Original Publication
Open Access

Protecting All Children's Teeth (PACT): Special Needs

Published: January 20, 2014 | 10.15766/mep_2374-8265.9680

Included in this publication:

  • Instructor's Guide.doc
  • PACT-Special Needs.ppt

To view all publication components, extract (i.e., unzip) them from the downloaded .zip file.

Editor's Note: This publication predates our implementation of the Educational Summary Report in 2016 and thus displays a different format than newer publications.


Protecting All Children's Teeth (PACT) was created by the AAP Oral Health Initiative to educate medical students, residents, pediatric primary care providers, and others interested in infant, child, and adolescent health about the importance of oral health in overall health. The curriculum provides in depth coverage of child oral health, oral health guidance, and preventive care to increase comfort in recognizing dental disease and conditions and communicate with dental professionals. The 13 modules of the PACT training program comprehensively address oral health promotion, disease prevention, diagnosis, and treatment of oral health disease in children.

Approximately 18% of US children and youth have a special health care need. Many of these conditions, including mental retardation, developmental disabilities, cerebral palsy, craniofacial abnormalities, and seizure disorders, can impact a child’s oral health. By understanding the potential barriers to oral health care and the consequences of poor oral health in children with special health care needs, health professionals can identify at-risk patients early, provide anticipatory guidance, refer to appropriate dental professionals, and assist patients and families in overcoming barriers to accessing and utilizing care.

The PACT Oral Health Curriculum has been in use since 2007 by physicians in training at the medical school and residency levels, as well as those in clinical practice. The content has been used by Pediatric, Family Medicine and Emergency Medicine physician training programs, as well as by Physician Assistants, Nurse Practitioners, Nurses, Dentists and Dental Hygienists in training and in clinical practice.

Educational Objectives

  1. Recall that dental care is the most common unmet need among the special needs population.
  2. List barriers to accessing dental care.
  3. State reasons why children with special health care needs are at increased risk for caries.
  4. Complete the oral health examination checklist at routine visits.
  5. Assist families in addressing oral hygiene concerns and suggest techniques for optimizing oral care in children with special needs.
  6. Discuss appropriate timing of referral to a pediatric dentist and list conditions that mandate early referral.

As this presentation is part of a complete oral health curriculum, educators and learners are encouraged to view the additional 12 courses in power-point or on-line format. The learning objectives of the entire PACT curriculum are as follows. Specific objectives are contained within each course.

Upon completion of this training, participants should be able to:

  1. Cite the structures of the mouth, their locations and nomenclature, and distinguish between normal and abnormal oral anatomy.
  2. Provide anticipatory guidance to families regarding dental development, teething, oral hygiene, dietary practices, and Early Childhood Caries prevention strategies.
  3. Assess dental caries risk in young children and discuss referral options for high-risk patients.
  4. State the proper ages for initiating routine oral health screening and establishing a dental home.
  5. Describe the risk factors associated with Early Childhood Caries, and review the impact this chronic disease has on a child's overall health.
  6. Discuss the important role that fluoride plays in preventing dental caries, as well as fluorosis prevention strategies.
  7. Cite potential barriers to optimal oral health care and the consequences of poor oral health for patients with special health care needs.
  8. Address concerns and provide intervention strategies for unhealthy oral habits, such as nonnutritive sucking, teeth grinding (bruxism), and nail biting.
  9. Properly diagnose, manage, and triage common oral pathology, with appropriate reassurance or referral.
  10. Distinguish between acquired, congenital and developmental oral findings and recognize the oral manifestations of common systemic diseases.
  11. Describe the epidemiology and the complications and consequences of dental injury.
  12. Provide the immediate management of an injured tooth, appropriate triage, and anticipatory guidance regarding prevention.
  13. Prepare, educate, and empower adolescents to take control of their oral health as they move towards adulthood.

Author Information

  • Melinda Clark, MD: Albany Medical Center
  • David Krol: Robert Wood Johnson Foundation

None to report.

The web-design of the PACT program was funded by the AAP Oral health Initiative, with support from the Maternal and Child Health Bureau (MCHB).


Clark M, Krol D. Protecting all children's teeth (PACT): special needs. MedEdPORTAL. 2014;10:9680. https://doi.org/10.15766/mep_2374-8265.9680

This publication is co-sponsored by the American Dental Education Association.