Providing Dental Care to Low Income Families Brenda Diamond, Director Ministry Dental Center

Patsy Mbughuni, Senior Planner CAP Services Inc.

CHALLENGE

AGENDA

• Culture• Barriers to Dental Care• Effects of Oral Health on Overall Health• History of Ministry Dental Center• Community Benefit

CULTURE

Culture is defined as learned behavior which has been socially aquired1

1Park K. Social sciences and medicine. Park’s textbook of preventive and social medicine. 17th ed. Jabalpur India; M/ s Banarsidas Bhanot publishers: 2002: pp 459-488.

Number of people with dental Insurance? Seen a dentist in the last 6 months for preventative

care? Children should be seen at age 2 for their first dental

exam? True or False Believe you have “soft” teeth. Want to see a dentist but cannot.

Myths Unveiled

• 65% of people who have dental insurance, utilize it annually.

• 46% with commercial insurance, have completed a yearly check up (re-care appointment). (Paid at 100%)

• On average, 30% of children in Wisconsin covered by Badger Care has seen a dentist in the last year. Children should be seen by age 1.

Myths Unveiled continued

• There is not such a thing as “soft” teeth. Teeth that break down easily could be a result of diet (sugar drinks), brushing habits, other oral habits such as smoking, chewing tobacco and drug therapy as well as lack of professional dental care. Fluoride and genetics do play a role in the enamel make up of your teeth.

• Access to comprehensive dental care continues to be a real problem in the state of Wisconsin.

• Based on utilization rates today, studies indicate there will be enough providers to cover the demand for care in the future. Should community demand increase, dental access could be constrained.

National Statistics

• 44 percent of American children will suffer from pediatric dental disease before they reach kindergarten.

• 73 percent of preschoolers and 48 percent of primary school age children have unfilled cavities

• Only 1.5 percent of 1-year-olds have had a dental office visit compared with 89 percent who have had an office-based physician visit. (Question of value placed on oral health)

Barriers to Seeking Care

• Fear• Embarrassment• Expense of non covered

treatment• Work Schedules• Transportation

(Reliable)• Mental Health • Limited providers

INSURANCE BARRIERS

• Commercial Insurance• Co Payments• Out of Pocket Costs• Maximum benefits reached

quickly

• Non-Insured• Initial $200 plus for

appointment• Tight Budget, no extra cash for

care• Chronic needs

• Public Assistance Programs • Limited providers• Travel Long distance • Wait list for care• Chronic needs• In/Out of Eligibility

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OVERALL HEALTH

Oral Systemic Connection

• Recent scientific research suggests a very strong correlation between chronic oral infections from periodontal (gum) disease and systemic health.  • Medical conditions may be complicated by

bacteria from the mouth.

Medical Conditions

• Cardiovascular disease - Inflammatory response to oral bacteria contributes to cardiovascular disease, heart attacks or strokes.

• Pulmonary Disease - People with chronic periodontal disease (10% of the general population and 50% of all seniors) are most affected by pneumonia. Improving the state of poor oral health may reduce the number of pneumonia cases and decrease patient mortality.

• Diabetes - 1/3 of all people with diabetes have severe periodontal disease. Untreated, periodontal disease can disrupt diabetic control. Periodontal disease may be considered a complication of diabetes.

• Orthopedic Implants

- Infections originate from oral bacteria may lead to failure of the prosthesis. Dental evaluation before surgery could decrease the potential risk of infection.• Cancer

- Elimination of all dental disease prior to cancer therapy may minimize or prevent the potential complicating effects of chemotherapy.• Fetus Development

- Risk of preterm birth was 3 to 8 times greater for mothers with periodontal disease.

Community Challenged

• Community-wide concern• CAP Services’ community needs assessment 1995 and 1998

identify lack of access to medical and dental care• Head Start dental assessments – no providers• Hospital Emergency Room visits for dental issues• Family Preservation and Support Initiative - Affordable Health

Care Task Force 1996- lack of dental care

Partnership Coalesced

• Delta Dental of Wisconsin, Saint Michael’s Hospital, CAP Services

• Each partner brought unique resources to the table:• Delta Dental: financial resources• Saint Michael’s Hospital: financial resources and

management/organizational medical infrastructure• CAP Services: resource mobilization capacity, outreach to

target community. “Mission of CAP Services is to bring about a permanent increase in the ability of low-income individuals to become economically and emotionally self-sufficient.”

