This paper focuses on the policy, financing, and workforce challenges that must be addressed to improve access to oral health care for young children, particularly those that are underserved at present. Until recently, little attention has been given to ensuring that the oral health needs of young children are met before they enter school. This is a serious omission, since dental problems are the most common unmet need among children. People with low incomes, minorities and immigrants, those with special health care needs, and people in rural areas have the greatest difficulty accessing care and maintaining good oral health. Needs are particularly stark among poor children. The consequences of untreated dental problems on school readiness are clear. Children with untreated dental problems experience pain and difficulty eating and sleeping, and can have trouble adjusting socially. Learning under these circumstances can be difficult. Serving more young children presents a host of challenges, as the current system of financing and delivering dental care is fragmented and inadequate even without expanding the target population. In addition to the financing and workforce challenges, this paper describes promising models of care and discusses options for policy makers seeking to improve access to oral health care for young children.