Henderson County Department of Public Health - Preventive Dental Health Program

State: NC Type: Model Practice Year: 2008

The most recent community health assessments from 2003 and 2007 listed dental health issues as a particular priority. Concerns about dental health access for low-income children and adults have been ongoing for many years. Families face many obstacles in trying to obtain dental care for their children. Many families receive NC Medicaid, but finding private dentists who accept that reimbursement method is very difficult. Some families must travel to Asheville, which is more than 30 miles away, in order to receive dental treatment. This poses a difficulty for many due to transportation challenges. Henderson County does have a rural health clinic with a dental clinic, but the clinic does not see children younger than three years old, and it can be difficult for patients to get timely appointments. Henderson County’s goal is to prevent tooth decay in children and to improve access to care. The goals for 2007-08, which are the most accurate available, include: 600 children will receive dental screenings. 300 children will receive fluoride varnish applications. 40 children will receive dental treatment. 30 teachers/directors will be impacted by health/safety training consultation. 400 children will be impacted by health/safety training consultation.
The Preventive Dental program addresses untreated dental decay and limited access to dental care for children in Henderson County. The community health assessments of 2003 and 2007 both listed dental health issues as a particular priority. In 1998, the local Smart Start board established dental decay prevention through fluoride varnish and education and access to dental care as some of their priority initiatives. In 1999-2000, 23 percent of Henderson County children entering kindergarten exhibited dental disease. Concerns about dental access for low-income children have been ongoing for many years. Many families received NC Medicaid but were unable to find dentists who would accept it. Some families had to make the 45-minute drive to Asheville in order to receive dental treatment. Henderson County does have a rural health clinic, which offers a dental clinic; however, it is often difficult to get a timely appointment. Parents, medical providers, and many others in the community were frustrated that the dental issues facing children were not being met. In May 1999, the Preventive Dental program began. The Preventive Dental program addresses the issues through three approaches: Fluoride varnish: Henderson County organized its fluoride varnish program by means of the WIC nutrition program. WIC was the ideal mechanism for children to receive their fluoride varnish treatments during their regular six-month recertification visits. Using this model, parents would not have to make a special appointment for fluoride varnish; the applications simply would take place while the child was at his or her WIC visit. Tooth Time dental education: Tooth Time is a dental health curriculum for preschool children ages two to five. Tooth Time was developed especially for daycare and preschool teachers to use in the classroom. The kits provide fun and easy-to-use dental education materials. The lesson plans contain interactive activities using materials that are developmentally and age appropriate. There are also resources to send home to parents to help reinforce the dental health lessons. Dental screening and treatment: The dental screening and treatment program has been operating since January 2002. Through the program, the public health dental hygienist provides dental screening in daycare centers and homes for children ages three to five. When a child is identified as needing dental treatment, the hygienist works with a patient navigator to find appropriate dental care for the child. The navigator is helpful in assisting families in finding dental care, making appointments, helping to obtain transportation, helping parents understand how important it is not to miss appointments and to arrive on time for dental care. The navigator is also bilingual, which is necessary for working with Henderson County's Latino population. For children who do not receive NC Medicaid, the "Smart Smiles” program provides dental treatment to children at no cost to the family. The hygienist refers these children to one of 11 participating area private dentists. The program reimburses the dentists for the dental treatment.
