Utilizing Fluoride Varnish Utilizing Fluoride Varnish through Women, Infants, and through Women, Infants, and

Children (WIC) programChildren (WIC) program

Oral Health Florida ConferencePalm Beach Gardens, FLAugust 4th, 2009

Champions For Early Champions For Early InterventionIntervention

Healthy People 2010Healthy People 2010Objective 21Objective 21--1a.1a.

Reduce the proportion of young Reduce the proportion of young children with dental caries children with dental caries

experience in their primary teeth.experience in their primary teeth.

(Focus Is On Early Intervention)

NHANES: 33% increase in rate of NHANES: 33% increase in rate of decay among Children (2decay among Children (2--4 Years)4 Years)

Center for Disease Control. QuickStats: Percentage of Children ACenter for Disease Control. QuickStats: Percentage of Children Aged 2ged 2----4 Years Who Ever Had Caries in Primary 4 Years Who Ever Had Caries in Primary Teeth,* by Race/EthnicityTeeth,* by Race/Ethnicity†† and Sex and Sex ------ National Health and Nutrition Examination Survey, United StatesNational Health and Nutrition Examination Survey, United States, 1988, 1988----1994 and 19991994 and 1999——2004. Accessed: July 16, 2009 2004. Accessed: July 16, 2009 fromhttpfromhttp://www.cdc.gov/mmwr/preview/mmwrhtml/mm5802a3.htm ://www.cdc.gov/mmwr/preview/mmwrhtml/mm5802a3.htm

Children Aged 2 Children Aged 2 -- 4 Years Who 4 Years Who Ever Had Caries in Primary TeethEver Had Caries in Primary Teeth

Mexican American Mexican American 35%35%

NonNon--Hispanic blackHispanic black 26%26%

NonNon--Hispanic whiteHispanic white 20%20%

PPREVALENCE OF REVALENCE OF DDENTAL ENTAL DDECAYECAY

SOCIAL RISK FACTORS DECAYSOCIAL RISK FACTORS DECAY

•• Low socioLow socio--economic statuseconomic status

•• Low education/ literacy levelLow education/ literacy level

•• Racial/Ethnic MinorityRacial/Ethnic Minority

80% of dental decay occurs in 25% of children80% of dental decay occurs in 25% of children

Oral Health DisparitiesOral Health DisparitiesDespite broad improvements in AmericaDespite broad improvements in America’’s s oral health, tooth decay remains a oral health, tooth decay remains a significant problem for the nationsignificant problem for the nation’’s s childrenchildren……especially those who are poor especially those who are poor and racial/ethnic minority.and racial/ethnic minority.Though the burden of disease is greater Though the burden of disease is greater among lowamong low--income children, they are 5 income children, they are 5 times less likely to receive dental times less likely to receive dental treatment than their wealthier treatment than their wealthier counterparts.counterparts.US Department of Health and Human Services. US Department of Health and Human Services. Oral Health in America: A Report of the Surgeon GeneralOral Health in America: A Report of the Surgeon General. . Rockville, MD. US Department of Health and Human Services, NatioRockville, MD. US Department of Health and Human Services, National Institutes of Dental and Craniofacial nal Institutes of Dental and Craniofacial Research, National Institutes of Health, 2000Research, National Institutes of Health, 2000

The The ““FailingFailing”” Medicaid SystemMedicaid System

60% of poor children are Medicaid recipients.60% of poor children are Medicaid recipients.Less than 1 % of FloridaLess than 1 % of Florida’’s Medicaid budget is s Medicaid budget is spent on dental servicesspent on dental servicesLess than 1% of the 9,500 practicing dentist in Less than 1% of the 9,500 practicing dentist in Florida, are active Medicaid providersFlorida, are active Medicaid providersEstimated 2,313 children for every enrolled Estimated 2,313 children for every enrolled provider dentist provider dentist In Florida 20.1% of Medicaid eligible children In Florida 20.1% of Medicaid eligible children saw a dentist in 2006saw a dentist in 2006

The Funnel EffectThe Funnel Effect

Burden falls to providers like the County Burden falls to providers like the County Health Departments.Health Departments.Long waits, full panel of patients, revolving Long waits, full panel of patients, revolving doordoorSee children after they have a problem or See children after they have a problem or a tremendous amount of disease. Limited a tremendous amount of disease. Limited opportunity to prevent disease. opportunity to prevent disease.

