Monday, November 9, 2015

Integrating Dental and Medical Care: MORE Care, More People

By Steve Pollock, President and Chief Executive Officer, DentaQuest

It’s no secret that millions of Americans lack access to basic oral health care. According to the American Dental Association, 181 million Americans don’t visit a dentist in a given year and nearly half of people over 30 suffer from various forms of gum disease. This is a significant issue plaguing Americans across the country.

And, those who live in rural areas can experience higher rates of poverty, lower oral health education, dental provider shortages and a scarcity of dependable transportation, providing even more barriers to receiving basic dental care. This culmination of factors is creating significant gaps in our oral health care system, leaving many without services they need.

So, what is the solution?

Well, for starters, we need to prioritize medical-dental integration. Under this model, dental and primary care providers alike would take an integrated approach to diagnosis and treatment of patients.

To provide an example, primary care practices would be trained to identify and manage oral health needs for their patients, and also appropriately refer and collaborate with dental partners. Similarly, if a patient went for a routine dental check-up and showed signs or risk of diabetes, the dentist would then refer them to a primary care provider for a closer look.

By training providers in both practice worlds to conduct simple screenings and spot specific signs, we can identify and thus address health issues more quickly. And, in the healthcare system of tomorrow, a connected, efficient network can help identify and address preventable diseases earlier on, while also expanding our reach in underserved communities and improving cost efficiency.

Does medical-dental integration work?

The thinking behind this type of integrated approach is exactly how the MORE Care (Medical Oral Expanded Care) initiative came to life. MORE Care is a pilot program launched by the DentaQuest Institute that connects doctors’ offices with the resources and training to provide preventive oral health services in South Carolina. It also connects medical and dental teams to establish a referral-based system for patients.

Through these efforts, MORE Care has already been able to access rural populations, bringing them reliable, preventive care that previously was difficult to obtain.

Using a phased approach, the DentaQuest Institute, in partnership with the South Carolina Office of Rural Health and Medical University of South Carolina, is initiating pilots of this program throughout the state that build oral health into primary care, while also laying the foundation for dental care referral networks.

In its first year, we’ve worked with six rural primary care practices to collaborate on solutions, test strategies to effectively deliver preventive oral health services, communicate with dental providers and identify best practices for the future of this program.

We’ve also expanded our partnerships (working closely with the South Carolina Dental Association) to enhance the program. 

Will there be MORE Care in the future?

So far, the results are promising – we are reaching underserved patient populations with integrated care and learning lessons to help us improve the program as we look to expand it. We hope to have significant data and insights early next year to inform our efforts to grow our reach.

As all of us in healthcare search for efficient solutions that achieve high-quality results, establishing medical-dental integration programs will allow providers to deliver care to the whole person, reach a patient population in significant need, and ultimately help control healthcare costs. 

Thursday, October 22, 2015

Teledentistry: Bringing Oral Care to You

By Dr. Rob Compton, DDS, President, DentaQuest Institute, and Chief Dental Officer, DentaQuest

Telemedicine, telehealth, teledentistry? Billboards are talking about the first two, advertisements are featuring them, and commercials are promoting them. Virtual health care is here, if only in its early stages. Gone are the days when seeking medical care automatically equated to travel and missed school or work. Providers and patients alike want and now can more easily access necessary, quality care virtually.

But what does an age of virtual health mean for oral health care? That third word: teledentistry.

Untreated tooth decay can lead to other serious and long-lasting complications, including bodily infections and heart disease. This is why teledentistry is such a unique and important opportunity to improve patient care, dentists’ reach, and the oral health of all.

What better way to improve access for underserved communities than to go straight to the person? Through the use of teledentistry, members of the dental team (namely dental hygienists and assistants) are traveling to schools, community centers and nursing homes to perform routine check-ups with virtual oversight from a remote dentist.

