Committed to Health Equity

By: Ralph Fuccillo, DentaQuest Chief Mission Officer

DentaQuest’s mission of improving the oral health of all includes an obligation to ensure equitable access to oral health care and prevention.  We believe everyone should have the opportunity to live a healthy life regardless of their background.

During April, the U.S. Office of Minority Health recognizes National Minority Health Month to raise awareness about health disparities that affect  people across this nation and to familiarize the public with the healthcare law's groundbreaking policies to reduce disparities and achieve health equity. 

This includes oral health. Every day, millions in America do not receive the oral health care they need for various reasons, including cultural, ethnic or language barriers, lack of oral health education, no insurance access, age or medical issues, geographic and transportation obstacles, and even roadblocks to accessing qualified oral health professionals.

Whatever the reason, the costs of inequity – with 51 million school hours and 164 hours of work missed due to due to dental problems and visits – are staggering.

As a leading U.S. oral health company, DentaQuest is in a unique position to make a difference. We serve 18 million individuals from all walks of life through Medicaid, CHIP, Medicare Advantage, commercial and individual plans. We make a particular effort to reach those who are most in need by:

• Sponsoring outreach programs focused on education and prevention through community ambassadors and local languages;
• Supporting  programs that provide dental care for adults and children with intellectual and physical disabilities;
• Providing customer care in multiple languages for our members;
• Ensuring safety net dental programs in community health centers across the U.S. are prepared to provide for the large numbers of individuals who will become eligible for dental services through the ACA, including 20 million children through the essential pediatric dental benefit, in 2014;
• Co-chairing the Region 1 Health Equity Council and making sure oral health is addressed ; and
• Advancing local leaders in 25+ states through the Oral Health 2014 Initiative, which was created to ensure oral health is part of state and community health policy.

All of us at DentaQuest are committed to removing barriers to care by emphasizing prevention and celebrating differences among our colleagues and community partners.

To learn more about National Minority Health Month and find events in your communities to become involved in health equity, visit: http://minorityhealth.has.gov/actnow/.

Ensuring All Children Have Access to Dental Care

By: DentaQuest Government Affairs and Policy Team

One of the key oral health elements of the Affordable Care Act (ACA) is the inclusion of pediatric dental as an essential health benefit (EHB). Recognizing the importance of having this benefit, HealthReformGPS recently posted a brief about how exchanges will offer pediatric dental benefits. We applaud the attention to this important benefit, and would like to add a few statements to further clarify the issue.

The HealthReformGPS brief points out there are two ways pediatric benefits will be offered: through a comprehensive plan that offers both medical and dental or through a stand-alone dental plan.  

Inside State and Federal Marketplaces

Under ACA, if an exchange offers stand-alone dental plans, qualified health plans on that exchange are not required to offer pediatric dental benefits. There is the assumption among many people that when a stand-alone dental plan is offered, the exchanges will “package” the medical and pediatric dental plans together, so the purchaser ends up with both. While this may be an option on some state-based exchanges, it is not the case universally.  

In fact, according to guidance from the United States Department of Health and Human Services (HHS),

a) the pediatric dental benefit is not required to be purchased by those shopping on an exchange, even by those with eligible children, and 

b) the Federally-Facilitated Marketplaces operated by HHS will not be able to support the offer of bundled medical and pediatric dental plans, at least in the first year. 

The unfortunate consequence is that people may purchase a qualified health plan on an exchange and not get the important pediatric dental benefit coverage.  This runs counter to intent of the ACA and its goal of ensuring all children have access to pediatric dental benefits. 

Outside the Marketplaces

Ironically, when a health plan is purchased outside of an exchange, the ACA requires that the pediatric dental benefit be included. The only way that a health plan can opt not to include the pediatric dental benefits is if the purchaser has already purchased the pediatric dental benefits from an exchange-certified stand-alone dental plan. The unfortunate consequence of the law as it is currently written is that low-income, childless adults will also be required to purchase a pediatric dental benefit that they cannot use. While we agree that families with eligible children should be enrolled in pediatric dental benefits, we hope the law is amended to exclude childless adults from this requirement. 

