There is sufficient evidence that home visits for the prevention of tooth decay in early childhood contribute to improved health outcomes, social outcomes, and healthcare cost, utilization, and value-related outcomes.
The findings below synthesize the results of the studies on home visits for the prevention of tooth decay in early childhood across three domains of measurement:
Tooth decay, gum disease (periodontal disease caused by advanced tooth decay), and oral cancers are the most common oral health diseases in the United States (U.S.). Tooth decay is one of the most common chronic diseases across all age groups and the most common condition among children[1], five times as prevalent as asthma[2]. 22% of children aged two to five have tooth decay (50% untreated), over 50% of children aged six to eight have at least one cavity of their primary (baby) teeth or their permanent teeth[3]. Left untreated, tooth decay can lead to severe infection and other sequelae. In the long run, tooth decay is associated with chronic pain, poorer school performance, and low self-esteem. Oral disease in pregnant women can be transmitted vertically to their children via gut dysbiosis and shared oral health practices, perpetuating a generational cycle of illness[4],[5].
Development of tooth decay is a predictor of suboptimal oral and physical health throughout life. Early prevention and intervention are essential to minimize tooth decay development and the subsequent related unfavorable health outcomes. Recommendations for personal oral care for children include twice-daily brushing with fluoridated toothpaste, daily flossing, consumption of a low cariogenic diet, an initial dental visit during the first year of life, and bi-annual visits thereafter for children at high risk of tooth decay development[6]. The oral health of preschool children and the incidence of tooth decay are highly dependent upon their caregivers' knowledge, attitudes, and behavior.
There are racial and socioeconomic disparities in oral health. Incidence rates of tooth decay among Mexican-American children aged two to five are almost twice as that for White people (33% vs. 18%), and this disparity persists in adolescence (70% vs. 54%). In households earning lower incomes, 17% of children aged two to five have untreated cavities in their primary teeth, thrice the incidence rate for children from households earning higher-incomes[4],[7].
In 2019, the Centers for Medicare and Medicaid Services (CMS) reported that nearly half of the children enrolled in Medicaid did not see a dentist[8]. In 2014, more than 40% of preschool-aged American Indian and Alaska Native children enrolled in Medicaid had untreated tooth decay, compared with about 20% of Black and Hispanic children and 11% of White children (in reporting states). Many states do not consistently collect or report children’s oral health indicators by race and ethnicity[4].
Experiences of dental care may impact disparities. In a survey of over 1,000 diverse families, parents reported dentists did not always involve caregivers in their child’s care: 66% of parents said they were not allowed in the exam room with their child, 27% said no one explained what was happening to their child, 25% were not asked to help calm their child, and 8% were not asked permission before dentists administered medications. Such experiences were more common for families who earn lower incomes than families who earn higher-incomes[9]. Additionally, conventional dental care often fails to account for individuals’ broader social contexts and lived experiences[10]. This lack of understanding is considered a key factor in the limited success of many traditional tooth decay prevention programs, particularly among socioeconomically disadvantaged populations.
Dental home visits (typically every six months) may reduce the incidence of tooth decay[11]. Home visits reduce barriers to care across many health-related disciplines, and for oral health in particular, the home setting provides an exceptional opportunity for the instructional and motivational delivery of preventive trainings to mothers and other caregivers within the critical early childhood period[12].
Home-based oral health interventions outlined in this assessment include single and multi-component approaches delivered by various professionals, including dental therapists, pediatric nurse practitioners, community health workers, and public health nurses. They may include multiple components such as oral health education paired with fluoride varnish application, distribution of oral hygiene supplies (toothbrush and toothpaste), and referrals to dental care. These interventions range from a single home visit to monthly visits over multiple years, with some programs incorporating telephone-based follow-up contacts between in-person visits[13]. Educational components typically address proper toothbrushing techniques, feeding practices that reduce the risk of tooth decay (such as avoiding bottles at bedtime and limiting sugary snacks), and strategies for establishing oral health routines[14].
Funding for home-based oral health interventions can be challenging to secure and often requires a patchwork of different sources. Medicaid coverage for preventive oral health services varies significantly by state, with some states providing reimbursement for fluoride varnish application by non-dental providers and preventive counseling delivered in home settings[6]. Programs such as Virginia's Child Health Investment Partnership (CHIP) Begin with a Grin have successfully integrated home-based oral health services into existing maternal and child health home visiting programs, leveraging both Medicaid reimbursement and local community funding[15]. Title V Maternal and Child Health Services Block Grant funding may support integration of oral health services into existing home visiting programs. Additional funding sources may include foundation grants, hospital community benefit dollars, and state or local early childhood programs. Some states have explored innovative financing mechanisms such as pay-for-success models or social impact bonds to fund preventive oral health interventions targeting high-risk populations. Integration of oral health services into existing evidence-based home visiting models (such as Nurse-Family Partnership or Healthy Families America) may provide opportunities for sustainable funding and service delivery[16].
