Medicaid data shows that few one- to two-year-olds receive a preventive dental visit, indicating our limited success implementing the existing policy paradigm of dental home establishment by 12 months of age. Few pediatricians refer children for early dental care, few dentists are comfortable seeing children younger than two-years-old, fewer still provide restorative care, and many dentists do not accept Medicaid insurance. These realities mandate new strategies to meet the needs of children and families and effectively tackle early childhood caries (ECC). Primary care medical providers have frequent contact with families, providing opportunities to incorporate oral health promotion and prevention in non-dental settings. Components of such an approach include: screening; risk assessment; oral health counseling; fluoride varnish application; successful referral for children needing intense intervention; policy support; and financial incentives to sustain change. Current research indicates that oral health counseling, particularly motivational interviewing, and fluoride varnish applied in the non-dental setting positively affect patient outcomes. Cost savings may only be realized if ECC prevention programs use: support professionals; integrative disease management; and innovative insurance structures. The purpose of this paper was to examine the evidence for the effectiveness of the provision of oral health preventive services in the primary care setting.