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PEPPERELL — According to the Center for Disease Control and Prevention, tooth decay affects children in the United States more than any other chronic infectious disease.

When left untreated, children may suffer from not only pain and infections but also problems with eating, speaking, playing, and even learning. Recent research from the CDC cites more 51 million school hours are lost each year because of dental-related illness.

And yet, tooth decay is completely preventable by following proper oral hygiene activities. In an effort to combat dental disease in young children, the state has deliberately transferred some responsibility beyond parents and the home.

Child-care directors across the state will soon be stocking up on toothbrushes, toothpaste, paper cups and permanent markers. They may even start an inventory of empty egg cartons to build their own sanitary toothbrush storage system.

The Massachusetts Department of Early Education and Care recently adopted a new regulation for child care settings to promote oral health and prevent tooth decay. Beginning January 2010 child-care workers must assist children with brushing their teeth if children are in care for more than four hours or they have a meal while in care.

This will require adjustments in the daily schedules of circle, stories and sing-alongs. To assist with the transition, the Massachusetts Department of Public Health Office of Oral Health has prepared a guide for centers to facilitate readiness. It includes an overview of the problem, the cause, the most current regulations and strategies for implementing an effective tooth brushing program.

The program is designed to have significant benefits; however, it will also necessitate more work by child care employees. Increased staff involvement will span several areas requiring new systems and procedures be put into place.

Caretakers will now have to, among other things, supervise proper brushing, manage and store supplies, monitor infection control, organize and schedule of the tooth brushing activities and communicate with parents and guardians.

The guidelines also offer suggestions for toothpaste dispensing, tooth brush storage and brushing techniques. Centers will also be required to lock up toothpaste, replace tooth brushes after three months or use by a sick child, label supplies, sanitize sink areas after use and help children actually brush their teeth.

The Family Tree Child Care Center in Pepperell has been preparing for this mandate for several weeks. Director Kim Casey says that she is taking advantage of available resources to become educated on the requirements as well as implement a successful plan.

“We are glad to contribute to our children’s health and help promote their future wellness.” She has been the director of the state licensed center for 15 years and currently has more than 100 children enrolled.

Casey’s planning positioned her to kick off 2010 in compliance and with a center full of shiny smiles. Last month, Dr. Ted Filandrianos visited Family Tree for a program designed to help the children understand the importance of proper oral care and brushing techniques. Joined by his dental hygienist, Filandrianos also helped the children feel comfortable around the white coats, rubber gloves and face masks in anticipation of dental exams.

Everyone had a chance to practice good “choo choo train” brushing on a dinosaur and participate in a rapid fire quiz about which foods make teeth “happy” and which make them “sad”. Following a quick lesson on bacteria, tooth decay and cavities, there was 100 percent consensus that everyone wanted to keep all of their teeth for as long as possible.

According to Dr. Filandrianos, proper care of young children’s teeth is especially important because they act as placeholders. Healthy “baby” teeth lay the foundation for appropriate spacing and healthy gums when permanent teeth arrive.

Dr. Filiandrianos is a cosmetic dentist in Newton and has been a resident of Pepperell since 1985. He donated his time for the program and sent each child home with a goodie bag of educational activities and brushing supplies.

“Dr. Ted’s visit was a great way to introduce the state mandated program,” said Casey. “The following week we started the program and the children really seem to be enjoying their new routine of brushing after lunch.” She also added that feedback from parents has been positive and some have even seen an increased interest in brushing at home.

Licensed centers statewide are faced with a daunting task by having to balance the most effective and efficient plan that provides the best service to the children while avoiding disruption to the staff and learning programs. They must also struggle with preventing or minimizing any costs associated with the extra time and effort.

Hollie Simao, the executive director of Rainbow Child Care in Townsend, is also preparing for the teeth brushing mandate and says that she is happy to support any effort designed to improve the well being of children.

“Good oral hygiene is an important step in keeping healthy and this is a wonderful opportunity to work with the children and their families to develop a life-long healthy habit,” said Simao. “Many of the habits we develop start in childhood and carry through our lifetime.”

The EEC recently compiled data showing that in Massachusetts 25 percent of kindergarten children, 40 percent of third graders, and 30 percent of sixth graders suffer from some tooth decay, with up to 50 percent of the cases going untreated. It also reports that tooth brushing in child care is not entirely new, stating that Head Start programs have been successfully brushing teeth for years without an increase in childhood illness or infection.

In addition to tooth brushing, other interventions can prevent tooth decay. Children who improve their diet, limit the frequency of sugar intake, use fluoride as directed and seek preventive care can also reduce their risk of dental disease.

For more information please visit Massachusetts Department of Public Health Office of Oral Health at

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