Five to six-year-olds attending kindergartens in Malaysia.
Children were randomized to receive either six-month dental home visits and education leaflets (Intervention group) or education leaflets alone (Control group) over 24 months.
Randomized controlled trial. N=251 children enrolled in the study of which 144 were randomized into the intervention group.
Health: At the 24-month follow-up, 19 children (14.4%) developed new caries in the intervention arm compared to 60 children (60.0%) in the control group (p=0.001). On average, 0.2 (95% Confidence Interval [CI]: 0.1–0.3) tooth per child in the Intervention Group was observed to have developed new caries compared to 1.1 (95% CI: 0.8–1.3) tooth per child in the Control Group (p=0.001).
Children enrolled in Virginia’s Child Health Investment Partnership (CHIP) Begin With a Grin (BWAG) program.
CHIP of Roanoke’s BWAG program provides preventive dental services in the home (oral health anticipatory guidance and fluoride varnish) for children aged zero to six years.
Observational study with a comparison group. N=432 children, with 216 enrolled in the CHIP program and 216 matching non-CHIP controls—all enrolled in Medicaid.
Healthcare Cost, Utilization & Value: Children enrolled in Virginia’s CHIP BWAG program had significantly higher usage of Medicaid dental benefits compared with children not enrolled. When CHIP children were compared with Medicaid-only children, the CHIP child was three times more likely to have at least one dental visit (odds ratio [OR]: 3.0 [95% CI: 1.9–4.7]) and have a higher number of dental claims (ratio of estimated average number of dental claims [cases/control]: 8.60/3.05=2.82 [95% CI: 2.56–3.12]).
Children’s families who visited a public maternity health clinic in Queensland, Australia. Children aged six to 48 months were included in the intervention.
Provision of dental care instructions to parents combined with child dental examination during home visits every six months. Contact from the dental therapist occurred in each arm at months 6, 12, 18, 30, and 42. Clinical assessments were performed at months 24, 26, 48, and 60. Another group received telephone-based interventions by dental therapists while a group of children from the same area received no intervention and served as controls.
Randomized controlled trial. N=529 in the home-visiting group, 185 in the telephone-based intervention, and N=40 in the control group.
Health: The telephone-based and home-visit interventions were estimated to prevent 113 and 100 carious teeth per 100 children, respectively, over a 5.5-year period.
Healthcare Cost, Utilization & Value: Costs evaluated included program costs (per person, including travel), treatment costs (anesthesia, crowns, extractions, medication, and restorations), and indirect costs (travel and loss of income). Compared with the control group, incremental costs per 100 children over 5.5 years were estimated to be $144,709 lower for the telephone-based intervention and $167,032 lower for the home-visit intervention. Sensitivity analyses indicated that general anesthesia costs had the greatest impact on cost-effectiveness.
Qualifying families included parent/child dyads with children aged 24 to 72 months with clinically diagnosed tooth decay and no disallowing cooccurring conditions that may have impeded the child’s ability to engage in the dietary and toothbrushing behaviors targeted by the intervention (e.g., autism, cerebral palsy, reliance on feeding tube, etc.). Their parent/caregiver (“parent”) had to be older than 18 years with access to a text-capable cellular phone.
The average age was 3.97 years, 99% were Medicaid insured, and 88% were Hispanic. Most parents (95%) were mothers/grandmothers, married or in a committed partnership (75%), unemployed (62%), and with modest education (80% high school degree or less).
The MySmileBuddy Program (MSB), a one-year community health worker–delivered intervention to prevent the progression of tooth decay. At the baseline visit, community health workers engaged parents in a home, community, or clinical setting, referred them to social services as needed, and guided an open-ended conversation in English or Spanish using the MSB app to complete and document the app’s education, risk assessment, goal setting, and action-planning components.
Pragmatic trial (no control group included). N=1,130 with post-intervention data.
Social: The largest improvements were seen in toothbrushing routines and when children ate meals and snacks, both of which are important for protecting teeth. Families were nearly twice as likely to report improved therapeutic toothbrushing by the end of the program (OR=1.79, 95% CI: 1.46–2.20; p<0.001). Several everyday behaviors that can increase cavity risk when they happen frequently or at bedtime became less common. These included using bottles or sippy cups, outside of meals, during the day and night (reductions of 0.29 and 0.22 units, respectively; both p<0.001), nighttime breastfeeding without brushing afterward (−0.15 units; 95% CI: −0.21 to −0.10; p<0.001), sharing utensils (−0.30 units; 95% CI: −0.39 to −0.21; p<0.001), and using sugary foods to calm a child (0.37-unit improvement; 95% CI: 0.31–0.44; p<0.001).
