HRSA/MCHB 2005 FEDERAL/STATE PARTNERSHIP MEETING

PUBLIC HEALTH ACROSS THE LIFESPAN

Improving the Oral Health of CSHCN through the lifespan

TONI WALL: Can I just have a show of hands? How many non-dental personnel there are here? Wow, quite a bit, good. How many CSHCN folks. Great.

Well, I’m glad that we all participated in that rather long lunch and introduction, but it was really quite rewarding to listen to that.

As Jay said, and I’ll probably talk longer than, but I’ll try to move it along faster. I’ve been with the Bureau of Health for 17 years, but I spent my first nine years in oral health. So oral health is sort of always at the back of my mind and especially been in the back of my mind as I’ve worked with Children with Special Health Needs for the past 10 years. I always like to remember, sort of start off a quote from Margaret Mead: “The solution of adult problems of tomorrow depends in large measure upon how our children grow up today.” And I think for me, that statement says that we really need to look at today. I thought I’d really give you an overview of the main CSHCN program. For most of the CSHCN programs across the nation, they really are diagnostically based. Dental services and for the person that is, they may or may not cover dental services. We cover dental services. They are disease specific, cardiac defects, childhood cancer. And it’s only routine and we charge up to, or pay up to $150. That doesn’t go very far in these days. In fact, one visit pretty much covers that. We let families use that for whatever they want. If they need restorative care, if they need X-rays or whatever.

Cleft, lip and palate, however may be a covered service in most states. We cover just about everything for cleft, lip, and palate. It’s got unlimited number of clinical visits for pediatric dentists, ortho, prostadontists, orthanathic, oral surgery; you name it, all the way up through age 21. So they really get the full force of dental health care.

I really like this Bright Futures charter that every child and adolescent deserves ready access to comprehensive, health promoting and therapeutic and rehab medical mental health and dental care. Because I think it all, for me, in Children With Special Health Needs now and really looking at medical home, it really comes back and says dental health care is part of that primary care and it should be part of preventive care and just care in general and I talked to my oral health program manager, who I’ve been friends with for 17 years. I said, “Let’s connect the head back to the rest of the body for goodness sakes.”

I looked at applying for a child health practioner grant and looking at oral health. We didn’t get that, but that was okay. Jamie’s husband called and was very polite. It was the first time I had ever gotten a call from a federal agent saying you did not get a grant. Most times they just send you a letter, so it was very nice. But part of the thing that we looked at was also the surgeon general’s initiative in 2001 looking at the conference that they had on children’s oral health and have really thought about incorporating those goals into how we’re going to address oral health for kids with special health needs. And for all the other kids who aren’t’ able to access good oral health care.

They had seven recommendations. I don’t know how many people are familiar with this, but it really was a great, it was really a great read. It’s called “The Face of the Child, Surgeon General’s, Workshop and Conference on Children’s Oral Health.” And I’m just really read those real quick. Number one, start her early, emphasize prevention, involve parents. Two, assure a sufficient work force. Revamp health professional and health education to include dental. Number four, integrate and innovative services. Five; expand the knowledge base and transfer of signs to include more than just dentists and pediatricians. Look at developing strategic communication plans and align policy with knowledge and children’s needs.

So in Maine we’ve really tried to look at that. Maine ’s a very rural state. Most states also have those rural portions. Maine encompasses all of the New England states in its landmass, so for us to go from Northern Maine to Southern Maine takes us about 10 hours. We have one primary route through Maine, so those of you who have been there, 95 is our only major highway and it’s quite lovely this time of year if you’d like to go up there. We have very minimal public health infrastructure. We have actually three city public health functions in our town and we don’t have a public health service in our town. Our oral health data is very limited, so trying to get reliable oral health data on our population. Especially kids with special health needs, is really hard. Access, it can be very problematic for someone in a rural community who’s looking for a pediatric dentist who may be three or four hours away, who only takes Maine care on the third Friday of the month of December between the hours of 12 and 12:30. And I’m not kidding; there really is a practice like that.