Agency Community RolesThe Henderson County Department of Public Health administers the Preventive Dental program and gives much support through supervision, financial reporting, staff time, office space, postage, copies, insurance, and donated FL-V services. The health department staff from the WIC Nutrition program and clinical staff support the Preventive Dental Program through their participation in the fluoride varnish component of the program. Key staff attend fluoride varnish Quality Assurance meetings each quarter. Smart Start requires quarterly reports to monitor the program for quality and compliance. The private dentists are updated annually on changes or new information via a newsletter. The hygienist is also in regular contact with the private dentists while children are undergoing treatment. The hygienist also stays in contact with daycare centers and homes with phone calls, annual letters, and periodic newsletter articles. Many agencies and community partners are involved in the Preventive Dental program. Some of the most important include: Child Care Resource & Referral – They promote dental trainings for childcare staff. They are instrumental in helping the hygienist to gain access to childcare homes and centers. They keep the hygienist up to date with new homes and centers, contact information, as well as new teachers/directors, etc. Childcare centers and homes – Work with the hygienist to gain parental approval for screenings, they provide access to children in the childcare setting for dental education and screening. They also cooperate in setting up staff trainings for dental education. WIC Nutrition Program – Identifies children for the fluoride varnish program and provides education and counseling to families enrolled in the program. Dental Providers – They have agreed to see children ages 3-5 who are referred through the Preventive Dental program. These include: Private dentists, Buncombe County Health Department Dental Clinic, Stokes Dental Clinic at Blue Ridge Community Health Services, and Carolina Dental Center in Asheville. Costs and ExpendituresThe current budget for 2007-08 includes: Salaries for a full-time dental hygienist and a part-time dental patient navigator; office supplies; Service-related supplies; Travel; Treatment costs. The total annual budget for the Preventive Dental Health Program is $87,900. The cash & in-kind contributions included: Administrative oversight, supervision, financial reporting, and staff time; Office space; Postage, Copies, donated FL-V services; Insurance. The total annual cash & in-kind contributions: $22,099. ImplementationThe Preventive Dental program concentrates on prevention and dental treatment with three focus areas: (a) fluoride varnish; (b) Tooth Time dental education; and (c) dental screening and treatment. The combination of these three elements provides a comprehensive dental program for preschoolers in Henderson County. a) Fluoride varnish - This is a preventive program that provides fluoride varnish treatments to very young children who are at high risk for dental decay, starting at six months old. Fluoride varnish is applied to children's teeth every six months until age three-and-a-half. The WIC nutrition program and the medical clinic in the Henderson County Department of Public Health administer this program. Fluoride varnish consists of a three-part appointment that includes both the child and the parent. At each appointment, the parent receives dental education, while the child receives a brief dental screening and the fluoride varnish application. All of these interventions provide opportunities for the parents to understand the importance of good dental preventive practices. b) Tooth Time - This educational component focuses on children ages two through five years old who are in daycare centers and homes. The hygienist targets Tooth Time education to daycares center/homes with lower than optimal star ratings. (The NC star system offers parents a simple way to understand the quality of their child’s daycare center/home.) Daycare teachers receive training in a hands-on dental curriculum using educational resource kits. The training enables them to provide ongoing dental education in the daycare centers. Parents are also given information so they can reinforce good dental hygiene practices at home. c) Dental Screening and Treatment - In this component, the public health dental hygienist provides dental screening in daycare centers and homes on children who are three to five years old. Children identified as needing dental care are referred to a dentist. Children without MC Medicaid may receive treatment at no cost to the parents. The hygienist or the patient navigator assists all parents in finding dental care for their children. It is very difficult for some parents to find regular dental care for children who are on NC Medicaid. The navigator is able to help with finding a dentist, make appointments, interpret, or arrange transportation for many of the children whose parents may otherwise be unable to figure out the complicated dental system. If children need dental care, but are not covered by NC Medicaid, the hygienist places them in the “Smart Smiles” program. The "Smart Smiles” program provides dental treatment to children at no cost to the family. The hygienist refers these children to one of 11 participating area private dentists. The program reimburses the dentists for the dental treatment they provide. Each area of this program is carried out throughout the fiscal year. (July 1-June 30).
FY 2006-07 data are the most accurate outcomes available; the following outcomes were achieved: 615 children received dental screenings. 288 children received fluoride varnish applications. 75 children received dental treatment. 34 teachers/directors were impacted by health safety training/consultation. 765 children were impacted by health/safety training, consultation.
The Henderson County Department of Public Health and Henderson County Smart Start strongly support this program. Results have been seen every year since the program began. Tooth Time: This component could operate without Smart Start funding on a limited basis. The Tooth Time curriculum is easily available, and the Tooth Time kits contain many items, such as books and puzzles, that would be accessible to the daycare centers. Since there is such positive feedback from daycare teachers about Tooth Time, the program would continue to be used in the county. The health department's Health Education Section would continue to make the Tooth Time kits available to daycare centers and homes. Fluoride varnish: This program could also continue to operate without Smart Start funding. The Preventive Dental program provides very few materials for this program, and those materials could easily be obtained by the health department through some of the Medicaid fluoride varnish reimbursement monies. The health department already donates this service to parents who do not receive NC Medicaid. The hygienist provides the necessary training the nurses require, but they could attend off-site trainings to gain this certification. The hygienist also collects data for the program, but that portion could be suspended if necessary. Dental Screening and Treatment : This portion of the Preventive Dental program would probably not continue to operate at the present level if Smart Start funding ended. The dental hygienist is needed to perform screenings, and the patient navigator is necessary to assist parents in finding dental care. Since area dentists and community leaders have given support for the program, many would work to find a way for the program to continue. The Preventive Dental program has been operating since 1999. Program funding has been renewed for the past eight years. The Henderson County Department of Public Health feels confident that, because of the success of the program, the program will continue to be funded. Medicaid revenues, while limited, could also be used to help maintain parts of the program.