Rating the Performance of Your State’s Health System

There’s an interesting new report by the Commonwealth Fund, Securing a Healthy Future: The Commonwealth Fund State Scorecard on Child Health System Performance, 2011 that is worth looking at.

The Commonwealth Fund’s researchers took a number of objective measures for good health -- such as access to prevention and treatment, the potential to lead a healthy life (defined as factors such as low prevalence of specific health problems, low obesity, and lack of habits and behaviors that impact health, such as smoking) and socio-demographic dimensions (such as income and where you live) -- and looked at how each of these measures impact the others. The result is a very interesting and comprehensive picture of elements that contribute to children's health in each state.

We’re pleased that this report includes preventive dental care and the absence of dental problems as measures of access to prevention and treatment and a factor in healthy lives. The Report concludes that the high rate of poor yet preventable dental health outcomes among children in many states points to the need to improve preventive dental health care.

Better access to oral health services can reduce tooth decay and lead to a better quality of life for children, as well as reduce financial and societal costs. The Commonwealth Fund found that almost one third of children did not see a dentist for a preventive visit in the bottom-ranked state and more than 10 percent did not have a dental check-up in the top-ranked state. Want to know who they are? Click the link on the report title and check out the report!

Dental disease is nearly 100% preventable when people have access to information about keeping their mouths healthy and access to dental services. Public education, expansion of access to dental care, and integration of oral health into routine well-child care are smart ways to do this.

It works best when FAMILIES are able get the services they need to maintain their oral health since parents need dental care themselves for their own good health AND so they can be a good example for their children. The U.S. Department of Health and Human Services Healthy People 2010 goals recommend that children have at least 1 dental visit annually. And the American Dental Association says that you can start this at the age of 1 or when the first tooth erupts.

So, check out the data for your state. And then let me ask you -- is an annual visit to the dentist something that you do for yourself and for your children?

Report from the Field: National Oral Health Conference, 2011

If you’re involved in public health dental care, are a health researcher, dental educator, legislator, public health official, Medicaid/CHIP dental program staff or consultant, or provide dental care at a community health center, chances are, you are in Pittsburgh, PA this week (April 11-13) at the National Oral Health Conference.

This is the 12th time the Association of State and Territorial Dental Directors (ASTDD), the American Association of Public Health Dentistry (AAPHD) along with the Centers for Disease Control and Prevention (CDC) have brought the national public oral health community together to highlight the many areas where public health systems can converge toward achieving “optimal oral health” for America’s citizens. As a leader in the national conversation about improving oral health for Americans, DentaQuest is playing a visible role.

The ASTDD board invited the leadership of the DentaQuest institute and the DentaQuest Foundation to its annual Board meeting to update them on the significant investments we have planned for 2011.

In the 1st general session of the conference, Mark Doherty, DDM, MPH, Executive Director of the DentaQuest Institute, Ralph Fuccillo, President of the DentaQuest Foundation and Marcia Brand, PhD, the Deputy Administrator of HRSA, walked participants through “Strategies for Achieving and Maximizing Return on Investment in Oral Health.” ARRA and the Affordable Care Act have made significant investments in the health safety net. Oral health programs will benefit. With good planning, this once in a lifetime investment can lead to increased access, improved oral health outcomes, and financial sustainability and potential partnership with private foundations to extend the dollars available for oral health expansion. DentaQuest Institute Director of Practice Improvement, Dr. Jay Anderson is representing the Institute on an ASTDD- and ADA-sponsored panel discussion on working in community health centers. The American Association of Medical Colleges Advisory Group on Oral Health Curricula is discussing adoption of the Smiles for Life online oral health training for health care clinicians.

The DentaQuest Institute is featuring information on Safety Net Solutions technical assistance services throughout the conference at its booth.

The DentaQuest Foundation and Institute look forward to these national events for the opportunity they provide us to connect with dental public health leaders from across the United States. It makes us better at the work we do with our partners in supporting effective approaches to preventing and caring for oral disease.

Blog post by Dr. Michael Monopoli, Director Policy and Programs, DentaQuest Foundation and Brian Souza, Managing Director DentaQuest Foundation and DentaQuest Institute, reporting from NOHC.

Smokeless Tobacco – YOU’RE OUT!

Images of opening day should be of cheering fans, baseball diamonds, baseball caps and crisp new uniforms, and NOT containers of smokeless tobacco anywhere near the dugout. Smokeless tobacco in all its forms -- chewing, plug, twist, snus, snuff, dissolvable -- is a dangerous (and dirty) habit that I hope will no longer be glorified on baseball fields – professional or neighborhood. This year Congress is putting pressure on Commissioner Bud Selig and MLB players association chief Michael Weiner to ban smokeless tobacco all together this baseball season. I can’t agree more. We do not want impressionable children and teens to see their sports heroes using smokeless tobacco and get the wrong message about the dangers. Make no mistake about it, smokeless tobacco is dangerous.