And then the insufficient number of dentists, every state faces that. And even you know, we look at Maine care and you hear, “Well, if you only gave us more money.” That’s not going to solve the problem, because dentists are overloaded now. They can’t take any more patients and we hear that all the time. And it really exacerbates the problem. If you’re low income, you have special needs, you’re elderly and you’re uninsured, so what are we going to do? I’m currently working with the oral health program. And as I’ve said, Judy and I have been friends for quite a long time. And we’re looking at really building the capacity of non-dental professionals to recognize and understand oral health diseases and conditions. And that means really working with the primary care docs, pediatricians in Maine to look at the structure of the teeth and not just look at the tonsils and adenoids, but to actually look around before they bypass.

So, thanks to Jay and Bev Antwhisel, and folks down in Georgetown. They really thought that it would be a great idea to incorporate dental health into the six core components for children with special health needs. So I’ve sort of addressed this. I’m going to go through it really quick. But Jay assures me that if you come to the round table, we’ll give you the handout and we’re going to request you to review it for us and send it back.

Maine has developed Maine Smiles Matter curriculum. It’s actually a curriculum for non-dental health providers and we’re currently collaborating with the Maine Dental Association and the Maine chapter of AAP to really look at how we can help the primary care providers become familiar with an identification and early preventive. The thing that we really need to look at is how to establish a referral system. When docs ID something, who can they refer to in their community with dental health? And then really look at making sure we provide families the information on good preventive care.

Insurance. Certainly increasing costs, I had said that, increasing payment to, sorry. Increasing payment may help, but we really need to look at increasing the number of providers who are out there who can provide good dental care. All kids should be screened early and continuously. Let’s begin at birth, let’s teach parents about good oral health care. When kids come into the practice, let’s talk about swabbing their teeth, let’s talk about not putting the baby to bed without anything but water, you know, some of the things that we hear about kids with behavioral problems is they hate to have their mouth touched, but one of the things if we start early, maybe we can overcome that. But I don’t really know. Start teaching parents on brushing and flossing. Let’s not wait till they’re three years old when they may get to a dentist at that time for the RD, they hygienist, to teach them how to do that. Let’s have the nurse or somebody at the practice teach them. And let’s look for signs of decay, because baby bottle tooth decay, it’s rampant and it’s quick.

Let’s have services, they’re organized on the web. Our docs know about them, or you go into a doc’s office and they know where the dental clinics are in the state. They know what those clinics offer, they know who can have access to them. Let’s look at alternative funding sources. Is that the Grotto? That exists. Maine also has, what’s it called, but they also have a place where there’s free dental services across the state that they work with too. Family Voices in our state may have information. The CSHCN program may have information on how to get to a dentist. The Oral Health Program, instead of just saying, “No, there are no other dental services,” There are other people that they could contact, hopefully to get services. And look for adaptive oral health devices. For kids with behavioral problems or kids who have cognitive problems, there are alternatives to help those kids learn how to brush. Where families help them learn how to brush.

Currently, Maine has been working with the Oral Health Advisory Committee; there are several of us attending the New England meeting that Jay spoke of on Monday. We also have family voices and parents who sit on this Oral Health Advisory Committee. So we can get their perspective and understand what their needs are. I’m hoping that they’ll also assist in the development and design of promotional materials as we move along. And let’s have them do some of the training, because what better way than to have parents teach other parents about what to look for.

And last, but not least, something that’s very near and dear to my heart is transition piece. As we think about transition, we need to have kids, let’s face it, I have a 14-year old and if I’ve asked him to brush, “Oh, I wait till tomorrow morning, I’m tired.” We really need to build and instill in them, the importance of oral health. It’s part of getting a job. What’s the first thing people look at when you go for a job? They look at your teeth. And if you don’t have good teeth or a pleasant smile, they really, I do it, I don’t know if the rest of you do it, but it’s the first thing I look at it, and it’s probably because I worked in oral health for eight years. Anyway, you should also be on advisory boards. They can, you know, we need to assist them in locating adaptive equipment and be able to move along. And certainly raise awareness of oral health screenings. And I’ve already gone over these, so I’m going to bypass those, but I think that’s it. And please come to the round table and get more information.