School-based oral health screenings, routine check-ups, educational programs, and delivery of preventive care are proven methods for setting kids and adults up for success. An established relationship between a child and a dental care provider leads to:
  • Improved oral health habits
  • A link to the child’s family members, who otherwise may not have access to care
  • Better overall health for both the child and the community at large
But how does this really play out? Let’s take a look at California. California was one of the first states to pioneer an innovative approach to using teledentistry to increase access to care. Designed to reach people in underserved areas around the state, the Virtual Dental Home program offers dental services in community settings like schools and nursing homes.

As part of this demonstration by the Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry (Pacific), hygienists and assistants perform routine exams and certain services with supervision by a remote dentist responsible for setting the appropriate treatment plan. Two thirds of those served by the VDH pilots were able to receive all of their care in community settings.

In its first three years, the demonstration program will bring care to 20 communities and benefit nearly 20,000 children and adults across the state.

For every dollar spent on preventive dental services, an estimated $50 is saved on more expensive and complicated procedures, according to California Dental Association President Dr. James Stephens, who spoke about this program during a recent PBS interview.

That cost savings statistic is a great example of what states can achieve when they support preventive care and expand access to dental care. Demonstration programs are already indicating that wider adoption of models like the Virtual Dental Home will continue to break down barriers to access, ultimately resulting in more cost-effective and prevention-focused dental care. The next step for California is to work with the oral health community to encourage wider adoption of the VDH model.

This model for delivering care in the community also allows dentists to fill valuable chair time with patients in need of more comprehensive restorative services at the same time that their dental team is out in the community providing routine preventive care.

We all look forward to a future where everyone has access to all critical services, regardless of where they live. Well, that future begins now. Virtual health care is here, and is ready to bring providers to you. Let’s all work together to make this a reality.

Wednesday, September 30, 2015

50 Years of Medicaid, Yet Oral Health Gaps Remain

By Steve Pollock, President and Chief Executive Officer

In 1965, Medicaid and Medicare were signed into law. At that time, there were more than 194 million people in the United States. Thirty-two million lived in poverty. America’s low-income population was in desperate need of medical coverage and the financial means to access care.

Enacting Medicaid and Medicare was the first step toward helping this largely underserved population. With the intended purpose of providing a public health insurance program for low-income people, Medicaid has made great strides in increasing access to coverage since its inception.

Medicaid Covers More People, Just Not for Dental

From the original 4 million Americans that enrolled in Medicaid to the 65 million who are enrolled today, the goal has remained the same: administer proper medical care to those with limited or scarce resources.

Policy and lawmakers alike have recognized the importance of creating an opportunity for all Americans, socioeconomic status aside, to be protected with quality medical care.

As background, Medicaid provides health coverage to non-elderly low-income parents, their children, other caretaker relatives, pregnant women, and other non-disabled adults. Most recently, Medicaid expanded to include more people under those definitions based on language in the Affordable Care Act.

While Medicaid’s accomplishments to date are something to be deeply proud of, the reality is that there is a major gap that still needs attending to: adult dental coverage.

Medicaid Members Need Dental Coverage

A few months ago, I wrote a blog post on Children’s Health Insurance Program (CHIP) funding being successfully extended for two more years. In that post, I pointed out the decision to include adult dental care coverage within Medicaid is up to each state to decide. As a result of that policy, millions of Americans are left without access to dental benefits. This still holds true, even though oral health is vital to overall health and lower health costs.

In the past decade alone, patients seeking treatment for dental pain in the ER doubled from 1.1 million to 2.1 million. And 80 percent of dental-related ER visits are caused by preventable conditions. This reality means our focus needs to be on providing preventive care that will ultimately cost three times less than ER visits, and save a lot of people from excruciating dental pain.

CHIP is a great example of how mandated dental coverage works. CHIP has been a critical source of health coverage for children and pregnant women who earn too much to qualify for Medicaid but too little to purchase private health insurance. It provides affordable medical and dental coverage to more than 8 million children across the country.

