9771

Fax: (202) 784-9777

E-mail: OHRCinfo@georgetown.edu

Web site: http://www.mchoralhealth.org