Serving ALL the Children: Achieving Optimal Head Start

Dental Services

Karen M. Yoder, MSD, PhDKaren M. Yoder, MSD, PhD

kmyoder@iupui.edukmyoder@iupui.edu

Why are Dental Services Important to Children’s Health• General healthGeneral health• Freedom from painFreedom from pain

• Improve quality of lifeImprove quality of life• Ability to concentrate in schoolAbility to concentrate in school

• Ability to eat nutritious foodAbility to eat nutritious food• Self esteemSelf esteem

Head Start Performance Standards

• Dental examination by a dentist within 90 Dental examination by a dentist within 90 days of enrollmentdays of enrollment

• Preventive services (when indicated)Preventive services (when indicated)• Fluoride treatment (varnish preferred)Fluoride treatment (varnish preferred)• Prophylaxis (daily classroom brushing Prophylaxis (daily classroom brushing

helps to reduce the number of children helps to reduce the number of children who need this service)who need this service)

• Complete needed follow-up care (fillings or Complete needed follow-up care (fillings or extractions)extractions)

Why is Providing Dental Services a Challenging Task

• Many dentists:Many dentists:• Do not accept patients with Medicaid/State Do not accept patients with Medicaid/State

Children’s Health Insurance ProgramChildren’s Health Insurance Program• Do not accept very young childrenDo not accept very young children

• Parents:Parents:• Many parents do not have children’s Many parents do not have children’s

examinations completed prior to enrollment examinations completed prior to enrollment • Parents can not be required to have Parents can not be required to have

examinations and treatment prior to their examinations and treatment prior to their children’s enrollment children’s enrollment

Consider recruiting one or more local dentist(s) to provide dental examinations on-site at your Head Start program

Benefits of Onsite Examinations

• Can avoid transporting children in smallCan avoid transporting children in small• groups to dental offices to reduce inefficient use of groups to dental offices to reduce inefficient use of

personnel timepersonnel time

• Identifies the approximately 25-35% of enrollees who will Identifies the approximately 25-35% of enrollees who will need follow-up care – only those who receive follow-up need follow-up care – only those who receive follow-up care will need to be transported to a dental officecare will need to be transported to a dental office

• Can provide examinations and fluoride varnish to fulfill Can provide examinations and fluoride varnish to fulfill two PIR reporting items (cleaning not required)two PIR reporting items (cleaning not required)

• Dentists will see the extent of need and have a better Dentists will see the extent of need and have a better understanding of Head Start’s role and accomplishmentsunderstanding of Head Start’s role and accomplishments

Who Should Communicate

• The Head Start Director should The Head Start Director should

meet with the dentistsmeet with the dentists

• Arrange for a face to face meeting with the Arrange for a face to face meeting with the dentist(s)dentist(s)• Hold discussions over lunch at a restaurant near Hold discussions over lunch at a restaurant near

his/her officehis/her office• Take lunch to his/her officeTake lunch to his/her office• Be available for a meeting after business hoursBe available for a meeting after business hours

Making the contact• Do not assume a local dentist will not help, based on previous refusals – try Do not assume a local dentist will not help, based on previous refusals – try

again with a different approachagain with a different approach

• Contact the president of the local dental society to explain recruitment Contact the president of the local dental society to explain recruitment • Ask for recommendations of whom to contact firstAsk for recommendations of whom to contact first• Ask for a few minutes on a Board of Directors meeting agenda to Ask for a few minutes on a Board of Directors meeting agenda to

describe Head Start and ask for dentists to participatedescribe Head Start and ask for dentists to participate

• Use the telephone book for a listing of local dentistsUse the telephone book for a listing of local dentists

• Contact as many dentists as possible, but let all know who has already agreed Contact as many dentists as possible, but let all know who has already agreed to help. Foster collaboration among the dentists. to help. Foster collaboration among the dentists.

• Recruit for examinations and fluoride varnish, even Recruit for examinations and fluoride varnish, even if they won’t immediately agree to do follow-upif they won’t immediately agree to do follow-up

What to Discusswith the Dentists• Describe Head Start: Describe Head Start:

• Clarify the difference from other pre-school Clarify the difference from other pre-school programsprograms

• Why Head Start is important in the communityWhy Head Start is important in the community• How other agencies/individuals in the How other agencies/individuals in the

community help Head Start fulfill health community help Head Start fulfill health related requirementsrelated requirements

• Outline Head Start requirements for dental Outline Head Start requirements for dental servicesservices

• Describe ways in which Head Start will help Describe ways in which Head Start will help the dentists when they provide services to the the dentists when they provide services to the childrenchildren

Understand Incentives for Dentists• Don’t expect or ask dentists to volunteerDon’t expect or ask dentists to volunteer

