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mother and child meeting with doctor
A health provider meeting with a parent and child during a well-child visit discuss oral health.

Oral health is integral to overall health, and public impact research has shown far too many people in Hawaiʻi are not able to access necessary oral health care. A report from the Hawaiʻi State Department of Health released in 2022 found that Hawaiʻi’s low-income preschool students have the highest prevalence of dental decay in the nation.The consequences of poor oral health affect the entire body, and many oral health conditions are preventable and can reduce expensive emergency room visits.

A University of Hawaiʻi at Mānoa associate professor from the Nancy Atmospera-Walch School of Nursing (NAWSON) has developed an oral health toolkit to teach nurses, doctors and healthcare students how to effectively integrate oral health into their practice. This project is a collaboration between the Hawaiʻi State Department of Health (HIDOH) Family Health Services Division and NAWSON.

deborah mattheus headshot
Deborah Mattheus

“The integration of oral health into pediatric primary care practice is one substantial and economical way to reduce the bad oral health outcomes and improve overall health and quality of life for our island residents,” said Deborah Mattheus, project lead and NAWSON’s Professor in School Health. “As a practicing APRN (nurse practitioner), I see kids in the clinic all the time who have poor oral hygiene. We have a great opportunity to proactively take care of their teeth as part of their well-child visit. This will set up these kids for good dental hygiene as they get older.”

Mattheus, who is also the Hawaiʻi Keiki: Healthy & Ready to Learn senior practice director and dental sealant program director, said young children are seen by primary care providers (pediatricians and nurse practitioners) more often than dentists, with an average of 12 recommended pediatric well-child visits in the first three years, and annually between three to 21 years.

“Every primary care visit is an opportunity to assess oral health status, provide oral health education, connect families to a dental home and when appropriate, apply fluoride varnish,” she said.

Toolkit development and training

The project funded by the HIDOH was titled Oral Health into Primary Care Practice: Oral Health Essential Services in a Well Child Visit and consisted of the creation of a training video and promotional toolkit, and dissemination of content to a national audience.

The toolkit includes: 1) a video and handout on steps to applying fluoride varnish; 2) visual examples of early childhood caries (cavities); 3) template for medical charting; and 4) fluoride varnish factsheet for families.

Local actors were used in the video with content customized for a Hawaiʻi audience. Feedback on the content was solicited from HIDOH, community partners, Hawaiʻi Oral Health Coalition members, Harvard University’s Center for Integration of Primary Care and Oral Health leadership, UH faculty, dentist, doctors and nurses. Watch the video here.

In May 2022, Mattheus provided training on oral health assessment and fluoride varnish application to Doctor of Nursing Practice (DNP) students at NAWSON. Mattheus has shared the toolkit with other Hawaiʻi nursing/medicine programs with requests being made to schedule workshops starting in the fall 2022 semester. She is working with these programs to integrate oral health into their curriculum.

National distribution

The video and toolkit were distributed to the American Academy of Pediatrics Hawaiʻi Chapter, Hawaiʻi Primary Care Association, National Association of Pediatric Nurses and Practitioners Hawaiʻi Chapter, Hawaiʻi American Nurses Association, Hawaiʻi Oral Health Coalition and Hawaiʻi Dental Service.

The toolkit also reached the continental U.S. and was distributed by the Academy of Pediatrics Section on Oral Health, Harvard University’s Center for Integration of Primary Care and Oral Health, Oral Health Progress and Equity Network, and Oral Health Nursing Education and Practice.

Mattheus has been invited to present the keynote address at the National Maternal and Child Oral Health Resource Center Oral Health Learning Cafe Webinar in November 2022.

For more information about the project or to request the video and toolkit, contact Mattheus at

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