In the FSM, dental caries remain one of the most unmet health needs among young children. For most of the children in Early Childhood Education (ECE), their first dental visit is through the Fluoride Varnish Program.  The reach of Fluoride Varnish Program needs to grow in all states in the FSM. In 2015, 37.8% of 1-5 years old reported to have treated with fluoride varnish, an increase from 28.3%  of 1-5 years old reported in 2014. The data reported an increase in the proportion of children 1-5 years old receiving fluoride varnish from previous year. The Public Health Dental Clinics serve the entire FSM communities. Public health nurses and support staff were trained to do oral health assessment, fluoride varnish application, education/counseling and referral to promote the integration of oral health into clinical services.  With funding support from the HRSA Oral Health Workforce Development Grant a three (3) months training program of Dental Assistants, from all the four states in the FSM, are ongoing in Pohnpei. It is hoped that those trained would be mobilized to ease the burden of shortage of dental staff and improve dental service throughout the schools and communities in the FSM States.  For pregnant women, a dental check is completed free of charge during prenatal care at the main public health clinic. Dental services are not available at the dispensaries though. There are four private dental clinics in the FSM, three (3) in Pohnpei and one (1) in Chuuk. However, access is somewhat prohibited given that in Chuuk the private clinic is only open for a week every month. The Public Health Dental Clinics, through a Memorandum of Agreement (MOA) with the Department of Education, Early Childhood Education Program, has the only established school prevention programs in the FSM.  Dental Assistants, paid by the MCH Program, along with dental nurses from the State Dental division are providing Fluoride Varnish and Dental Sealant in the schools and communities in all states in the FSM. Poor oral health literacy contributes to not seeking preventive oral health services as individuals may not understand the connection of good oral health in relation to their general health.  The limited oral health workforce also contributes to not accessing preventive care. The heightened oral health issues found in the FSM is due, in large part, to a high incidence of chewing betel nut, especially in Yap State. Betel (areca) nut chewing is often used in combination with tobacco and slaked lime (predominantly calcium hydroxide). Use of betel nut in adults is very high in the FSM, as well as most of Micronesia, and starts at a young age.  In the 2012 FSM (SAP NOMs) Substance Abuse Prevention Survey the mean age at which betel nut chewing started among chewers (12-20 years old) was 13 years old. It was also found in the same study that the proportion of betel nut chewer on Yap alone  was 80.3%. Betel nut is sold in gas stations, grocery stores, and roadside stands and can be obtained from homegrown trees.  It is easily available throughout the FSM and there is no minimum age for purchase.   Because addictive, betel nut users don’t stop chewing during pregnancy. Therefore a related finding is the high use of tobacco in pregnancy.  As part of the last grant cycle data collection, FSM tracked women who reported smoking in their last three months of pregnancy.  The findings of 0.8% in 2014 and  0.3% in 2015 respectively are quite low, but this does not assess tobacco use outside of smoking.  MCH Program intended to track and reduce not just smoking in pregnancy, but all types of tobacco usage during pregnancy. The FSM MCH Program needs to improved data collection on tobacco usage during pregnancy.  The reliability and validity of the data collected by the States and reported to the National MCH Program is still questionable.  The data reported from year to year is quite variable without any valid justification for the severe fluctuations.  The FSM National MCH Program needs to develop guidance through policies, develop common educational messages for the communities to be shared by State Programs, and strengthen its oversight role to avoid a disjointed programs. These initiatives can help produce the unity, organization and consistency that need strengthening while still allowing for some individualization on certain provisions of the program.