• Will not promote sustainability – likely to volunteer Will not promote sustainability – likely to volunteer one year but perhaps not ongoingone year but perhaps not ongoing

• If they are willing to volunteer they will offerIf they are willing to volunteer they will offer

• Promote accepting Medicaid feesPromote accepting Medicaid fees• Do the mathematicsDo the mathematics

• Number of children x examination fee + fluoride Number of children x examination fee + fluoride varnish feevarnish fee

• Indiana example for 50 childrenIndiana example for 50 children• Examination = $20.25Examination = $20.25• Fluoride = $22.50Fluoride = $22.50

• 50 children = $2,137.5050 children = $2,137.50• 50-75 children can be examined in a day 50-75 children can be examined in a day

Incentive for Dentists (cont.)• Media coverage including a photograph Media coverage including a photograph

of the participating local dentistsof the participating local dentists• Especially important in small townsEspecially important in small towns

• Help the dentists understand their role in helping Head Help the dentists understand their role in helping Head Start to survive/thrive in their communityStart to survive/thrive in their community• Without dentists’ help Head Start cannot meet a Without dentists’ help Head Start cannot meet a

required Performance Standardrequired Performance Standard

• Providing examinations on site will eliminate one of the Providing examinations on site will eliminate one of the most frequently cited reasons for dentists not accepting most frequently cited reasons for dentists not accepting Medicaid patients: failure to keep appointmentsMedicaid patients: failure to keep appointments

Providing On-site Examinations May Encourage Providing Follow-up Dental

Services • Through providing examinations on-site at Head Through providing examinations on-site at Head

Start, local dentists will: Start, local dentists will: • See the extent of dental need among the See the extent of dental need among the

childrenchildren• Have a greater understanding and value for Have a greater understanding and value for

Head Start through being on-site and observing Head Start through being on-site and observing the programthe program

• Observe that most of the children are very Observe that most of the children are very cooperativecooperative

Equipment & Supplies to Provide• Equipment Equipment

• Portable dental equipmentPortable dental equipment• Cost: approximately $2,000Cost: approximately $2,000• Durability: Durability:

• Decades Decades • Can share cost and use at other sites or programsCan share cost and use at other sites or programs

• SuppliesSupplies• Gloves, masks, disposable paper clinic gowns, Gloves, masks, disposable paper clinic gowns,

disposable mirrors and explorers, and dose pack disposable mirrors and explorers, and dose pack fluoride varnishfluoride varnish

• Cost: approximately $1.50 per childCost: approximately $1.50 per child

Equipment to Provide

• Portable equipment will make it possible to do a Portable equipment will make it possible to do a thorough examinationthorough examination• Adjustable chair = good positioningAdjustable chair = good positioning• Operator’s stool = dentist’s comfortOperator’s stool = dentist’s comfort• Adjustable light = good visibilityAdjustable light = good visibility

Portable Dental Equipment Suppliers

• DNTL works Equipment CorporationDNTL works Equipment Corporationhttp://DNTLworks.comhttp://DNTLworks.com

• AsepticoAsepticohttp://aseptico.comhttp://aseptico.com

• AdecAdec• http://www.a-dec.comhttp://www.a-dec.com

Offer Help

• Offer to: Offer to: • Supply a person to record examination resultsSupply a person to record examination results• Supply a person to get the children from Supply a person to get the children from

classrooms and return themclassrooms and return them• Put a name tag on each child to assure accurate Put a name tag on each child to assure accurate

recordsrecords• Provide a translator if neededProvide a translator if needed• Promise to make it well organized, AND Promise to make it well organized, AND

MAKE IT WELL ORGANIZEDMAKE IT WELL ORGANIZED

Offer Help (continued)

Offer to assist in the completion of Medicaid formsOffer to assist in the completion of Medicaid forms

• Will eliminate one of most frequently cited reasons for Will eliminate one of most frequently cited reasons for not accepting Medicaid patients – Medicaid paperworknot accepting Medicaid patients – Medicaid paperwork

• Consider personnel costs an investment in obtaining Consider personnel costs an investment in obtaining servicesservices

• Will be especially appealing to retired dentists who do Will be especially appealing to retired dentists who do not have an office staffnot have an office staff

Invite parents to come to the Head Start site to be present during the examination

• Allows the dentist to talk Allows the dentist to talk with parents about their with parents about their child’s oral healthchild’s oral health• Educational for parentsEducational for parents• Begins to establish Begins to establish

parent/dentist rapport parent/dentist rapport

Utilize Give Kids A Smile Day• Nation-wide program in February sponsored by the Nation-wide program in February sponsored by the

American Dental Association (www.ada.org)American Dental Association (www.ada.org)• All state dental associations participateAll state dental associations participate• Free dental services one day per yearFree dental services one day per year• In private dental officesIn private dental offices