• Smokeless tobacco contains higher quantities of nicotine than most cigarettes. And it increases the likelihood that the person using it will become a smoker.1


• It shocked me to learn that according to the Academy of General Dentistry (AGD) 4% of boys in middle school and 20% of high school boys use smokeless tobacco. Half of them will likely develop pre-cancerous white patches in their mouths. ·


• Smokeless tobacco products, just like cigarettes, contain at least 28 cancer-causing chemicals. And the sugar that is often added to enhance the flavor increases the risk for tooth decay.2 ·


• Smokeless tobacco is known to cause cancers of the mouth, lip, tongue and pancreas. Users may also be at risk for cancer of the voice box, esophagus, colon and bladder, if they swallow toxins in the juice.2

April isn’t just the time that baseball comes back in full swing; it’s also Oral Cancer Awareness Month. That makes this a great time to remind you that oral cancer affects males and females, adults and kids. And even if you are not a smoker, make sure your dentist does an oral cancer exam [pulls and twists your tongue] at every visit.

Please share these facts with the teens and youth in your life. And I’d be curious to know what they think about smokeless tobacco and keeping it out of baseball? Check out the facts:

• University of Iowa
• CDC

Eradicating Early Childhood Caries

This year, the Centers for Medicare & Medicaid Services and other experts estimate that more than 300,000 children under the age of six, many from lower-income households, will suffer from Early Childhood Caries (ECC) and require hospitalization. These young children often have a mouthful of cavities and a potentially life-threatening bacterial infection that may cause them to seek hospitalization. Another 1.5 million children are considered at risk for ECC. Hospital resources are so limited that children requiring operating room care at one of the few hospital-based dental clinics commonly wait up to six months before receiving treatment. In the meantime, parents rely on powerful antibiotics to keep the infection in check. (Not much can be done about the pain).

Early Childhood Caries can be prevented. But to do this, young parents need the right information about the oral health of their babies and toddlers in time to prevent infection. Without access to preventive education and care, children may find themselves facing rampant cavities, a hospital stay, and residual lifelong disadvantages—such as malnutrition, school absences, and missed work.

We at the DentaQuest Institute are tackling this preventable, chronic childhood disease head on. Working in partnership with researchers at Children’s Hospital Boston, we have developed a clinical protocol for treating Early Childhood Caries that works with primary care providers and parents to improve treatment in the hospital and, most importantly, at home. This program is using education and case-management to help change behavior at home and the dental office. Where this treatment plan has been used, we have been able to reduce the percentage of young children (under 60 months) with new cavities by 69 percent; reduced those who needed treatment by 55 percent; and reduced reports of children with mouth pain by 50 percent. The DentaQuest Institute is now working to expand the ECC program to 10 dental clinics across 8 states—including MA, RI, OH, NY, FL, CA, WA and NY. In many ways, Early Childhood Caries is a parable for what plagues healthcare: small problems that turn into big problems because the right information and resources weren’t available in the first place to stop the progression. Preventive health care is part of the solution, but it means nothing unless you know how to use it.

Dr. Mark Doherty, Executive Director, DentaQuest Institute and Dr. Jay Anderson, Director of Quality Improvement, DentaQuest Institute

Some Good News at Massachusetts’ Medicaid Dental Program

This February, U.S. District Court Justice Rya W. Zobel ended 5-years of court oversight of the MassHealth (Medicaid) dental care program for low-income children.

This is a milestone to celebrate.

In 2005, as the conclusion to a class action lawsuit against the Commonwealth of Massachusetts, Judge Zobel ruled that Massachusetts children covered by the MassHealth dental program encountered “extraordinary difficulty” in obtaining timely dental care, and that the program violated federal Medicaid law. At the time, barely a third of eligible children Massachusetts were being treated by a dentist.

The judge ordered Massachusetts to bring the MassHealth children’s dental program into compliance with federal law and appointed a neutral Monitor, Dr. Catherine Hayes, to make sure the necessary changes were made.

Since then, Massachusetts has made significant improvements to its Medicaid dental program.

1. The state established a full time Medicaid Dental Director. Previously, there was a part-time leader/advocate for oral health.

2. The state hired a 3rd party dental management administrator (DentaQuest) to efficiently manage the processing of claims and to provide provider relations.

3. The Massachusetts legislature increased the fees paid to dentists treating Medicaid patients to a point far more comparable with the cost of providing care. Previously, dentists were reluctant to treat Medicaid patients. In 2009, the Massachusetts Dental Society set a goal to have 65 percent of its membership, including specialists, participate in the MassHealth program by the year 2013. New dentists are joining MassHealth every day.

These changes are making a difference. In 2010, 50% of the children in the program saw a dentist compared to 33% before 2005. So after reviewing the current data, Judge Zobel declared the MassHealth dental program free to function without a guardian.

