‘Points of Light’ Presented to the Michigan Oral Health Coalition January 30, 2008

Enduring Goals of the Organized Dental Community : Improve the Oral Health of the Citizenry. Improve the Oral Health of the Citizenry. Improve Access to Oral Health Care. Improve Access to Oral Health Care. Improve the effectiveness of Oral Health Care delivery systems. Improve the effectiveness of Oral Health Care delivery systems. Improve the Oral Health of Children, (MAPD). Improve the Oral Health of Children, (MAPD).

Defining the Issue: Michigan ~ 130,000 live births/year ~ 130,000 live births/year Nationally, 15 to 17 million children without access to oral health care (increasing). Nationally, 15 to 17 million children without access to oral health care (increasing). ~900K of Michigan’s 2.5 million kids are Medicaid eligible, (increasing). ~900K of Michigan’s 2.5 million kids are Medicaid eligible, (increasing). Decay rates are on the rise in pre-school children (4% in last 10 years; CDC, 07) Decay rates are on the rise in pre-school children (4% in last 10 years; CDC, 07) 58% of Michigan 3 rd Graders have caries. 58% of Michigan 3 rd Graders have caries.

Dentistry in Michigan: By the Numbers 82 pediatric dentists of which an estimated 84% (~70) see 1 year olds. 82 pediatric dentists of which an estimated 84% (~70) see 1 year olds general dentists, (MDA, 08) 4630 general dentists, (MDA, 08) Evidence suggests that Pediatric Dentist migrate to upper income communities. Evidence suggests that Pediatric Dentist migrate to upper income communities. There will never be enough Pediatric Dentists and most general dentists are not comfortable treating very young children. There will never be enough Pediatric Dentists and most general dentists are not comfortable treating very young children.

Good doctors treat disease. Great doctors prevent disease.

Justifying IOH: General Overview Demographics of the Professional Communities, (Medical and Dental). Demographics of the Professional Communities, (Medical and Dental). Cariology that defines: Primary Prevention vs. Secondary Prevention that create timing dependant opportunities. Cariology that defines: Primary Prevention vs. Secondary Prevention that create timing dependant opportunities. Economic Implications that define the impact on dental practices and lower the cost of managing low SES populations. Economic Implications that define the impact on dental practices and lower the cost of managing low SES populations. Culminating in a new ‘Best Practice’. Culminating in a new ‘Best Practice’.

Addressing the Needs of Michigan’s Infants Currently: 130,000 live births =>1800 new patients/pediatric dentist/year. Currently: 130,000 live births =>1800 new patients/pediatric dentist/year. If all Pediatric Dentists accepted infants = ~1500 infants/year. If all Pediatric Dentists accepted infants = ~1500 infants/year. If all Dentists accepted infants = ~27 infants/year. (If only half see infants = ~ 60 infants/year) If all Dentists accepted infants = ~27 infants/year. (If only half see infants = ~ 60 infants/year) Conclusion: This is possible! Conclusion: This is possible!

Advocacy: Improving the Oral Health of the entire community. (Not just low SES, because low SES will benefit along with the community) Improving the Oral Health of the entire community. (Not just low SES, because low SES will benefit along with the community) Enacting the ‘Atlas Concept’: Taking responsibility for all patients within a community regardless of the fact that they will never walk into your practice. Enacting the ‘Atlas Concept’: Taking responsibility for all patients within a community regardless of the fact that they will never walk into your practice.

Advocacy Goals: To improve the Health and Oral Health of the Citizenry, (Pan SES). To improve the Health and Oral Health of the Citizenry, (Pan SES). To Create behavioral transitions in arenas of impact: Dentistry, Medicine, Legislative, General Public. To Create behavioral transitions in arenas of impact: Dentistry, Medicine, Legislative, General Public. To have infants presented to a ‘Dental Home’ for primary prevention rather than surgical intervention. To have infants presented to a ‘Dental Home’ for primary prevention rather than surgical intervention.

The Challenge of providing care to Low SES: Medicaid covers 25% of children and 33% of infants Medicaid covers 25% of children and 33% of infants Nationally, 27 million children are covered by Medicaid. (Michigan: 1:1.5) Nationally, 27 million children are covered by Medicaid. (Michigan: 1:1.5) Economic distress is increasing, impacting middle income families. These are NOT ‘Welfare Deadbeats’! Economic distress is increasing, impacting middle income families. These are NOT ‘Welfare Deadbeats’!