Coverage Leads to Improved Prevention

According to a report from the U.S. Department of Health and Human Services, 80 percent of CHIP enrollees saw a dentist in the past year, a number much higher in comparison to children who do not have coverage. That preventive care will ultimately save kids from future dental emergency visits, keep kids in school instead of at excessive dental appointments, and ensure more kids are pain-free and smiling. 

Moving forward, I urge legislators to rise to the challenge: let’s continue increasing access for those in need and secure adult dental coverage under Medicaid at the federal level.

Oral health is crucial to overall health and wellness, and should be recognized as so by the law. Mandating adult dental coverage is the necessary next step towards achieving improved oral health for all.

Thursday, September 17, 2015

Back to School: Advancing Oral Health in the Classroom

By Ralph Fuccillo, MA, President, DentaQuest Foundation

It’s that time of year again – the time when kids all across our country head back to school for another year of learning, growth and development. But, did you know that the classroom is also a crucial point of connection, education and even treatment when it comes to oral health?

If you are a parent, you can attest that you always have your child’s health and wellbeing on your mind, particularly in an age where fast food, lack of exercise and other issues plague the next generation. For kids, tooth decay is actually the most common childhood disease, more common than asthma. Each year, children across the United States lose approximately 52 million school hours due to dental disease. Unfortunately, this impacts low-income children disproportionately, as they face more barriers to getting much-needed, preventive dental care. It’s sometimes a challenge to find a provider that accepts their insurance, and if they are able to secure an appointment, they may have trouble getting transportation to and from the office, and their parents may not be able to take the time off from work to get them there. To drive this home, kids from low-income families have twice the untreated tooth decay compared to their higher-income counterparts.

Schools are a practical and cost-effective place and time to reach children, teach them about healthy habits and even ensure they receive the preventive oral care they need. In addition to education on healthy personal dental care, school-based oral health programs can provide a range of services from screenings to sealants to fluoride treatments. To illustrate the potential of these programs, according to a recent issue brief from the Centers for Medicaid and Medicare Services’ (CMS) Oral Health Initiative, the Centers for Disease Control and Prevention (CDC) estimated that over half of kids’ tooth decay could be prevented if half of those high-risk children participated in school sealant programs.

Think of the potential! This is why one of our Oral Health 2020 goals is centered on this important, cost-effective initiative. By 2020, we strive to have oral health education and services incorporated into the curriculum and offerings of the 10 largest school districts in the country.

To make this goal a reality, we partnered with Oral Health Colorado to develop a toolkit for local communities. The recently-launched, free Smart Mouths Smart Kids (SMSK) toolkit is available to help communities assess need for such a program in their local schools, measure feasibility of program administration and create a program that is sustainable for years to come. Its development took into account best practices and key learnings from our work to provide local stakeholders with the tools they need to make oral health a priority in local schools.

From engaging appropriate partners to understanding reimbursement methodology and building a sustainable business plan, this toolkit has everything a community needs to get started with implementing school-based oral health care – along with support at every step of the way – to help bring dental care and education to the next generation. While the toolkit is focused on Colorado communities, it’s a model that can be scaled and tailored to states across the country.  We encourage you to take a look and share with school administrators, local government leaders, and teachers, and empower your community to bring good oral health back to school this fall. 

Tuesday, September 8, 2015

Missions of Mercy: Oral Health Improvement in Motion

Guest post by Marcia Brand, Ph.D., senior advisor for national policy and programs, DentaQuest Foundation, and executive director, National Interprofessional Initiative on Oral Health

Are you familiar with Missions of Mercy?

Missions of Mercy – sometimes also called “MOMs” – provide dental services, including cleanings, fillings, oral surgery, x-rays and dentures, to people in underserved communities across the country. These services are provided free of charge by dentists and hygienists who donate their time as volunteers. By bringing free dental screenings and care to those who need it most, these missions are a crucial, hands-on way to improve the oral health of all.

I recently volunteered as a dental assistant at the Wise County Mission of Mercy in Virginia. Pat Finnerty, another senior advisor to the DentaQuest Foundation, volunteered as well, managing patient flow in the triage tent.

