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The From the First Tooth Model

From the First Tooth (FTFT) is a Maine-based statewide children’s oral health initiative funded by the Children’s Oral Health Network of Maine. FTFT aims to improve the oral health of Maine’s children from the eruption of a child’s first tooth up to age 21 by implementing an evidence-based preventive oral health approach in the medical home. Oral health is a part of overall health, so it is important for medical providers to play a key role in preventing childhood caries. FTFT encourages pediatricians and family medicine providers to incorporate the following steps into well-child visits:

  • Oral health risk assessment
  • Fluoride varnish application
  • Parent/caregiver education
  • Referrals to dental services

FTFT provides technical assistance to primary care practices interested in participating in the initiative. Technical assistance includes:

  1. Implementation Assistance
  2. Medical Staff Training based on the Smiles for Life curriculum
  3. Risk Assessment and Oral Health Evaluation EMR Integration
  4. Materials for parents and Caregivers (materials can be ordered here)

Problem Statement

Early Childhood Caries is the most widespread, chronic, infectious disease among children living in the United States. The prevalence of Early Childhood Caries in 2-year-old children is 11% and rapidly increases to 44% in 5-year-old children. The consequences of untreated decay include pain and infection, impaired speech, delays in learning, problems with eating, social development, and, potentially, reduced quality of life.

Multiple interrelated social and demographic factors –including income, race, parents’ access to dental care, and educational level–can affect children’s access to preventive dental care. For example, it is well documented that low-income children are only half as likely as middleand high-income children to access preventive dental services, despite the higher occurrence of dental problems in this population. Low-income children are also two to three times more likely to suffer from untreated dental disease than their more affluent peers.  Adding to this issue, most Maine counties contain federally designated Dental Health Professional Shortage Areas.

Unfortunately, U.S. populations with the greatest burden of dental caries are the least likely to have access to dental care. Without access to regular preventive dental services, dental care for many children is postponed until the disease has to be treated in the operating room or symptoms such as toothaches and facial abscesses become so acute that care is sought in hospital emergency departments. The latter consequence of failed prevention not only is wasteful and costly to the healthcare system, but also rarely addresses the problem, as few emergency departments deliver comprehensive dental services.

Moreover, in the current healthcare system, dentists generally play a limited role in an infant’s health. The U.S. Public Health Service Oral Health Coordinating Committee suggests that pediatricians play a more active role in addressing infant oral health. The U.S. Department of Health and Human Services Oral Health Strategic Framework has provided a foundation of evidence-based solutions to many healthcare access issues and is beginning to address oral health care and reshape the dental care system for young children.

Often healthcare providers see children more than six times in their first year for well-child visits before the child ever sees a dentist. The medical home can play a vital role in improving the oral health of children. In fact, the American Academy of Pediatrics established a policy stating that every child, 6 months through 5 years old, should receive an oral health assessment by a healthcare professional, including a caries risk assessment during the well child visit.


Request an Onsite Training

Trainings typically include a CME training using the Smiles for Life curriculum, and hands-on training on the application of fluoride varnish as well as assistance with office flow and billing.

Virtual Trainings

For practices in Maine including Memorial Hospital, please click here to access the virtual training. This 45 minute on demand virtual training focuses on caries prevention, oral health assessments and fluoride varnish application. There is one interactive quiz imbedded at the end of the training. The training concludes with a short demonstration video on the application of fluoride varnish and tips for implementing varnish in the office setting.
Duration: 45 minutes


Complete the online Smiles for Life Course
This online course is part of a national oral health curriculum called Smiles for Life, and is available at no cost. The course focuses on dental caries (tooth decay) prevention. It offers a brief review of Early Childhood Caries (ECC) and addresses how the use of fluoride is part of a comprehensive approach to a child’s oral health. Specifically, clinicians will learn the benefits of fluoride varnish and how to apply fluoride varnish and provide adequate follow-up care.
Duration: 45 minutes
CME/CNE credits: 1 Category 1 CME/CNE

Provider Guidance

Dental Caries

The Pediatric Specialty Guidelines for Dental Caries describes the management and potential referral for children with dental caries and the timing of the referral. The video presents a dialogue with a pediatrician and pediatric dentists that walks through the referral guidelines for early childhood caries for primary care providers and expands upon a few specific cases.

 Dental Trauma

The Pediatric Specialty Guidelines for Dental Trauma discusses the management and referral for children with dental injuries as well as the timing of referrals. The video presents a dialogue with a pediatrician and pediatric dentist that walks through the referral guidelines for primary care providers and expands upon a few specific cases.