The ABCD program is designed to begin seeing children as soon as the first teeth emerge. The American Academy of Pediatric Dentistry recently adopted the standard for children to be seen by a dentist at age one. Recognition of the need for early pediatric dentistry is new for many dentists and parents; the ABCD Program provides education and training for both.

  • Parent Orientation
  • Family Oral Health Education
  • Pediatric Dental Techniques
  • Fluoride Varnish
  • Atraumatic Restorative Technique
  • Knee-to-Knee Examination Procedure
  • Enhanced Dental Fees

    • Parent Orientation

    Parents are coached in their initial ABCD orientation and in follow-ups to bring their children in to the dentist before there are problems.

    Family Oral Health Education

    A Family Oral Health Education session can be billed twice per year by the dental office, this education may be delivered by the dentist and/or auxiliary staff. The session should include:

    • Risk Assessment
    • "Lift the Lip" Training (a videotape and flipchart teaching the parent/guardian how to examine the child's mouth) Order materials
    • Training in teeth cleaning
    • Nutritional counseling and use of cup for drinking
    • Discussion and prescription of fluoride supplements
    • Follow-up (contact within three months as a reminder about teeth cleaning, lift the lip exams, fluoride supplements)

    Pediatric Dental Techniques

    Dentists receive continuing education in early pediatric dental techniques and are certified by University of Washington Pediatric Dentistry staff. This qualifies them to receive enhanced reimbursement for selected Medicaid preventive service codes for enrolled children.

    In the initial training, the dentist is taught the "knee-to-knee" examination procedure as a better method than using a dental chair for examining very young children.

    Fluoride Varnish

    Fluoride Varnish applications are encouraged for high-risk children. Three applications per year can be billed to Medicaid-ABCD and can be delivered over any time period the dentist wishes (i.e. three days, three weeks or three in a year).

    Atraumatic Restorative Technique

    Dentists are encouraged to use the Atraumatic Restorative Technique (A.R.T.) for providing restorative therapy to children in a way that no pain is involved. Glass ionomer restorative material which releases fluoride is used for treating carious lesions without local anesthesia. This process is often referred to as "scoop-and-fill" or "band-aid" restorations. The idea is to stabilize the lesions until the child's behavior can be better managed and the lesions treated with conventional techniques.

    For more information, visit the following sites at the University of Washington School of Dentistry:

    Knee-to-Knee Examination Procedure

    1. Position the child in caretaker's lap while the adult sits in a chair. The clinician interacts warmly with the infant/toddler and the caretaker.
    2. Ask if the child will allow you to pick her/him up. If you have permission to do so, hold the child-briefly. Bounce, jostle, interact with the youngster and then return the child to the caretaker. If the child is obviously reluctant to be held by you or the caretaker advises that the child will not allow you to hold her/him, proceed to Step 3.
    3. Give the child a toothbrush (remove from packaging).
    4. Determine if the caretaker or another adult assists the child with toothbrushing by asking "How do you take care of your child's teeth?" If the caretaker does assist the child with tooth cleaning at home, communicate approval and praise. Request that the caretaker demonstrate brushing of the child's teeth. "Catch the caretaker doing something right" during tooth cleaning and praise that behavior.
    5. Assume the "knee to knee" posture. If you are sure you can successfully hold the child based on your previous experience in Step 2, hold the child "face to face" and place the child's legs around your hips. Lower the child's head onto the caretaker's lap. Ask the caretaker to continue brushing the child's teeth. While this is happening observe the child's mouth and teeth as much as possible as you supervise the tooth cleaning activity. If you are unable to complete this step proceed to Step 7.
    6. You should continue to lavish praise on the caretaker for appropriate behaviors or skills.
    7. Reverse the position of the child by asking the caretaker to take the child from you and reproduce the position you have just completed. Say, "Give your child a hug now and put her/his legs around your hips." Now gently lower the youngster's head onto your lap. Mother/caretaker can assist you by holding the child's hands as you complete the assessment.
    8. Use the child's toothbrush and quickly assess the child's oral condition.
    9. Use a dental mirror and continue to assess the child's oral condition and record findings.
    10. Advise caretaker of oral findings and recommendations for follow-up.

    Knee-to-Knee Examination Procedure, article by Peter K. Domoto, DDS, Professor and Chair, Pediatric Dentistry, University of Washington School of Dentistry and Donna Oberg, RD, MPH, Seattle/King County Public Health, in WSDA News, February 1998. Reprinted with permission.

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    Enhanced Dental Fees

    The Department of Social and Health Services (DSHS) pays enhanced fees to ABCD-certified dental providers and other DSHS-approved participating providers (e.g., physicians and ARNPs) for furnishing ABCD program services. For the current fee schedule