In Massachusetts, there are other good news events for children’s oral health. School-based programs are now in place across the state, some state-funded and some funded by private philanthropy-- they provide dental examinations including placing dental sealants (thin plastic coatings on molars) and fluoride treatments on children’s teeth to protect against cavities. And, MassHealth is now paying pediatricians and nurse practitioners when they apply fluoride treatments and advise parents and caregivers on how they can help prevent cavities in children.

That’s not to say that there still aren’t oral health challenges in Massachusetts. Benefits are closely tied to the economy and the state’s budget. In 2010, dental benefits for adults in the MassHealth program were cut back. Adult benefits are vulnerable because states are not required to provide them, even though doing so makes good sense. Parents’ dental coverage is a good predictor of whether or not their children will obtain dental services.

Despite economic challenges, more Massachusetts children are getting good preventive dental care, and that’s great news.

Using Performance Measurement to Improve Oral Health and Patient Care

This week, I have the pleasure of recognizing my colleague Dr. Rob Compton, who was recently appointed to the American Dental Association’s (ADA) Dental Quality Alliance (DQA) Advisory Committee on Research and Development of Performance Measures.

Dr. Compton, vice president of quality improvement for DentaQuest, is a nationally recognized expert on evidence-based oral health care and cost management methodologies. In 1999, Dr. Compton opened DentaQuest’s model dental office in Massachusetts. Its goal has been to deliver cost-effective, appropriate dental care using scientific, evidence-based technologies and treatments that are tailored to the dental needs of each patient. Today, under the direction of Dr. Peter Blanchard, the DentaQuest Oral Health Center is a thriving multi-specialty dental office—and the American Dental Association’s Adult Preventive Practice of the Year. Disease management and patient education are at the heart of its business and clinical systems. And for patients, that means healthier mouths, keeping their teeth for life, and much less need to drill and fill. The DentaQuest Oral Health Center has become a model for other dental offices who want to emphasize disease management in patient care.

Dr. Compton has brought the same thoughtful care and attention to quality improvement for better patient outcomes to DentaQuest’s dental benefit plan designs. He has encouraged DentaQuest to cover new services once they have been shown to have real impact on slowing the progression of dental and gum disease, particularly in higher-risk patients. His appointment to this ADA committee is acknowledgement of DentaQuest’s role as a major stakeholder and subject matter expert in high quality oral health benefits that emphasize cost and quality and which lead to improved patient outcomes.

The DQA was established by the American Dental Association in 2008 at the request of the Center for Medicare and Medicaid Services (CMS) which is also a co-sponsor. Its mission is to advance performance measurement as a means to improve oral health and patient care and safety through a consensus-building process.

Sweet Breath and Healthy Mouths for Valentine’s Day!

A Valentine’s Day kiss is good for your health! A nice smooch will stimulate saliva production. That helps prevent tooth decay. As you get ready to pucker up, take these steps to be sure your breath is sweet.

Bad breath, or halitosis, can be embarrassing. The best way to prevent bad breath is to eliminate the potential causes. Bacteria lingering in your mouth from food or infections can create odors (and lead to decay). Brushing and flossing your teeth twice a day is a good start. Also clean your tongue –it can retain bacteria. A gentle and thorough cleaning with a tongue scraper or toothbrush can remove lingering food particles.

Foods play a role in lingering bad breath. Most people know they should avoid foods with strong smelling ingredients, like garlic or onion. Did you know that oils from some cheeses and soft drinks are absorbed into your lungs and the smell is given off in your breath for a while! Foods such as apples or oranges contain helpful enzymes that naturally remove bacteria. Crunchy foods like carrots or celery help stimulate the flow of saliva which also helps get rid of odor causing bacteria. Chewing on parsley or mint leaves can also help freshen your breath.

Sometimes the cause of halitosis is a dry mouth and not food. Saliva is a natural cleaner for the mouth, helping to remove food and other particles that may cause halitosis. Some people don’t produce enough saliva to keep their mouth wet.

A side-effect of some medications, such as antihistamines, tranquilizers, and various blood pressure medicines, may be a decrease in the flow of saliva (in children and adults). Diseases like Sjögren's Syndrome, HIV/AIDS, diabetes, and Parkinson's disease can also cause dry mouth. Cancer patients may find salivary glands are impaired after exposure to radiation treatment. Chemotherapy drugs can make saliva thicker, leaving the mouth feeling sticky and dry. If any of these symptoms sounds familiar to you, talk to your dentist and physician. They may be able to suggest alternative medications or prescribe a medicine that helps your salivary glands work better.

People experiencing dry mouth can stimulate the flow of saliva with sugarless gum or candy. It is also a good idea to drink six to eight glasses of water a day. Try to avoid alcohol and tobacco; both are “drying agents” which remove saliva from your mouth. Ultimately that can lead to an increase in bad breath and a higher tendency to tooth decay.

Adding a mouthwash to your daily care routine can help sweeten your breath. Select alcohol-free products -- they are less drying. And, pick a mouthwash with fluoride; it can help prevent cavities by strengthening your teeth.

Happy Valentine’s Day! Brush, floss, and rinse before you pucker up!