Access to Baby and Child Dentistry (ABCD) began as an idea by Dr. Peter Milgrom and Dr. Peter Domoto, University of Washington professors of dentistry, who recognized that huge numbers of children across the state were not receiving adequate dental care and decided to do something about it. 

Starting with a pilot program in 1995 in Spokane, they developed a model in which dentists, dental societies, local health districts, the state’s Medicaid program and the UW collaborated to encourage more dental offices to serve young children.   The Pew report notes that the program began spreading across the state in 1999 when the Washington Dental Service (WDS) Foundation learned about ABCD and contributed resources to implement the program in Benton/Franklin and Yakima counties.

Today ABCD programs provide preventive care and dental services to Medicaid-insured children under age six in 33 of Washington’s 39 counties.*  In 1997, less than one in four such children saw a dentist each year.  Since then the number of Medicaid-insured children under six receiving dental care has more than doubled, and the number of children visiting the dentist before their second birthday has more than quadrupled.

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Having children teeth screened by either a physician or dentist by their first birthday is crucial.  WDS Foundation President & CEO Laura Smith says in the report, “We believe that if you can keep them from getting those first few cavities, they’re going to have better health the rest of their lives.”

Other ABCD program components that are cited by the Pew report as keys to its success include:

·        Financial incentives for dentists to perform certain preventive and restorative procedures, which encourage provider participation.

·        Training sessions for dentists that provide hands-on experience in treating very young children.

·        Local health departments that administer the program, coordinate community dental screenings and outreach events, and provide case management for the parents of children who need ABCD’s services.

·        Beginning in 2008, providing training and reimbursement for pediatricians and family physicians to provide dental health screenings, risk assessments, family education and fluoride varnish during well-child checkups.  This innovative approach is particularly promising because young children typically see a physician more than eleven times for well-child checkups before age three.


There are now more than 1,300 ABCD-trained dentists across the state, and the report notes that surveys show these dentists are three times more likely than other dentists to say they are comfortable seeing children under a year old. *


Collaboration among the many participating entities and solid policy and financial support at the state level are also cited as important factors in the program’s success.  The report lauds the cost-effectiveness of the program, noting that the state has spent only about $13.50 more per Medicaid-insured child per year in the counties with ABCD than in those without it.  That $13.50 difference is less than one-quarter of the cost Medicaid pays to restore a tooth with a cavity.


This is in addition to, “the many thousands of dollars saved each time ABCD’s mix of education and prevention saves a child from cavities that develop into infections or surgical extractions, requiring emergency-room visits and operating-room services,” the report says.


The bottom line is that the savings from avoiding expensive treatment more than covers the costs of the program.


“ABCD’s decade-long success in improving children’s dental health is a reflection of the sustained commitments and investments made by the program’s broad base of supporters,” the Pew report concludes.  “The program’s resilience is a tribute to its solid results and efficient public-private financing model.”




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WDS Foundation has invested more than $2.5 million in grants and other support for the program.

 We are thrilled to have a part in this nationally recognized effort to improve children’s oral health,” WDS Foundation President & CEO Smith said. “Preventing disease is critical. As the country moves forward with healthcare reform legislation, programs that promote prevention and early identification of disease are critical.  ABCD is an excellent example of a successful prevention program.”


About the Pew Center:  The Pew Center on the States is a division of The Pew Charitable Trusts that identifies and advances effective solutions to critical issues facing states. Pew is a nonprofit organization that applies a rigorous, analytical approach to improve public policy, inform the public and stimulate civic life.

Link to the report,

About Washington Dental Service Foundation: Washington Dental Service (WDS) Foundation, a non-profit funded by Washington Dental Service, the leading dental benefits company in Washington State, is dedicated to significant, long-lasting improvements in the oral health and overall health of Washington’s young children and seniors.  WDS Foundation works to prevent oral diseases such as tooth decay and gum disease with a focus on children and seniors.  For more information, visit:


* When the Pew report was compiled 30 counties had ABCD programs and more than 1,000 dentists had received ABCD training. The release has been updated to reflect the current numbers: 33 counties now have ABCD programs and more than 1,300 dentists have received ABCD training.