Healthy Kids Express Dental (HKED) is a mobile dental clinic sponsored by St. Louis Children's Hospital that addresses barriers to oral health care using a multi-pronged approach that provides dental exams, treatment, and education at no cost. The van serves the community 4-5 days per week in schools, preschools, and child care settings and sees patients ranging from 3 - 21 years of age. Services include education, exams and cleanings (x-rays, prophylaxis, fluoride varnish, charting, dental oral hygiene instructions, injury prevention instructions, and parent education), and restorative treatment (local anesthetic, composites, extractions, pulpotomy, stainless steel crowns). Patients who need or want orthodontic treatment are referred to other providers. This program increases access to healthcare and health literacy for vulnerable children and adolescents by reaching children in school or childcare settings and by providing medical interpretation for children and parents with Low English Proficiency.

Tooth decay is one of the most common childhood diseases and often goes untreated due to many potential barriers, including lack of access to Medicaid providers, language, and health literacy. A thorough literature review of evidence-based practices for dental education was completed to develop an age-appropriate dental education program. The Information-Motivation-Behavioral Skills Theory was applied to create teachable moments that address brushing technique, proper nutrition, and practice personal and social motivation. This multi-component health promotion program utilizes iPad technology and cues to action in the classroom and at home to reduce anxiety and improve knowledge to prevent tooth decay in children.

The team provides a multifaceted approach to education to improve its clinical quality and increase pediatric oral health literacy to empower children to begin and continue good oral health habits. The HKED team developed an approach with the goal of oral hygiene best practices (twice daily brushing for two minutes each session, once daily flossing, and dental checkups twice yearly). The HKED team's modes of delivery include verbal instruction to patients, dental specific applications on an iPad, distribution of brushing charts (in which the patient marks in the box for morning brushing and nightly brushing to help develop a commitment of brushing two times per day in a month and visually see one's success), two-minute sand timers (so that children will know that effective brushing requires a certain amount of contact to mechanically to remove plaque and food debris from teeth), and disclosing tabs (children can check the efficacy of their brushing efforts by biting into disclosing tabs that highlight residual plaque so children can see areas missed and improve over time).

The mission of Healthy Kids Express Dental is to improve oral healthcare in children through education on the importance of regular brushing, flossing, and using fluoride as well as through restorative treatments when necessary.

During the 2014-2015 school year, children pre-Kindergarten through 7th grade saw their average score on a dental knowledge test rise from 64.7% on the pretest to 72.1% on the posttest.

During the 2014-2015 school year, children pre-Kindergarten through 7th grade receiving dental exams were tested on dental knowledge prior to their exam and were given a corresponding posttest when they were seen for necessary treatment. The number of students who received a posttest is lower than the number of students who completed a pretest. Posttests were given to children that failed their dental exam and completed their follow up restorative care exam on the dental van; some of the children who failed the dental exam were referred to outside offices and did not receive the posttest. Additionally, posttests were given to children who did not fail their dental exam at their six month checkup.

1,450 children were pre-tested and 331 children were post-tested. The average test score rose from 69.3% to 73.2% from pre to posttest. In a sample of 253 students who took both the pre and posttest, the average pretest score was 64.7% and the average posttest score was 72.1% (paired t-test, p <.001). This program is a promising strategy to increase oral health knowledge among a population vulnerable to poor oral health outcomes.

The HKED team aims to continue its clinical quality in order to create a reproducible model for other mobile health programs to assist each child's ability to effectively remove plaque from their teeth with proper brushing position, time, targeting the correct teeth, and frequency of the practice to ultimately encourage lifelong dental health.