Tioga Mobile Dental Services

State: NY Type: Model Practice Year: 2006

The goal of the practice is to ensure access to and delivery of quality preventive and restorative dental care for the low-income and Medicaid population. Objectives of this program include: Reduce the proportion of children and adolescents with untreated decay Reduce the proportion of children who have dental caries in their primary or permanent teeth by use of sealants and fluoride supplements Increase the proportion of children who have received dental sealants on their molars Decrease periodontal disease  Increase the proportion of children and adults who access the oral health system each year  Increase the proportion of low-income children and adults who access the oral health system each year  The public health issue that this program addresses is access to dental care for the low-income population and the rate of dental decay.The target population consisted of low-income, Medicaid, and those without a dental home. The first patients were seen in December of 2003. The program became the dental home for over 2,000 low-income patients through the School-Based Dental Clinic and Article 28 dental clinic.
The mobile dental program addresses not only the dental needs of Tioga County but also transportation issues. The mobile dental program is comprised of a 53-foot long tractor-trailer outfitted with two fully equipped dental chairs. During the school year the dental van travels to Tioga County’s schools serving students during school hours and the community before and after school hours. For the summer months, the dental van is centrally located at a community center. Depending on the dental van schedule, it can be easily accessed to the entire county. In addition to community access, the mobile dental van provides dental care to the low-income population through the School-Based Dental Clinic and Article 28 dental clinic. Children that would have gone without dental care due to transportation, insurance or financial barriers now have the dental office come to them. The mobile dental program’s School-Based Dental Clinic is available for students without a dental home regardless of insurance or lack of insurance. Students are scheduled for half-hour appointments and receive a dental exam, prophy, fluoride treatment, radiographs and if needed, restorative care including fillings. The Article 28 dental clinic is available to the community when the dental van is not serving school students. The Article 28 clinic accepts all insurances and utilizes a sliding fee scale for Article 28 visits. This practice can be viewed as innovative right from the start. A collaboration of efforts between the Tioga County Health Department and the Rural Economic Area Partnership (REAP) helped to secure the funding. The Small Cities Block Grant was an untraditional funding source for a dental program. The concept of a dental office with wheels is extraordinary but to operate it has both a School-Based Dental Clinic and an Article 28 Dental Clinic is what makes it truly unique. Regulations that were typically followed in reference to fixed dental clinics, were difficult to apply to the mobile dental office. A State Environmental Quality Review had to be completed. Topics such as disposal of waste water, division of clean and dirty areas in a small sterilization room, access to a bathroom for staff and patients, access to a phone and barriers to billing were a few of the issues to be overcome. Other dental programs were primarily limited to preventative services and did not bill insurances. This practice intends to be self-sustaining and relies on the ability to bill. To do so the practice had to be designated as an Article 28 Clinic and to serve the school students, it also had to be a School-Based Dental Clinic. These designations also brought regulations, which had to be applied to a unique project.
Agency Community RolesThe Tioga County Health Department sponsors the Mobile Dental Program. In the implantation phase of this practice, the Tioga County Health Department worked closely with the Rural Economic Area Planning (REAP) organization in securing funding. REAP was also looking to address the lack of dental care in Tioga County was wanting to secure a Small Cities Block Grant. A Dental Steering Committee comprised of county residents, business owners and local county officials, was key to early planning and decisions. Community partners from multiple disciplines play an important role on the Quality Assurance/Record Review Committee and on the Medical Advisory Committee. The Mobile Dental Program also works with local medical offices and other agencies in providing information on oral health and the services of the dental van. Tioga County schools provide hook-ups for the dental van, which includes electric, water and waste water disposal. The Mobile Dental Program works closely with Tioga County Headstart to provide students with a dental exam, prophy and fluoride treatment. The Office for the Aging has provided hook-ups at their community center for community access, including senior citizens. ImplementationIn 1998 and again in 2003, Tioga County was designated by HRSA as a Dental Health Professional Shortage Area. In response to this and the high rate of dental carries in children, the Tioga County Health Department collaborated with local efforts to develop possible methods to address the situation. The primary goal was to link the population with needed dental care. The Tioga County Health Department examined all possible options and sought assistance from community dentists. Local dentists felt there was a tremendous need but could not help due to current practice sizes. The original plan was to have a fixed dental clinic. However, due to the ruralness of the county, transportation was seen as a barrier. Thus, the idea of a mobile dental clinic that would travel throughout the county was conceived. The first three years of the grant involved the design and building of the dental unit, policy and procedure development and recruitment of dental staff. To help decorate the exterior of the dental office, a contest took place at the local schools. The final design includes graphics of children and a child’s drawing of a toothbrush along with the motto, “We travel miles to Bring Bright Smiles”. Following a New York State Health Department (NYSDOH) inspection a Temporary Emergency Certificate of Need was granted dated November 24, 2003. Staff of the mobile dental office began patient appointments that following month of December 2003. The final NYSDOH approval and the additional clinic sites were added to the Health Departments Operating Certificate approximately one year after opening, which allowed the program to bill for services and cover costs.
Goal: To increase access to and delivery of quality preventive and restorative dental care for the population of Tioga County. Objective: Increase the proportion of low-income children and adults who access the oral health system: Performance measures: 50% or more of clients served will be NYS Health Insurance recipients or no fee clients.  Data collection: 1) patients of the dental van who are recipients of Medicaid/SFS. All Article 28 clients are asked to state their income; 2) dental Staff; and 3) dental software. Outcomes: Of 3,510 clients served in 2005, 2,208 (62%) were Medicaid, CHIP or no pay. Objective: Increase the proportion of children who have received dental sealants: Performance measures: 20 % or more of the students served receive dental sealants; percentage based on application to molars usually occurring in grades 2 and 6.  Data collection: 1) number children receiving dental sealants; 2) dental Staff; and 3) dental Software/Sealant tally sheets. Outcomes: 563 (53%) students received sealants for a total of 1652 sealants applied; This is a first year of service figure. The percentage should drop over time. Objective: Reduce the proportion of children and adolescents with untreated decay: Performance measures: 90% of SBHCP students needing restorative care will receive restorative care.  Data collection: 1) children receiving restorative care; 2) dental staff; and 3) dental software. Outcomes: In 2005, SBHCP students received 1,003 fillings and 134 extractions.
The mobile dental program submits claims to Medicaid and third party insurances. The Tioga County Legislature strongly supports the dental program and will provide financial support if needed. Community stakeholders such as the schools and Office for the Aging are vested into the program by providing the electrical, water and septic hook-ups. Other stakeholders help to perpetuate the practice by dispersing our information and referring clients to the dental van.