Southwest Virginia is an area where much of the population doesn’t have access to regular dental care and services. Would you believe that more than 47 percent of the total population of Virginia doesn’t have dental insurance? I hope this helps drive home the importance of these events.

We don't often realize the powerful impact that poor oral health has on the lives of those who cannot access oral health care. I recall one young woman, perhaps 30, who came through the triage tent at the Wise MOM. After examining her mouth, the dentist gently told her that her best option was going to be to have all of her top teeth in the front extracted. There were multiple infections and they could not be saved. He had to step awayand she began to weep. I asked her if she was afraid and she said, "No, they really do hurt me, but I can't get them pulled. I'm a bartender. If I lose my front teeth, I'll lose my job." What a terrible choice she had to make remain in pain, with multiple infectionsor lose her job. Fortunately, we were able to make arrangements for her to have her teeth extracted and get a partial denturebefore her next shift. Stories like these continue to indicate to me that we must improve access to affordable dental care for all.

The DentaQuest Foundation has participated in the Wise MOM project for 11 years. Since its start in 2000, this particular MOM has brought $15.3 million in free dental care to 19,060 patients – what an incredible impact.

This year, we partnered with the Virginia Dental Association, Virginia Commonwealth University School of Dentistry and Dental Hygiene, the Health Wagon, Remote Area Medical, Virginia Health Care Foundation and other sponsors to fund the Wise County event. Over the three days, more than 1,000 patients passed through the triage tent, resulting in a total of 1,181 exams, 177 cleanings, 1,082 x-rays, 1,569 fillings and 3,527 extractions.

For many people, MOM events are the only time all year that they are able to get care. With 69 localities throughout Virginia lacking a dental safety net provider, the MOM events are a critical stop gap that reach more than 4,000 residents annually. 

While MOMs and other similar events provide dental services to people in desperate need of oral care, they also highlight the demand for an increase in access to quality, affordable care. That is why it is the DentaQuest Foundation’s goal, by 2020, to address this unacceptable gap head on. As a part of the Oral Health 2020 goals, we hope to have at least 30 states with a comprehensive Medicaid adult dental benefit and a comprehensive adult dental benefit under Medicare. Will you join us and put oral health improvement in motion?

Wednesday, July 22, 2015

Debunking Dental Myths: How Well Do You Know Your Teeth?

By Dr. Brian NovĂ˝, Director of Practice Improvement, DentaQuest Institute

Myths are something we are exposed to every day – we hear them from our co-workers, friends and family. Everyone has heard the ones about chewing gum staying in your stomach for seven years, if swallowed, or that you should never wake a sleep walker. But, did you know there are many myths about oral care and your teeth? In this post, we’ll play a game of true or false, and cover 9 common “facts” about teeth. Can you guess what is a myth and what is true?

1.    You should floss before you brush your teeth.
This is in fact true. If you floss after you brush, there is a risk that you will wipe plaque all over your clean teeth. Ideally, you would brush, floss and then brush again.

2.    Whitening your teeth will hurt your enamel.
This is a myth. While excessive whitening can be harmful, a tiny bit of bleaching gel, like carbamide peroxide, can help kill bacteria on your teeth that can cause periodontal disease and tooth decay.

3.    Bad breath is only caused by not brushing your teeth.
Would you believe that this is false? Bad breath can be caused by a number of factors. For instance, your tonsils can collect debris causing your breath to smell. Bad breath can also be caused by more serious issues, like periodontal disease and untreated tooth decay.

4.    You should use an electronic toothbrush over a regular toothbrush.
Also a myth – a regular toothbrush can do a great job of brushing, but some patients find that an electronic toothbrush can make brushing easier. Soft toothbrushes do a better job cleaning than medium or hard bristled toothbrushes, so always select a toothbrush with soft bristles.

5.    You only need to visit your dentist only once a year.
False! Everyone needs to visit the dentist at least once a year, and some patients need to visit the dentist four times a year. You should talk with your dentist about how many times a year you should visit his or her office.

