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Delta Dental/Head Start Early Childhood Caries Prevention Project

  • Need: To provide dental care to Head Start children on South Dakota reservations.
  • Intervention: The Early Childhood Caries (ECC) Prevention Project brings dental hygienists to tribal Head Start programs to provide dental care to children and oral health education to parents.
  • Results: In three years, 1,133 children and their parents completed an ECC visit. An additional 2,780 children received preventive care.


American Indian children in South Dakota are more likely than White children to have untreated tooth decay: 42% of Native children compared to 16% of White children, according to the 2014 Oral Health Survey of South Dakota Children. In addition to healthcare barriers like lack of transportation options, there is a shortage of dental professionals on the reservations. For example, the Pine Ridge Indian Reservation has three dental hygienists for about 40,000 residents.

The Delta Dental of South Dakota Foundation partnered with seven Head Start programs to bring dental care to young children. Its Early Childhood Caries (ECC) Prevention Project currently serves the Cheyenne River, Crow Creek, Lower Brule, Pine Ridge, Rosebud, and Yankton reservations.

Two children at oral health lesson
Two children sit with a dental hygienist and learn about oral health.

The ECC Prevention Project received a 2015-2018 Federal Office of Rural Health Policy (FORHP) Rural Health Care Services Outreach grant. Six of the seven Head Start programs are continuing with the project after the grant cycle, but program coordinators have reported a significant drop-off in parent participation when incentives for attendance ended.

Services offered

Dental hygienists in tribal Head Start centers provide the following services:

  • Caries risk assessment
  • Cleanings
  • Fluoride varnish
  • Dental sealants
  • Parent education, using motivational interviewing, during child's appointment
  • Head Start staff education on applying fluoride varnish and advocating for increased dental insurance coverage


Child as dental hygienist
A child pretends to examine a dental hygienist's teeth.

During the grant cycle, 1,133 children and their parents completed an ECC visit. Another 2,780 children received preventive care, but the parents were not present for the educational portion of the visit. The percent of children with new tooth decay dropped 47%, from just under 12% in the spring of 2015 to just over 6% in the fall of 2017.

Two Head Start directors reported that their staff had increased their oral health knowledge, and one staff member's child, who was attending Head Start, is the first child in the family to avoid oral surgery.

Thanks in part to the project's advocacy work, South Dakota Medicaid now includes silver diamine fluoride application in its covered services.

Coordinators presented information about this project at two conferences: the Midwest Dental Public Health Conference at the University of Iowa and the Symposium on Caries in AI/AN Children.


It can be challenging to get parents to buy in to the importance of oral health, especially when your audience is lower-income and already facing healthcare barriers like lack of transportation options or insurance. Project coordinators are addressing this by staying involved with the Head Starts and speaking with tribal members about oral health.

Program coordinators report that there has been almost no parent participation after incentives for attendance ended.


Project coordinators trained one dental hygienist in the ECC protocols and motivational interviewing (to discuss oral health with parents) before training the other two hygienists in the location and then expanding the program across the state. This strategy helped gain buy-in since trainees heard firsthand from their dental care peers how the program worked.

Child and two dental hygienists
A child receives an ECC visit.

Motivational interviewing is an important tool to make sure parents feel listened to (instead of feeling lectured to) and have the opportunity to ask questions.

Contact Information

Connie Halverson, Vice President of Public Benefit
Delta Dental of South Dakota Foundation

American Indian or Alaska Native
Children and youth
Oral health

States served
South Dakota

Date added
May 28, 2019

Date updated or reviewed
June 4, 2020

Suggested citation: Rural Health Information Hub, 2020. Delta Dental/Head Start Early Childhood Caries Prevention Project [online]. Rural Health Information Hub. Available at: [Accessed 7 December 2021]

Please contact the models and innovations contact directly for the most complete and current information about this program. Summaries of models and innovations are provided by RHIhub for your convenience. The programs described are not endorsed by RHIhub or by the Federal Office of Rural Health Policy. Each rural community should consider whether a particular project or approach is a good match for their community’s needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep in mind that changes to the program design may impact results.