Upload
sheila-shaw
View
212
Download
0
Embed Size (px)
Citation preview
New Opportunities for Integrating Oral Health into the Medical Setting
No Tooth Left Behind…
Joyce Starr
Massachusetts Department of Public Health
I have no relevant financial relationships with the manufacturer(s) of any commercial product(s)
and/or provider(s) of commercial services discussed in this CME activity.
Burden of Oral Disease in Massachusetts
• Tooth decay is the most common chronic disease of childhood– 42% of low income Kindergarteners
have experienced tooth decay– 26% of low income Kindergarteners
have untreated tooth decay
Oral Health Prevention Strategies
• Not everyone has access to community water fluoridation (CWF)– 140 communities (65 percent of the state’s population)
offer the health benefits of CWF
• Not everyone has access to regular professional dental care– 1.5 million (25 percent) of residents do not have dental
insurance – Just 2,152 dentists were MassHealth providers as of
7/31/11– Limitations to MassHealth dental benefits for those 21
years of age and older
Fluoride Varnish
• Prevents tooth decay by about 30 percent– Reduces disparities and the burden of dental disease
• Remineralizes early tooth decay– Eliminating/reducing dental treatment costs
Why Medical Professionals?
• Few dentists see children enrolled in MassHealth– Just 2,152 dentists were providers as of 7/31/11
• Despite recommendations that children see a dentist by 12 months of age, few dentists treat young children aged 1-3
– >50% of MA dentists see children under 3 years of age
• Primary care medical providers are seen earlier and more frequently than dentists– Children have 13 well child visits from birth to age 5
• 45 states allow medical professionals to administer the varnish
Organizations and Agencies Supporting Fluoride Varnish
• American Academy of Pediatrics• American Academy of Pediatric Dentistry• American Association of Public Health Dentistry• American Dental Association• American Public Health Association• Association of State and Territorial Dental Directors• US Centers for Disease Control and Prevention
MassHealth Child Members (0 to 21) Receiving Fluoride Varnish
SFY11: n=566,194
SFY12: n=563,247FY 2011 FY 2012
1st Quarter
Members: 0-21 years (Medical Provider)
2,338 908
Amount Paid $60,788 $23,608
Unduplicated Members: 0-21 years
(Medical Provider)
2,112 901
Amount Paid $59,912 $23,426
105 CMR 700.003(K) (April 13, 2012)
• Non-licensed individuals, authorized by a registered individual practitioner registered pursuant to 105 CMR 700.000, may administer topical fluoride varnish or comparable fluoride agent approved by the Department for topical administration to prevent dental caries, provided that:
– Non-licensed individual must successfully complete a MDPH approved training and any Department mandated refresher courses in proper administration, storage, handling, record keeping and reporting of adverse reactions;
– FV must be administered in accordance with the order of a registered individual practitioner;
– Non-licensed individual is supervised by a registered individual practitioner or his/her designee.
Medical Providers
• Who may administer fluoride varnish include:
– Physician– Physician Assistant– Nurse Practitioner– Registered Nurse– Licensed Practical Nurse– Non-Licensed Individual (Medical Assistant)
BLOCK Oral Disease Toolkit
– Oral Health 101 (CD 1)– Multi-lingual
Anticipatory Guidance (CD 2)
– A to Z Guide on Oral Health Implications of Systemic Diseases and Conditions
– Examination Room Resources
– Poster
BLOCK Trainings
• Established in 2009
• In Office or Online– ~60 minutes
• Includes information on – Oral Health 101– Caries Risk
Assessment– Fluoride Varnish
– Tools
• MassHealth reimburses BOTH medical AND dental providers to administer fluoride varnish to a member under 21 years of age who is moderate to high-risk for tooth decay
• MassHealth will reimburse a dental provider in addition to a medical provider one time per quarter to administer fluoride varnish to a member under age 21.
• Fluoride varnish costs no more than $2 per unit. MassHealth reimburses both the medical and dental provider $26 per administration.
• MassHealth requires a caries risk assessment and oral health education be provided to the member or member’s parent/guardian at the time the FV is administered.
Fluoride Varnish Reimbursement
Public Health Dental Hygienist
• January 2009/August 2010• At least 3 years experience• Medical Offices and Clinics,
Homebound, WIC, etc.• Provide all preventive dental
services• Must have dentist(s) for
referrals
• May be reimbursed directly by MassHealth
Partnering with a PHDH
• The PDHD could be a valuable resource to child health providers by reducing barriers to implementing the AAP recommendations and supporting fluoride varnish administration.
- Dental screenings - Caries Risk Assessments - Anticipatory Guidance -Oral Hygiene Instruction -Interaction with Medications -Chronic Disease Management -Proper Nutrition - Fluoride Varnish Administration - Establishing a Dental Home
ResourcesResources
• BLOCK Oral Disease Training and Toolkit• MDPH SEAL and Dental Sealants• Fluoride Varnish in the Medical Settings• Information on Community Water Fluoridation• Other Fact Sheets and Resources
• www.mass.gov/dph/oralhealth
• Public Health Dental Hygienists• www.mass.gov/dph/hcworkforcecenter
Office of Oral Health250 Washington Street
Boston, MA 02108
www.Facebook.com/mdphoralhealth