Tax Credits

The HealthReformGPS brief also discussed the credits available to low-income families to purchase insurance through the exchanges. The credit available to families will be calculated based on the premium associated with all 10 EHBs, including dental. When dental is purchased separately, the amount of the credit will be allocated first to the Qualified Health Plan and then to the dental plan. 

Essential is Essential

We believe the most important piece on which to focus the discussion is ensuring that all children have pediatric dental coverage whether their plan is purchased on or off the exchanges.  That is the intent of the ACA. Tooth decay is the most common chronic illness among school-age children. It affects one in every four children, yet it is almost entirely preventable when children have access to care and preventive education. The rate of tooth decay among low-income children is more than twice that for children with more income (31 percent versus 14 percent), according to the Kaiser Family Foundation. 

Clearly, it is imperative that all children have access to dental benefits. The ACA is a major step in making this happen by including pediatric dental and vision as an essential health benefit. That’s not exactly how the rules are working today. With our colleagues in the dental community, we are working with federal policymakers to ensure that all children have this benefit.

Conversations with your Dentist About Office Safety

By: Dr. John Luther, Chief Dental Officer, DentaQuest

Following the recent news about unsanitary conditions in one Oklahoma dental office, you may have wondered – if even for a second—what your dental office is doing to ensure you are receiving the best and safest dental care. Healthy teeth and gums are essential to your overall health. Dentists take their role to keep you healthy very seriously; this includes proper infection control. Your safety and well-being are their priority.

At DentaQuest, we encourage patients to have an open dialogue with their dental care team about their care; sanitation and safety concerns should be part of that. Often, as patients we become so wrapped up in the services we are receiving that we forget to ask questions to make us feel comfortable about the care. It's okay to ask your dentist about sanitary procedures of his or her office.

Here are questions to discuss with your dentist prior to your service:

• What is the sterilization process? How are non-disposable items, like the dental tools, cleaned and sterilized between patients?
• Are dental anesthetics provided using sterile, single-use needles and cartridges of anesthetic? Are these items properly discarded after each patient?
• If IV medications are needed, are the medications from single-dose vials or from multi-dose vials? How do they manage sterile procedures when using multi-dose vials? 
• Does your dentist follow the evidence-based infection control precautions outlined by the Centers for Disease Control and Prevention?
• Are all procedures requiring licensure or certification provided only by licensed professionals?

And here are some important things you can look for:

• Are the dental instruments that will be used during your visit maintained in sterile pouches until they are used? The office staff may unwrap them just prior to your entering the room while setting up for your procedure so confirm that they were sterilized and protected prior to your arrival.
• Are disposable items like needles or gauze placed in special bags or containers?
• Does the dental staff use appropriate protective garb such as gloves, masks, gowns and eye wear?  Ask how they clean or dispose of these items between patients.

The case in Oklahoma is unfortunate. However, it is not at all representative of the vast majority of dental offices that adhere to the highest standards of sanitation and infection control.

The Great Water Fluoridation Debate & The Role of Oral Health

By Dr. Michael Monopoli, Director of Policy and Programs, DentaQuest Foundation

Water fluoridation, or the controlled adjustment of fluoride levels in a community water supply to reduce tooth decay, continues to spark debate across the nation as decision makers and constituents face tight budget and priority shifts. In the debate on whether to eliminate fluoride from community water sources, the effectiveness of water fluoridation to improve oral health has played a major role. Recently, researchers from University of North Carolina (UNC) School of Dentistry and University of Adelaide issued a new study in the Journal of Dental Research that is changing the conversation.

This population-level study found adults who spent more than 75 percent of their lifetime living in a community with water fluoridation had significantly less tooth decay than those who had lived in one for less than 25 percent of their lifetime. Although fluoridation was previously thought to primarily benefit children who were raised drinking fluoridated water, this study shows the benefits for all ages. We hope this evidence, along with other current findings, will strengthen our understanding of the preventive effects of fluoride on oral health and reinforce the need for communities to continue to invest in keeping fluoride in community water.