January 2002 - Open

Ministry Dental Center

Our Mission is to continually improve the health and well being of people, especially the poor, in the communities we serve.We believe people have the right to quality dental care services that are efficient, effective and accessible. We believe care should be compassionate and delivered in a dignified and respectful manner by a culturally sensitive and highly professional team of people.

Demographics

Ministry Dental Center provides comprehensive general dental care for infant, pediatric, adolescent, adult and geriatric patients.

Eligibility:Recipient of Badger Care Benefits in Portage & Waupaca Co

The patient population served is approximately

40% under age 20; 52% patients aged 20-59; and 8% 60 and older.

21% self report disabled.

Ethnicity:

Caucasian 81%, Hispanic 5%, Asian 1%, Hmong 9%, African American 3%, Bi-racial 1%.

SCOPE & COMPLEXITY OF PATIENT’S CARE NEEDS

The most prevalent reasons patients present for dental care are:• Diagnostic (Oral evaluations, diagnostic imaging)• Preventive (prophylaxis which includes scaling and polishing

procedures to remove coronal plaque, calculus and stains; fluoride treatment; nutritional and dental disease counseling; tobacco counseling for the control and prevention of oral disease; oral hygiene instructions and sealant placement)

• Restorative (placement of amalgam, resin fillings)• Emergency Treatment of dental pain (Open a tooth to drain

infection and/or extraction as necessary)• Limited Endodontics, Periodontics and Prosthodontics (Root

Canal Therapy, treatment of gum disease and replacement of missing teeth)

Ministry Dental is staffed by Total of 13.4 FTE.2.80 FTE Dentist. 2.4 FTE Dental Hygienists, 4.6 FTE Dental Assistants, 2.6 FTE Schedulers, and 1.0 Director.

HOURS OF OPERATION:Monday 8 a.m. – 5 p.m.Tues-Thursday 8 a.m. - 6 p.m.Friday 8a.m. - 4:30 p.m.

2013 Patients Seen By County

CountyPatients Seen

Patient Encounters

Periodic Exams

New Patients

Treatment Complete

Portage 2796 6950 1454 645 1961

Waupaca 1424 3595 711 310 807

Other 48 137 39 0 41

 2013 Total 4268 10,682 2202 955 2809

2012 Totals 4281 10,227 2892 1001 2798

Patients Seen in 2013

OPERATIONAL EFFICIENCY

Operational Philosophy Patients First Standardization Organization Lean-eliminate

waste

Sustainablity_Filling the GAP

• United Way of Portage County

• WI Department of Health Services Dental Grant

• Delta Dental

• Anthony Family Foundation

• Frame Memorial Presbyterian Church

• Jeregan’s

• Manawa Telephone company

• Wetherbee Donation

• Saint Michael’s Foundation

• Central Wisconsin Community Foundation*Average Annual Deficit of $460,000

COMMUNITY BENEFITS

IMPACT TODAY• Children are seen next

available appointment starting at age 9m – 1 yr.

• Fluoride Varnish • Sealants • Patient Education utilizing

teach back techniques• Emergency & Restorative

Care• Treatment plans are

completed in 90 days• Over 15,000 persons seen• Low income families have

dental home

FUTURE IMPACT

• Decrease decay rates in children

• Decrease adult dental care needs

• Increase demand for preventative recare appointments to sustain oral health.

• Community awareness of the effectives of oral health on overall health

• Improve overall health in the Community

Community Out Reach

• Improving oral health in the community involves changing the community culture around oral health. (learned behavior which has been socially acquired)

• Way to impact community culture is through outreach and education. • New Moms groups• Pregnancy Fairs• Public nurses – education in-service• Primary care, OB-GYN, Pediatric physician forums on early

intervention and education. • Physicians applying fluoride varnish during well baby checks.

Back to the Mission

Our Mission is to continually improve the health and well being of people, especially the poor, in the communities we serve.

We believe people have the right to quality dental care services that are efficient, effective and accessible.

We believe care should be compassionate and delivered in a dignified and respectful manner by a culturally sensitive and highly professional team of people.

Patient Satisfaction

Making a difference in our community !

QuestionsThank you!