RecommendationsRecommendationsCoordinated outreach and oral health education Coordinated outreach and oral health education efforts can capitalize on the participation by efforts can capitalize on the participation by many lowmany low--income families in multiple public income families in multiple public programs. *programs. *

Oral health education should be included within Oral health education should be included within prenatal and early childhood education and prenatal and early childhood education and offered synchronously with programs targeting offered synchronously with programs targeting improved nutrition.improved nutrition.

**The Henry I. Kaiser Family Foundation. The Henry I. Kaiser Family Foundation. Filling An Urgent Need: Improving ChildrenFilling An Urgent Need: Improving Children’’s Access to s Access to Dental Care in Medicaid and SCHIPDental Care in Medicaid and SCHIP. July 2008 . July 2008 http://www.kff.org/medicaid/upload/7792.pdfhttp://www.kff.org/medicaid/upload/7792.pdf

**US Department of Health and Human Services. **US Department of Health and Human Services. Oral Health in America: A Report of the Surgeon Oral Health in America: A Report of the Surgeon GeneralGeneral. Rockville, MD. US Department of Health and Human Services, Nat. Rockville, MD. US Department of Health and Human Services, National Institutes of ional Institutes of Dental and Craniofacial Research, National Institutes of Health,Dental and Craniofacial Research, National Institutes of Health, 20002000

Early Intervention Pilot Project Early Intervention Pilot Project Palm Beach CountyPalm Beach County

Best Practice Award, 2007Best Practice Award, 2007Davis Productivity Certificate of Commendation, 2008Davis Productivity Certificate of Commendation, 2008NACCHO Model Practice Award and Stipend, 2008NACCHO Model Practice Award and Stipend, 2008

Davis Productivity Sustainability Plaque, 2009 Davis Productivity Sustainability Plaque, 2009

Ultimate Goals of Early Ultimate Goals of Early InterventionIntervention

Timely Delivery of Educational Information to Timely Delivery of Educational Information to Populations at High Risk of Caries (WIC)Populations at High Risk of Caries (WIC)

Decrease Early Childhood Caries (ECC)Decrease Early Childhood Caries (ECC)

Avoid The Need For Later Surgical InterventionAvoid The Need For Later Surgical Intervention

Methods To Address ObjectiveMethods To Address Objective

Early Access to Oral Health Care (Prior to Disease Onset)Establish Dental HomeOral Health Risk Assessment (Screening of High Risk Parent-Infant Groups) Community-based, Collaborative Care EffortIdentify High Risk Patients Provide Timely Referral and Intervention

Focus Is On Early Intervention

WICWIC

Special Supplemental Nutrition Program Special Supplemental Nutrition Program for Women, Infants, and Childrenfor Women, Infants, and Children

WICWIC--Dental PartnershipDental Partnership

Oral Health Group helps to achieve WIC Oral Health Group helps to achieve WIC second nutrition education contact goalssecond nutrition education contact goals

WIC Group Education GoalsWIC Group Education Goals

Promote Nutrition and Good HealthPromote Nutrition and Good Health

Provide education to a diverse population, Provide education to a diverse population, considering ethnic, culture and geographic considering ethnic, culture and geographic preferencespreferences

Promote nutrition knowledge to achieve Promote nutrition knowledge to achieve positive food consumptionpositive food consumption

BenefitsBenefits

VISION: Champions for strong bodies with healthy smiles

MISSION: To establish a strong WIC/Dental partnership that promotes, protects, and strengthens our youngest and most vulnerable children through nutrition and oral health education with a focus on prevention.

•• Started May 8Started May 8thth 2006 2006 •• Target population : 12 Target population : 12 –– 18 18

month oldsmonth olds•• WIC Frontline and WIC Frontline and

Nutritionists promote the Oral Nutritionists promote the Oral Health GroupHealth Group

•• Parents are informed to bring Parents are informed to bring their childrentheir children

Oral Health Group

•• Children and their Children and their caregivers receive caregivers receive oral hygiene and oral hygiene and nutrition educationnutrition education

Oral Health Group

•• Children are evaluated for Children are evaluated for their risk of decay: Oral their risk of decay: Oral hygiene, diet, fluoride status hygiene, diet, fluoride status

•• Children receive Fluoride Children receive Fluoride VarnishVarnish

•• Appropriate followAppropriate follow--up care up care for atfor at--risk clients and recare risk clients and recare system for all clients (dental system for all clients (dental home) home)

