Work in Progress

What We're Learning

Our goal of optimal oral health has us focused on four important systems -- Policy, Funding, Care and Community. The DentaQuest Foundation believes that there is great opportunity for improvement and impact in the interplay of these key systems. Here are examples of how grantees are implementing this strategy.

Care

Florida Institute for Health Innovation

A study by the Florida Institute for Health Innovation (formerly known as the Florida Public Health Institute) found more than 139,000 Floridians were treated in 2012 in hospital emergency departments for oral health problems that could have been treated in a dental office or clinic or avoided with adequate prevention and primary dental care. Charges for these visits exceeded $141 million. View the State Data Fact Sheet.

Tufts University School of Dental Medicine

The Tufts School of Dental Medicine is turning attention to the interprofessional health-care model, establishing a Director of Interprofessional Education (IPE) position, funded with a grant from the DentaQuest Foundation. The School of Dental Medicine has reached out to sister schools at Tufts and to other health sciences schools and organizations in the region with an eye toward partnerships. At a symposium on IPE hosted at Tufts earlier this year, representatives of nearly a dozen Boston-area institutions met to exchange ideas and forge connections. Read Building a Better Health Care Home in Tufts Dental Magazine, Fall 2013.

Interprofessional Program at Northeastern University Bouve College of Health Sciences

The Technology, Instruction, Practice, and Service (TIPS) Program is advancing nterprofessional oral health education and collaborative practice in primary care and promoting innovative interprofessional, team-based approaches. The goal is to reduce oral health disparities across the life cycle. Read more.

National Oral Health Curriculum

The American Dental Association (ADA) has endorsed Smiles for Life, a national online oral health curriculum for primary care providers. Funded by the National Interprofessional Initiative on Oral Health (NIIOH), the free online curriculum is designed by and for primary care clinicians who want to learn about and promote oral health. Smiles for Life addresses a need among health care providers for clinical information about oral health and disease prevention, demonstrated by the 195,000 site visits -- from nurses, physicians, physician assistants, pharmacists, nutritionists, medical assistants, therapists and program administrators since it launched in 2010. In 2013, 89% of registered users completed courses for CE credit.   Learn about Smiles for Life.

Oral Health in the Patient Centered Medical Home

The Funders Oral Health Policy Group (FOHPG) commissioned the Qualis Group to study options to meet the oral health needs of the underserved population. FOHPG had identified a number of key drivers, resources and emerging models supporting a more optimal, integrated medical-dental care framework. The resulting white paper, Oral Health Integration in the Patient-Centered Medical Home Environment, explores community health center medical/dental collaboration efforts and documents four community health center case studies where steps have been taken to have the medical and dental delivery systems work more closely together to incorporate oral health in their quality improvement processes. Additional funding for the white paper was provided by the REACH Healthcare Foundation.

Community

The Los Angeles Trust for Childrens' Health /L.A. Unified School District

Dental pain is a leading reason why children miss school. In 2013, The LA Trust and its partners held two universal screening and fluoride varnish days at two elementary schools. Many more are scheduled for 2014. The 2013 screening days evaluated some 570 children with alarming results: 25 children had urgent dental issues, meaning either broken teeth or abscesses in their mouths; 50 percent of the other children had significant levels of dental decay (caries) and needed dental care within the month. School district nurses contacted parents and the children were quickly connected with resources for restorative care. Designed to minimize student time outside of the classroom, the program relies on parent volunteers and dedicated school staff guiding students through various stations in the auditorium. They are given toothbrushes and instruction from LAUSD District Nursing and UCLA Pediatric staff, an individual screening with the dentist at the front of the room, an oral hygienist-applied fluoride varnish, and finally return to class. Listen to Maryjane Puffer, Executive Director of The Los Angeles Trust, talk about building a sustainable model for this program.

Rhode Island

TeethFirst! RI partnered with Reach Out and Read RI during Children’s Dental Health Month and donated the book, Going to the Dentist, to offices of primary care providers. Using communication funds from their DentaQuest Foundation grant, TeethFirst! RI bought 4,500 books; Reach Out and Read RI contributed $2,000 to help with the cost. The book is being distributed to patients six months through 5 years at well child visits, along with a message about the importance of early oral care. Along with the books, each practice receives a letter introducing TeethFirst! and the many resources available through this initiative. A sticker on the inside cover of each book encourages parents and family members to visit the TeethFirst! website and learn more. Listen to Katy Chu and Jill Beckwith discuss why Kids Count RI decided to focus on early dental visits.

West Virginia

At the start of school in September 2013, West Virginia’s public schools from pre-kindergarten through 12th grade are focusing on oral health  Prevention is a key aspect. Registered public health dental hygienists employed through Marshall University, serving as regional oral health coordinators are providing oral health education training, promoting good oral hygiene and helping to expand school-based dental sealant and fluoride projects. They are also working with local water systems on fluoridation. Read more.

Pennsylvania

The Importance of Access to and Utilization of Oral Health Care in Pennsylvania, a report by the Pennsylvania Association of Community Health Centers, summarizes the current state of oral health in Pennsylvania and makes recommendations for improvement. Among the proposed improvements are educating communities on the importance of oral health care, training medical and dental providers, increasing access to fluoridated water, increasing application of fluoride varnish by medical professionals, increasing reimbursement for oral health services, and permitting dental providers to work at the top of their licensure scope. This multi-pronged approach will address the fundamental problem of acess to oral health care for Pennsylvanians, and particularly for vulnerable Pennsylvanians.

