Transcript Slide 1

No Tooth Left Behind…
New Opportunities for Integrating
Oral Health into the Medical Setting
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
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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=563,247
Members: 0-21 years
(Medical Provider)
Amount Paid
Unduplicated Members:
0-21 years
(Medical Provider)
Amount Paid
FY 2011
FY 2012
1st Quarter
2,338
908
$60,788
$23,608
2,112
901
$59,912
$23,426
FLUORIDE VARNISH UPDATE
105 CMR 700.003(K)
(April 13, 2012)
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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
Fluoride Varnish Reimbursement
• 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.
A New Partnership to Consider…
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
Resources
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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 Health
250 Washington Street
Boston, MA 02108
[email protected]
www.Facebook.com/mdphoralhealth