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Young children who are enrolled in Medicaid or the Children’s Health Insurance Program (CHIP) can be at risk for developing early childhood caries (ECC). ECC is a chronic bacterial infection that causes severe tooth decay and can begin to develop before baby teeth erupt. Along with asthma and obesity, ECC is one of the most common chronic diseases of childhood in the United States, and it is much more likely to affect low-income children than others. Although clinical guidelines recommend ways to prevent and manage ECC—using strategies similar to those for other chronic diseases—many children in Medicaid and CHIP do not receive appropriate preventive and management services. As a result, many cases of ECC worsen until costly hospital-based restoration or surgical removal of decayed teeth is unavoidable.

As states improve their health care systems to advance high quality services, good health outcomes, and cost reduction, Medicaid and CHIP program managers can contribute to these broad system goals by taking steps to promote ECC prevention and management. The prevention and management of ECC follows these clinical and program objectives:

• Ensuring fluoride varnish is applied periodically to the baby teeth of children younger than 6
• Ensuring children younger than 6 are assessed periodically for ECC risk
• Ensuring that a care plan is developed and implemented for high-risk children
• Educating and engaging families in ECC prevention and management