Providing oral health care to rural populations in the United States is a major challenge. Lack of community water fluoridation, dental workforce shortages, and geographical barriers all aggravate oral health and access problems in the largely rural Northwest. Children from low-income and minority families and children with special needs are at particular risk. Familycentered disease prevention strategies are needed to reduce oral health disparities in children. Oral health promotion can take place in a primary care practitioner's office, but medical providers often lack relevant training. In this project, dental, medical, and educational faculty at a large academic health center partnered to provide evidence-based, culturally competent pediatric oral health training to family medicine residents in five community-based training programs. The curriculum targets children birth to five years and covers dental development, the caries process, dental emergencies, and oral health in children with special needs. Outcome measures include changes in knowledge, attitudes, and self-efficacy; preliminary results are presented. The program also partnered with local dentists to ensure a referral network for children with identified disease at the family medicine training sites. Pediatric dentistry residents assisted in didactic and hands-on training of family medicine residents. Future topics for oral health training of family physicians are suggested.

Dental disease, the most prevalent chronic disease of childhood, affects children's overall health and ability to succeed. Integrating oral health into routine well-child checkups is an innovative and practical way to prevent dental disease. The Washington Dental Service Foundation is partnering with Group Health Cooperative, a large integrated delivery system, and other providers in Washington State to change the standard of care by incorporating preventive oral health services into primary care for very young children. This paper describes systemic and policy changes for engaging primary care providers in oral health, including provider training, expanding access to dental care, and reimbursement.

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