Children were also more likely to eat meals and snacks at a table rather than grazing throughout the day, which limits how often teeth are exposed to sugars. The odds of eating meals at a table increased by 57% (OR=1.57, 95% CI: 1.28–1.93; p<0.001), and the odds of eating snacks at a table increased by 80% (OR=1.80, 95% CI:1.50–2.15; p<0.001).
Finally, families reported fewer perceived barriers to maintaining healthy routines, with improvements noted for both toothbrushing (0.38 units; 95% CI: 0.31–0.44; p<0.001) and dietary behaviors (0.33 units; 95% CI: 0.29–0.38; p<0.001).
Children recruited from community health centers at a mean age of 42 days.
Home visits (HV) and telephone contacts (TC) by dental therapists.
Observational study with a comparison group. A total of 188 children completed three HVs every six months, and another 58 had three TCs every six months. An additional 40 age-matched children from childcare facilities served as reference controls.
Health: The original study authors, Plonka and colleagues (2012), published clinical outcome data at 24 months, which showed that three of 188 children (1.5%) in the home visit arm had developed tooth decay, compared to nine out of 40 (22.5%) in the control arm (p<0.001).
There were also more children with early colonization of mutans streptococci (risk factor for tooth decay) in both the telephone-based intervention arm (47%) and control arm (35%) compared to the children who received home visits (28%); (p=0.01 and p=0.02, respectively).
Children of Roanoke Valley in Virginia enrolled in the Child Health Investment Partnership (CHIP). Enrolled children were an average of 12 months old and enrolled for an average of 24 months. Participants were between the ages of six months and 36 months old.
CHIP’s Begin with a Grin (BWAG). Home visits were conducted by a CHIP community health nurse and a pediatric nurse practitioner who provided the primary caregiver with anticipatory guidance regarding oral hygiene, nutrition, and eliminating habits that are known to contribute to tooth decay. The child also received an application of fluoride varnish by the nurse.
Observational study with a comparison group. N=1,375 for children enrolled in CHIP’s BWAG over a six-year period (September 2008-September 2014). N=1,050 for children who did not participate in the program.
Healthcare Cost, Utilization & Value: 57% of the sample participated in BWAG and received more documented fluoride treatments than those in Medicaid alone (1.17 vs 0.08, p<0.0001) and had more visits with a dentist outside of the BWAG program (0.92 vs 0.22, p<0.0001). Study authors conclude that “the CHIP BWAG home visitation program is an effective way to increase the exposure of young children to preventive dental care.”
Mother-child pairs in a socioeconomically disadvantaged community of Sao Leopoldo, Brazil. In the intervention arm, home visits took place monthly for up to six months, and at eight, 10, and 12 months.
A general nutritional program advising mothers on healthy eating during the child’s first year of life.
Randomized controlled trial. N =141 children received home visits and N=199 children in the comparison group.
Health: The primary outcome measure was the occurrence of early childhood caries (ECCs) at four years of age. At study end, 54% of the intervention arm had developed ECCs compared to 69% in the control arm; the incidence of caries was reduced by 22% (relative risk [RR]=0.78; 95% CI: 0.65-0.93). Nutritional education delivered in the home setting during the first year of life reduced the incidence of ECCs at four years of age.
Populations in the U.S., U.K., Brazil, Iran, Belgium, Australia, and India.
Integrating oral health education into services already being delivered to expecting mothers and children five years and younger.
Systematic review. Nineteen studies were reviewed, including eight incorporating home visits.
Health: Of the five studies where the incidence of tooth decay was an outcome, three demonstrated a positive impact (tooth decay reduced). The review authors concluded, “incorporating oral health promotion into nursing practice is a promising initiative for reducing oral health disparities by reducing tooth decay and promoting increased access to dental care, especially amongst the poor disadvantaged communities.”
Populations in Canada, United States, Brazil, Ireland, and Iran.
Maternal oral health programs administered during the antenatal or postnatal period, specifically by non-dental health professionals, with the primary objective of reducing tooth decay.
Systematic review. Nine studies were conducted (two in Canada, three in the United States, two in Brazil, and one each in Ireland and Iran).
Health: Three studies included home visits for one-to-one preventive advice. The types of oral health interventions administered in the studies to address tooth decay varied, but all included a component of preventative education. The study concluded that comprehensive interventions that include face-to-face counselling sessions can result in 1.5 times increased likelihood of being free of tooth decay. The demonstrated improvements in oral health outcomes were sustained through referrals, follow-up, and reminders.