DentaQuest stands behind water fluoridation as an effective and safe way to prevent dental decay. The DentaQuest Foundation is supporting community-based strategies to promote community water fluoridation through our Community Water Fluoridation Initiative. We believe, along with the Centers for Disease Control and Prevention,  the American Dental Association, and many other organizations, that community water fluoridation is one of the most cost-effective means of preventing dental caries.

As an enterprise committed to improve the oral health of all, we are concerned by the growing number of communities debating whether to end long-term community water fluoridation programs, reversing a generation of improvements to America's oral health. It is penny-wise and pound foolish. Tooth decay is the most prevalent chronic disease in children; it is 5 times more common than asthma. And it’s not just children. 51 million adults suffer from mouth pain at least twice a year. Americans spend more than $106 billion (2010) on oral care;  30 million don’t get treatment. That includes 1 in 5 children.  All this despite the fact that dental disease is largely preventable! Community water fluoridation is an important first step.

Advocate in your community for water fluoridation. To learn more and get the facts on water fluoridation’s impact on oral health, visit http://www.ilikemyteeth.org/.

Don’t Fear the Dentist (Or Your Kids Will, Too)

Dr. John Luther, DDS, Chief Dental Officer of DentaQuest

A recent study conducted by scientists at the Rey Juan Carlos University of Madrid highlights the important role that parents play in the transmission of dentist fear in their family. The authors confirmed that the higher the level of dentist fear or anxiety in one family member, the higher the level in the rest of the family.

The study highlights an important notion: Many parents who have had negative experiences at the dentist when they were young do not want to subject their own children to the dentist office; they believe they are protecting their children by keeping them away from the dentist.

This could not be further from the truth! Dentists encourage parents to bring their children in as early as after they have their first tooth-- before there are problems. That way parents can learn about eating in ways that keep teeth healthy, and about proper dental care at home and how to support it as their children grow up. Parents play a very important role in encouraging their children to practice effective oral health habits into adolescence and adulthood – potentially saving them a lifetime of pain and infection.

With dental disease ranked as the most common chronic disease in children, spotting dental disease early in children and making sure they get preventive care are very important. Parents know when their child is okay and when something is not right. Be proactive —make sure dental visits are a part of your child’s routine. Make sure you have a family dentist who knows your child as he or she grows up. Find out if your community has school programs that offer cleanings, fluoride treatments and dental education.

By removing negativity surrounding the dentist for children, parents dramatically lessen the likelihood of dental disease, avoid unnecessary dental emergency room trips and missed school days, and most of all, create a foundation for a lifetime of good health for their child.

Besides, most dentists are really nice people!

What is the Role of Dental Benefits in Healthcare Reform?

By Steve Pollock, DentaQuest Chief Operating Officer

Starting on January 1, 2014, public healthcare exchanges will be required to offer pediatric dental benefits to individuals and small groups, meaning as many as 20 million children will have new benefit plans and, consequently, better access to important dental care—many for the first time in their lives. 

At DentaQuest, we think this is great. The oral health of our children is an important, far-reaching issue, and one that hasn’t always gotten the attention it should. Consider this: dental disease is the most common chronic disease among children – five times more common than asthma. Children lose 52 million school hours each year because of dental disease. Poor oral health can affect nutrition, speech development, and learning during critical developmental years, putting many children at a serious disadvantage for life. None of this should be the case, because dental disease is almost 100% preventable.

The details of the Affordable Care Act (ACA) can be confusing, to say the least, and many aspects of the new law are still being defined. DentaQuest has been monitoring healthcare reform closely, and developed these questions and answers to help keep you informed of how the law impacts dental coverage. Here are some basics that you should know. 

Q: Is dental coverage an essential benefit?
A: There are ten essential benefits. Pediatric dental and vision coverage is one of the ten.

