When nurses think of chronic diseases in children, many come to mind such as asthma, childhood obesity, and diabetes; however, dental caries is the most common chronic disease in children. Although it is highly preventable, it is about five times as common as asthma. According to the American Academy of Pediatric Dentistry, early childhood caries can affect speech, nutrition, sleeping, learning, playing, and quality of life, extending into adulthood. Satcher and Nottingham (American Journal of Public Health, 2017) note that this issue has remained as relevant as it was when the U.S. Surgeon General's landmark report, Oral Health in America, was first published in 2000 with the recommendation that efforts to ameliorate the problem should be accelerated. The nursing profession has a responsibility to increase the oral health knowledge of its workforce to help minimize the incidence of this preventable chronic disease among children.

As active members of the health care community in Flint, Michigan, we have noted concern regarding children's oral health. For example, according to the American Academy of Pediatrics, in 2011 a majority of eight-to-nine-year-old schoolchildren in Flint had fillings and decayed first molars. The 2014 Flint water crisis added to the dilemma, as residents of Flint were forced to drink nonfluoridated bottled water, further compromising the oral health of children. The perceived lack of communication between elected officials and residents led to a loss of confidence in local government, and many people today continue to drink bottled water. Add to this the fact that the Flint community has a 40% poverty rate and 52% of its citizens are African American, and the risk of health disparities and dental caries formation further increases. Access to oral health care remains a complex issue that disproportionately affects minorities and those living in poverty.

Nurses are in a unique position to offer preventative oral health information to patients, families, and caregivers and can help further reduce oral health disparities among children. For instance, nurses in acute and primary care, public/community health, childcare settings like Head Start, schools, and other child-focused venues are in an ideal position to be strong advocates of oral health in children. Some ways to accomplish oral health wellness may be to prioritize oral health exams in practice regardless of the setting, participate in oral health screening clinics, coordinate with dental hygiene programs to create oral health fairs, and develop educational programs and activities with community partners such as local school districts and health departments.

One of the most commonly reported barriers to implementing oral health education in children and their families is inadequate training of nursing students during the formal education process. The paucity of content within undergraduate nursing curricula regarding children's oral health does not support application in practice. One reason for the lack of emphasis on oral health issues in nursing education as well as in practice is the assumption that the oral cavity is the responsibility of the dental professional and not that of all health care providers. This disconnect leads to a lack of accountability in practice for children's oral health and its effects on a child's overall well-being. The development of nursing values and attitudes that support the oral health of children needs to begin in the academic setting in order to encourage a positive change in nursing practice.

It is imperative that nurse educators accept the call to action to include children's oral health when covering chronic diseases. Policies, procedures, and expectations of practice need to be verbalized and delineated in order for hospitals, public health organizations, and schools to understand that a basic expectation of assessment and intervention includes inspection of the oral cavity in children followed by appropriate action. Ultimately, nurses must have the knowledge to perform basic oral health assessments and provide accurate education in order to support truly holistic nursing practice.