6.    Brushing bleeding gums is bad.
This is one of the biggest myths out there! If your gums are bleeding, you need to brush more carefully and floss more often. If your gums still bleed after a week of gentle thorough brushing, see your dentist to ensure everything is ok.

7.    People who get cavities simply just don’t brush their teeth.
It’s much more complicated than that – this is another myth. Cavities are caused by a bacterial infection. Brushing is an easy way to prevent some cavities but you need to encourage oral health by eating protective foods, flossing and visiting the dentist for regular check-ups. 

8.    All fillings you have in your mouth will eventually need to be replaced.
This is true! Once you have had a filling, your tooth has been weakened. There currently is no perfect filling material out there, so fillings must be maintained over your lifetime. You can help you fillings last longer by caring for them with proper home care.

9.    You should not go to the dentist when you are pregnant.
This is a very common myth. While you are pregnant, your hormone levels change which can make it easier for bacteria to cause dental infections. It is important for expecting mothers to also let their dentist know if they have any changes in their oral health, like bleeding gums. Be sure to see your dentist regularly if you are pregnant.

How did you do? Did you get all 9 right? As you can see, knowing the difference between the facts and myths surrounding dental health is important not only for your oral health, but also your overall health. Always check with your dentist if you have any questions or want to clarify any myths!

Wednesday, July 15, 2015

The importance of community water fluoridation to oral health

By John Luther, DDS, Senior Vice President, Chief Dental Officer DentaQuest and Michael Monopoli, DMD, MPH, MS, Director of Policy and Programs DentaQuest Foundation  

A recent recommendation by the U.S. Department of Health and Human Services (HHS) has brought about a resurgence of support for community water fluoridation within the oral health community.

Dentists have consistently been strong advocates for the health benefits of fluoridating public water supplies, and fluoridation is widely regarded as one of the top public health achievements of the past century. Officials from both public health organizations and professional dentistry agree that water fluoridation and fluoride toothpaste are largely responsible for the significant decline in tooth decay in the U.S. over the past several decades.

Fluoride doesn't cure or medicate -- it simply prevents. Similar to a vitamin, the right amount of fluoride in our drinking water improves resistance to tooth decay and causes us no harm. By preventing tooth decay, community water fluoridation has been shown to save money, both for families and the healthcare system.

In 2000, the U.S. Task Force on Community Preventive Services examined 21 studies and concluded that fluoridated water reduces tooth decay by a median rate of 29% among children ages 4 to 17. While children are typically cited as the beneficiaries of this protection, a 2010 study in the American Journal of Public Health (October 2010, Vol. 100:10, pp. 1980-1985) found that the fluoridated water consumed as a young child makes the loss of teeth from decay less likely 40 or 50 years later when that child is a middle-aged adult.

Recently, HHS announced the first change in the recommended amount of fluoride for public drinking water supplies in more than 50 years. The new guidelines utilize the best evidence available to clarify the amount of fluoride needed to achieve the optimal amount of tooth decay prevention.

The department gave several reasons for the change, mainly citing that Americans have more access to sources of fluoride than they did when water fluoridation was first introduced in the 1940s, but water is just one of multiple sources. Consumers also have access to fluoride toothpastes, mouth rinses, and prescription fluoride supplements, as well as fluoride applied by dental professionals.

We, along with the Centers for Disease Control and Prevention, the American Dental Association, and many other organizations, know that community water fluoridation is one of the most cost-effective means of preventing dental caries. The new recommendation, along with other current findings, strengthens our understanding of the preventive effects of fluoride on oral health and reinforces the need for communities to continue to invest in keeping fluoride in community water.

After more than 70 years of studying fluoridation in drinking water, it is clear that this practice is one of the most important health-promoting policies that a community can offer all its residents. This is especially true for those who are low-income, those with limited access to regular dental care, and those who experience health disparities firsthand. It's effective. It's safe. And it's the reason why both children and adults today have much less tooth decay than people had a generation ago.

This piece originally ran on