Q: How is pediatric defined?
A: The ACA defines “pediatric” as up to 19 years of age. At DentaQuest, we cannot stress enough the importance of including child-specific services in the essential health benefits package. This is a crucial step toward improving lifelong oral health.

Q: What is covered by the pediatric dental benefit?
A: The U.S. Department of Health and Human Services (HHS) gives states two options for defining the pediatric component of the essential health benefit. Pediatric dental benefits can mirror (a) those offered through the state Children’s Health Insurance Program (CHIP) or (b) those offered through the largest Federal Employees Dental and Vision Insurance Program (FEDVIP).  Today, both of these programs cover dental visits for children including preventive services such as routine dental exams, x-rays, sealants, fluoride varnish treatments, restorative services such as fillings, and other necessary dental services. 

Q: What about adults?
A: Adult dental coverage is not one of the ten essential health benefits mandated in ACA. If your current health plan doesn’t offer dental benefits, you have the option of buying a dental plan separately. 

Q: What is “the exchange”?
A: Healthcare exchanges are new virtual marketplaces where consumers can go to shop for and compare qualified health plans and qualified dental plans. All plans offered on a public exchange must offer the essential health benefits outlined by the ACA. Exchanges ensure that pediatric dental and vision care are offered to anyone purchasing benefits, thereby expanding access to dental care for all eligible children.

Q: When will people sign up for benefits through exchanges?
A: Open enrollment is scheduled to begin in October 2013, with new members coming on board on January 1, 2014. 

DentaQuest’s in-house healthcare reform and government relations staff members are closely monitoring developments related to the ACA. Watch this blog for updates on new details as we learn them.

Swish Away Dental Decay

By Dr. Linda Vidone, Dental Director of DentaQuest

Tubes of toothpaste, toothbrushes and dental floss have long been considered the tools for keeping your pearly whites healthy and clean. But more often than not, many of us forget a key component in keeping our teeth in tip top shape: mouthrinse. Mouthrinse, also known as mouthwash, is a tool that has often been considered a cosmetic item, its purpose to freshen your breath and leave you with a clean feeling.

However, there is a new version of mouthwash currently on the market called the therapeutic mouthrinse. Therapeutic mouthrinse has two key components that separate it from other mouthwashes. It is composed of fluoride and antimicrobial agents which play a big role in keeping your chompers strong and healthy. The fluoride fights cavities and prevents decaying, and the anti-microbial agents help gingivitis and plaque to the curb.

Although it may seem like a do-it-all product, mouthrinse is not a substitute for flossing or brushing your teeth twice a day; however, it can be a useful addition to your daily oral hygiene routine.

You might be wondering what the difference is between cosmetic mouthrinse and therapeutic mouthrinse. Cosmetic mouthrinses may temporarily reduce or control bad breath; however, they do not reduced cavities, gingivitis or plaque. On the other hand, fluoride and antimicrobial agents in therapeutic mouthrinses may help reduce cavities, gingivitis, plaque and bad breath in children and adults of all ages.

By removing the plaque that is left behind after brushing and flossing, therapeutic mouthrinses helps prevent gingivitis, an early stage of gum disease, and periodontitis, a type of advanced gum disease. This was seen in a recent study released by the Academy of General Dentistry, which found greater declines in both plaque and gingivitis among people using therapeutic germ-killing mouthrinse than among those using placebo mouthrinses.

Plaque declined 26 percent among those using the antiseptic mouthwash than among those using a placebo mouthrinse. Among testers whose teeth had plaque problems at the start of the study, 51 percent of those who cleaned with the antiseptic mouthrinse had less plaque at the end of the study compared to 12 percent of those who cleaned with the placebo mouthrinse. Ninety-eight percent (98%) of people using the antiseptic mouthrinse showed measurable improvement in gingivitis compared to only 30 percent of the others.

Interested? During your next exam, talk to your oral health professional about adding a mouthrinse to your daily routine. Happy Swishing!

Study Source: January/February issue of General Dentistry (www.agd.org/gdabstracts).