Socioeconomically disadvantaged families in high-, middle-, and low-income countries.
Interventions with pregnant women, new mothers, and other primary caregivers for preventing tooth decay.
Systematic review. The review included 17 randomized controlled trials comprised of 23,732 caregivers (primarily mothers) and their children.
Health: In studies that characterized the impact of child-centered nutritional advice versus standard of care, authors observed a probable 15% reduced risk of tooth decay (RR=0.85, 95% CI: 0.75-0.97; three trials; 782 participants; moderate-certainty evidence), and a potential lower incidence of decayed, missing, or filled primary surfaces score (two trials; 757 participants; low-certainty evidence). The authors conclude that “providing advice on diet and feeding to pregnant women, mothers, or other caregivers with children up to the age of one year probably leads to a slightly reduced risk of tooth decay in their children during their early years.”
[1] American Dental Association. (2004). State and community models for improving access to dental care for the underserved—A white paper. https://govinfo.library.unt.edu/chc/recommendations/orgs/ada_att3.pdf.
[2] World Health Organization. (2025, March, 17). Oral Health. https://www.who.int/news-room/fact-sheets/detail/oral-health.
[3] Centers for Disease Control and Prevention. (2024, May 15). About Cavities (Tooth Decay). https://www.cdc.gov/oral-health/about/cavities-tooth-decay.html
[4] Hoeft KS, Rios SM, Pantoja Guzman E, Barker JC. (2015). Using community participation to assess acceptability of "Contra Caries", a theory-based, promotora-led oral health education program for rural Latino parents: a mixed methods study. BMC Oral Health, 15:103.
[5] Institute of Medicine. (2011). Improving Access to Oral Health Care for Vulnerable and Underserved Populations. https://nap.nationalacademies.org/catalog/13116/improving-access-to-oral-health-care-for-vulnerable-and-underserved-populations
[6] American Academy of Pediatric Dentistry. (2025). Policy on early childhood caries (ECC): Consequences and preventive strategies. https://www.aapd.org/globalassets/media/policies_guidelines/p_eccconsequences.pdf
[7] Centers for Disease Control and Prevention. (2024, May, 15). Health Disparities in Oral Health. https://www.cdc.gov/oral-health/health-equity/
[8] Pew Charitable Trusts. (2022, March 11). Inequitable access to oral health care continues to harm children of color. https://www.pew.org/en/research-and-analysis/articles/2022/03/11/inequitable-access-to-oral-health-care-continues-to-harm-children-of-color
[9] Society for Research in Child Development. (2018, December 31). Disparities in the quality of pediatric dental care: New research and recommended changes. https://www.srcd.org/research/disparities-quality-pediatric-dental-care-new-research-and-recommended-changes
[10] Skeie, M. S., & Klock, K. S. (2018). Dental caries prevention strategies among children and adolescents with immigrant - or low socioeconomic backgrounds- do they work? A systematic review. BMC oral health, 18(20). https://doi.org/10.1186/s12903-018-0478-6
[11] Edelstein BL, Basch CE, Zybert P, Wolf RL, Custodio-Lumsden CL, Levine J, et al. (2025). Chronic Disease Management of Early Childhood Dental Caries: Practices of US Pediatric Dentists. Prev Chronic Dis, 22. doi: http://dx.doi.org/10.5888/pcd22.240151
[12] Plonka KA, Pukallus ML, Barnett A, et al. (2013). A controlled, longitudinal study of home visits compared to telephone contacts to prevent early childhood caries. Int J Paediatr Dent., 23(1):23-31.
[13] George A, Sousa MS, Kong AC, et al. (2019). Effectiveness of preventive dental programs offered to mothers by non-dental professionals to control early childhood dental caries: a review. BMC Oral Health, 19(1):172. https://pubmed.ncbi.nlm.nih.gov/31375106/
[14] Lumsden CL, Edelstein BL, Leu CS, Zhang J, Levine J, Andrews H. (2024). Behavioral Outcomes of a Pragmatic Early Childhood Caries Management Trial. JDR Clin Trans Res, 9(2):140-149. https://pubmed.ncbi.nlm.nih.gov/37553996/
[15] Brickhouse TH, Haldiman RR, Evani B. (2013). The impact of a home visiting program on children's utilization of dental services. Pediatrics, 132 Suppl 2(Suppl 2):S147-S152.
[16] Mariani M, Velazquez L, Kattlove J. (2016). Healthy Mouth, Healthy Start: Improving Oral Health for Young Children and Families through Early Childhood Home Visiting. The Children’s Partnership. childrenspartnership.org/research/healthy-mouth-healthy-start-improving-oral-health-young-children-families-early-childhood-home-visiting/