Oral Health Group

Oral Health Group Oral Health Group Take Home MessagesTake Home Messages

• Teeth, including baby teeth, are essential for good general health and proper development

• Dental decay in early childhood is a serious infectious disease which is entirely preventable

• Decay develops in the presence of teeth, bacteria and sugars

• First dental visit by first birthday

Steps To SuccessSteps To Success

••Educate dental staff on early Educate dental staff on early intervention and the program; (staff intervention and the program; (staff buybuy--in)in)••Approach WIC staff concerning early Approach WIC staff concerning early intervention proposal;intervention proposal;••Develop oral health training module to Develop oral health training module to present to WIC staff;present to WIC staff;Work with WIC staff to implement Work with WIC staff to implement program.program.

Partnership for Prevention• We do not define success solely in

terms of numbers.

•The overall objective is to partner withWIC in preventing decay by providing oral health education, dental screeningsand fluoride varnish treatment for clientswho happen to be of the demographicthat is the most at risk for decay.

Financial success just happened to become a program outcome.

☺Our Target group are children12 to 18 months of age. This population of children have a higherprobability of being Medicaid eligible. Many currently have Medicaid coverage.Therefore, we are able to bill Medicaid forthe WIC-Dental Service.

BillingBilling• Medicaid Billed. No other grant or funding

source for this program.

• Exam, Fluoride Varnish, NutritionalCounseling and Oral Hygiene Instruction.

• Need to utilize code D0150when billing.

How are you compensated for the Children who do not have

Medicaid?Children who do not have Medicaid

coverage at the time of service are absorbed by the Dental program.

Parents are given guidance to obtain Florida Kidcare coverage for their children.

Program Outcomes Since Program Outcomes Since Inception in 2006Inception in 2006::

Program now operating in 4 PBCHD Program now operating in 4 PBCHD clinic locations.clinic locations.2,262 Families Educated2,262 Families Educated2,342 Children who received exams and2,342 Children who received exams andvarnishvarnish331 Children referred for treatment331 Children referred for treatment$263,875.25 Total Revenue Generated in 3$263,875.25 Total Revenue Generated in 3years. Approximately, $87,958.41annually.years. Approximately, $87,958.41annually.

Winner of 2 Davis Productivity Awards!!!Winner of 2 Davis Productivity Awards!!!

Early Intervention at itEarly Intervention at it’’s Best!s Best!Early InterventionEarly Intervention: Provides a dental home : Provides a dental home and access to care that this population of and access to care that this population of children do not have.children do not have.

Efficient use of staff timeEfficient use of staff time: Able to reach : Able to reach more families and provide a quality more families and provide a quality educational and clinical service to more educational and clinical service to more children in a shorter period of time.children in a shorter period of time.Reduction of dental clinic time. Reduction of dental clinic time.

Future Program ExpansionFuture Program Expansion

Expansion to providing more WICExpansion to providing more WIC--Dental Dental Groups per week per clinic.Groups per week per clinic.

Piloting a second WICPiloting a second WIC--Dental Recall Dental Recall Group utilizing portable dental equipment.Group utilizing portable dental equipment.

Expand to Community Based Expand to Community Based Organizations and Agencies. Organizations and Agencies.

NonNon--Dental ProvidersDental ProvidersImplementation of an Oral Health TrainingImplementation of an Oral Health TrainingModule for Health Department Medical Module for Health Department Medical Providers. Pilot currently operating inProviders. Pilot currently operating inDelray Beach Health Center.Delray Beach Health Center.

PrePre--natal and Parent Groupsnatal and Parent Groups which will which will educate the parent on the need for them to educate the parent on the need for them to care for their own oral health. Mothercare for their own oral health. Mother’’s s Oral Health linked to babyOral Health linked to baby’’s health. s health.

ExpendituresCost of Fluoride Varnish $0.25 per childCost of Fluoride Varnish $0.25 per child

Cost of Materials $1.00 per childCost of Materials $1.00 per child

Cost of Staff TimeCost of Staff TimeDMD or DDS 75.00 for 1.5 hoursDMD or DDS 75.00 for 1.5 hoursRDH 37.50 for 1.5 hoursRDH 37.50 for 1.5 hours

A Child with no DecayA Child with no Decay

Priceless!