North Dakota Tribes Come Together For the First Time To Address Access to Oral Care

It was a first and exceeded the organizers' expectations. Representatives from all the state's tribal communities -- the Manda, Hidatsa, the Arikara Nations, Spirit Lake Nation, Turtle Mountain Band of the Chippewa Indians, Standing Rock Sioux Nation and Trenton Indian Services Area were there. This powerful convening in North Dakota considered oral health for their communities and shared information and concepts for improvements and was the culmination of work by the North Dakota Oral Health 2014 grantee, spearheaded by the North Dakota Department of Public Health. "Each Reservation sent a diverse group of organizations to participate in the workshop," said grant manager Bobbie WIll. "They discovered through our workshop how they can work together to improve oral health education and prevention. It was beautiful to see plans form for collaboration to move oral health forward when they return to their reservations." The final report, including presentations and learnings, can be found here.

Arizona Tribal Leaders Commit to Improving Oral Health

Native Americans are among the most underserved populations in Arizona in terms of oral health care and are disproportionately impacted by oral disease. Tribal leaders and others concerned with the health of American Indians living in Arizona came together in 2010 to address this issue. The Arizona Dental Foundation, an Oral Health 2014 grantee, convened a series of regional Tribal Leaders' Round Tables at which creating a statewide American Indian Oral Health Coalition was identified as a priority. To learn more, read the status report on the formation of a statewide coalition (2012).

HRiA Champions Community Water Fluoridation

It’s a fact, plain and simple. Fluoridated drinking water helps decrease the incidence of tooth decay resulting in better community oral health. Yet, in a report issued by the Centers for Disease Control and Prevention (CDC), three New England states – Massachusetts, Vermont, and New Hampshire – ranked among the least fluoridated in the Nation. HRiA is spearheading the Community Water Fluoridation Initiative, a public health campaign aimed at building support for fluoridation through an approach that includes both social marketing and community mobilization. Thhe initiative is developing new strategies and tools that can be used across the United States to mobilize communities in favor of community water fluoridation. Read more.

Financing

Marshfield Clinic

Family Health Center of Marshfield Clinic is making sure patients understand that oral health is an important component of their diabetes management program. As Markshfield Clinic looked at quality and care management measures for chronic diseases (diabetes, hypertension, coronary heart disease) under an ACO model, it became evident that improvement efforts were going to hit a ceiling because dentistry and oral health had not been included in the equation. Listen to Joseph Kilsdonk, AuD, MS, Director of Education talk about opportunities to improve management of chronic diseases like diabetes, hypertension and heart disease by improving oral health.

Integrating Oral Health and Primary Care

GIH convened an Issues Dialogue, entitled Returning the Mouth to the Body: Integrating Oral Health and Primary Care to further discussion amongst funders on the subject of oral health. The DentaQuest Foundation was the lead funder of the dialogue. Though highlighted as a “silent epidemic” by the U.S. Surgeon General in 2000, widespread, untreated dental disease continues to plague children and adolescents, low-income families and ethnic minorities, who experience the heaviest disease burden. The concept of coordinating and perhaps even integrating oral health into primary care, reverses the traditional divide that has separated the mouth from the whole body.

Policy

Adult Dental Benefits in Medicaid

Although states are required to provide dental benefits for children covered by Medicaid and the Children's Health Insurance Program (CHIP), there are no minimum requirements for adult dental coverage. While most states provide at least emergency dental services for adults, less than half of states provide comprehensive dental care. Earlier in 2014, the American Dental Association's (ADA) Health Policy Resources Center updated its categorization of state adult Medicaid dental programs by coverage type.  In this new categorization, 12 states offer extensive benefits to their adult members, 20 offer limited benefits, 16 offer emergency benefits, and 3 offer no benefits. In the past year, nine states have been actively reviewing Medicaid adult dental coverage. California, Colorado, and Washington restored dental benefit packages for adult enrollees. A number of other states are poised to make similar positive changes to their programs in Fiscal Year 2015 state budgets.

Colorado

In 2012, Governor Hickenlooper put oral health at the top third of the state’s winnable battles list; the Colorado legislature delivered in the 2013 legislative session. Through the collaborative work of oral health advocates around the state, including Oral Health Colorado, an Oral Health 2014 grantee, the legislature (1) added a dental benefit for all adults covered by Medicaid, including pregnant women, parents, adults without dependent children and adults with disabilities; (2) approved Medicaid expansion to increase the income eligibility for the Medicaid program to 133 percent of the Federal Poverty Level (covering an additional 160,000 adults with family incomes below $31,322 for a family of four as of January 1, 2014 and (3) eliminated the current 3-month waiting period for CHP+ that required some children to be uninsured for three months before applying for the program. And there is more: the list of Colorado's 2013 oral health wins is here. “We’re excited to see that Colorado is doing a lot of things right towards improving the oral health of citizens, especially in offering preventive care that can avert serious health problems down the road,” said Karen Cody Carlson, Oral Health Colorado (OHCO) Executive Director. Listen to Karen tell this story.

Iowa

An estimated 120,000 new adults are projected to be eligible for dental care through the Iowa Health and Wellness Plan, Iowa’s version of the Medicaid expansion, under the Affordable Care Act. That means the dental system will need to adapt. As a first step toward determining how it will need to do that, the University of Iowa’s Public Policy Center and College of Dentistry conducted a survey to investigate the current state of access to dental care in Iowa, assess capacity of the current dental safety net, and identify current gaps in the system. Read the full report here. Listen to Peter Damiano, DDS, MPH, Director of the University of Iowa Public Policy Center, discuss the work being done to assess the capacity of the private and public side of the oral health safety net.

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