• Reserve for minor restorative needs that can be done in Reserve for minor restorative needs that can be done in one appointmentone appointment

• Consider using these Consider using these appointments for appointments for children who are children who are not eligible for Medicaid not eligible for Medicaid or SCHIP coverage and or SCHIP coverage and cannot afford servicecannot afford service

Additional Strategies/Issues:Promoting understanding

• Include a dentist and dental hygienist on the Include a dentist and dental hygienist on the health advisory boardhealth advisory board• Can serve as an advocate to encourage Can serve as an advocate to encourage

other dentists & hygienists to help other dentists & hygienists to help • Can provide professional adviceCan provide professional advice

Additional Strategies/Issues: Waivers - Parental refusal to consent to dental examinations & treatment

• Assure translation of Assure translation of information into information into parents’ first languageparents’ first language

• Examine reasons if Examine reasons if more than a few more than a few parents refuse dental parents refuse dental examinations and examinations and treatmenttreatment

Additional Strategies/Issues: If you can’t find a local dentist…..Mobile programs – what to ask

• What services does the mobile dental program provide?What services does the mobile dental program provide?• Preventive only?Preventive only?

• Can fulfill examination and prevention requirementsCan fulfill examination and prevention requirements• Requires cooperation with local dentists to provide follow-up care? Requires cooperation with local dentists to provide follow-up care?

Do the local dentists endorse the mobile program?Do the local dentists endorse the mobile program?• Restorative?Restorative?

• Can fulfill all dental requirementsCan fulfill all dental requirements• What are the arrangements for follow-up care for emergency needs?What are the arrangements for follow-up care for emergency needs?

• Does it have a local permanent site for follow-up care or emergencies?Does it have a local permanent site for follow-up care or emergencies?

• Are x-rays readily available to be mailed to another dentist?Are x-rays readily available to be mailed to another dentist?

• Are they endorsed by, or have good communication with the local dentists?Are they endorsed by, or have good communication with the local dentists?

Additional Strategies/Issues: Fluoride Varnish

• Fluoride varnish is a new method of providing topical fluoride – fluoride adheres to teeth longer Fluoride varnish is a new method of providing topical fluoride – fluoride adheres to teeth longer to make treatment last longerto make treatment last longer

• Fluoride varnish is new in the USA and not yet Fluoride varnish is new in the USA and not yet used by many private dental offices.used by many private dental offices.ADA recently recommended that it be ADA recently recommended that it be used, especially for children < 6 yearsused, especially for children < 6 years

• Optimal for Head Start programs because:Optimal for Head Start programs because:• Low dose of fluoride for young childrenLow dose of fluoride for young children• Does not require prophylaxis (cleaning)Does not require prophylaxis (cleaning)• Can be done at the Head Start site Can be done at the Head Start site

together with an examinationtogether with an examination• In many states it can be done by a In many states it can be done by a

dental hygienist without a dentist presentdental hygienist without a dentist present

Additional Strategies/Issues: Approach dental and dental hygiene schools for help with examinations and follow-up care

• Call the school – ask for the director of community-based Call the school – ask for the director of community-based programs or dental public health teacherprograms or dental public health teacher

• Dental hygiene schools have dentists as faculty supervisorsDental hygiene schools have dentists as faculty supervisors• May consider bringing dental hygiene students for May consider bringing dental hygiene students for

community experience to:community experience to:• Provide classroom educationProvide classroom education• Screenings and fluoride varnish done by students Screenings and fluoride varnish done by students

followed by exam by faculty dentist (fulfill exam followed by exam by faculty dentist (fulfill exam requirement)requirement)

What to Discuss with dental/dental hygiene school faculty:

• Describe Head StartDescribe Head Start• Outline Head Start requirements for dental servicesOutline Head Start requirements for dental services• Dental and dental hygiene schools have received a letter introducing the Dental and dental hygiene schools have received a letter introducing the

new Region V Oral Health Consultant who will provide technical new Region V Oral Health Consultant who will provide technical assistance and other servicesassistance and other services

• Describe how Head Start can provide an educational experience for Describe how Head Start can provide an educational experience for dental/dental hygiene students:dental/dental hygiene students:

• Classroom education experienceClassroom education experience• Experience providing screening for young childrenExperience providing screening for young children• Child managementChild management• Experience observing the results of disparities in access to careExperience observing the results of disparities in access to care

• How other professional schools in your state/area are involving students How other professional schools in your state/area are involving students in working with Head Start in working with Head Start

• Describe ways in which Head Start will help the school provide Describe ways in which Head Start will help the school provide services for the childrenservices for the children

For Additional Information:

www.mchoralhealth.org/HeadStart/RegionalConsMap.html