Relationships are not about obligation. Relationships are about opportunity. This tenant pertains to all relationships. This tenant pertains to all relationships. If you not looking at relationships from this perspective, you are really missing the point of relationships altogether. If you not looking at relationships from this perspective, you are really missing the point of relationships altogether. What opportunities can you create for your patients and your community? What opportunities can you create for your patients and your community?

Caring for our poorest and most vulnerable: Consider that children seen early are less costly to care for over time. Consider that children seen early are less costly to care for over time. Consider that, with very young patients, preventing decay is far easier than restoring teeth. Consider that, with very young patients, preventing decay is far easier than restoring teeth. Consider that children with less complex restorative needs are less likely to require referral to a pediatric dentist. Consider that children with less complex restorative needs are less likely to require referral to a pediatric dentist.

Involvement vs. Commitment: The difference between involvement and commitment is like an eggs & ham breakfast. The chicken was ‘involved’, the pig was ‘committed’!

Ongoing Efforts : Varnish! Michigan Varnish! Michigan Adopt-a-Head Start program Adopt-a-Head Start program Early Head Start & Head Start Programs Early Head Start & Head Start Programs PA 161 PA 161 Community Dental Health Coordinator Community Dental Health Coordinator

Ideal Dental Care: ‘Dental Home’ Ongoing relationship between the dental office and the family. Ongoing relationship between the dental office and the family. Care that is Comprehensive Care that is Comprehensive Care that is Accessible Care that is Accessible Care that is family-centered Care that is family-centered Care that is Culturally-effective Care that is Culturally-effective Care that you would want for your child Care that you would want for your child

Meta-Questions: How do we improve the oral health of very young children? How do we improve the oral health of very young children? How do we lower the cost of providing oral health care to low SES populations? How do we lower the cost of providing oral health care to low SES populations? How do improve the oral health of the community at large? How do improve the oral health of the community at large? How do we best utilize our workforce? How do we best utilize our workforce?

What is ‘Points of Light’?

Organizational Transition: Changing Behaviors on a large scale MavensBrokersPragmatistsConservatives Tipping Point # of Adopters (early adopters)(late adopters)

‘Social Proof’ A behavior that has reached a ‘tipping point’ within a given population group resulting in mass adoption and participation, (Herd Behavior). i.e., stock runs, fads, voting tends, drug use, suicides, movie attendance, etc….

Organizations of Interest: The General Public: Parents & children. The General Public: Parents & children. Dentistry: General Dentists, Pediatric Dentists, Dental Hygienists, etc… Dentistry: General Dentists, Pediatric Dentists, Dental Hygienists, etc… Medicine: Pediatricians, Family Practice, Nurse Practitioners, Physician Assistants, etc… Medicine: Pediatricians, Family Practice, Nurse Practitioners, Physician Assistants, etc… Legislative Bodies: Federal, State & local. Legislative Bodies: Federal, State & local. Educational Institutions: Pre & Post Doctoral Programs in Medicine and Dentistry. Educational Institutions: Pre & Post Doctoral Programs in Medicine and Dentistry.

Organizations of Impact DentistryMedicine General Public Education Legislators

“Points of Light” Identify a ‘Point Dentist’ within a community. Identify a ‘Point Dentist’ within a community. Establish a dental provider network, ‘EPII’. Establish a dental provider network, ‘EPII’. Provide the EPII list to Pediatric Medical Providers. Provide the EPII list to Pediatric Medical Providers. Interact with medical providers, ‘ECTAMR’. Interact with medical providers, ‘ECTAMR’. Educate medical providers, AAP policy. Educate medical providers, AAP policy. Operationalize ‘Points of Light’ locally. Operationalize ‘Points of Light’ locally. Operationalize ‘Points of Light’ state wide. Operationalize ‘Points of Light’ state wide. Infant Dental Exams become a ‘Social Proof’. Infant Dental Exams become a ‘Social Proof’.

Three Levels of Advocacy : Bronze Level: Initiating an Infant Oral Health program in your practice. Bronze Level: Initiating an Infant Oral Health program in your practice. Silver Level: Instigating ‘Infant Oral Health’ Programs in your community, (EPII). Silver Level: Instigating ‘Infant Oral Health’ Programs in your community, (EPII). Gold Level: Developing a multi-community project that impacts the entire state over time, (Points of Light). Gold Level: Developing a multi-community project that impacts the entire state over time, (Points of Light).

“Life has taught us that love does not consist in gazing at each other but in looking outward together in the same direction” -Antonio de Saint- Exupéry

Question/Comments

MOHC, Thank You!!