New Opportunities for Integrating Oral Health into the Medical Setting No Tooth Left Behind… Joyce Starr Massachusetts Department of Public Health

I have no relevant financial relationships with the manufacturer(s) of any commercial product(s) and/or provider(s) of commercial services discussed in this CME activity.

Burden of Oral Disease in Massachusetts Tooth decay is the most common chronic disease of childhood –42% of low income Kindergarteners have experienced tooth decay –26% of low income Kindergarteners have untreated tooth decay

Oral Health Prevention Strategies Not everyone has access to community water fluoridation (CWF) –140 communities (65 percent of the state’s population) offer the health benefits of CWF Not everyone has access to regular professional dental care –1.5 million (25 percent) of residents do not have dental insurance –Just 2,152 dentists were MassHealth providers as of 7/31/11 –Limitations to MassHealth dental benefits for those 21 years of age and older

Fluoride Varnish Prevents tooth decay by about 30 percent –Reduces disparities and the burden of dental disease Remineralizes early tooth decay –Eliminating/reducing dental treatment costs

Why Medical Professionals? Few dentists see children enrolled in MassHealth –Just 2,152 dentists were providers as of 7/31/11 Despite recommendations that children see a dentist by 12 months of age, few dentists treat young children aged 1-3 –>50% of MA dentists see children under 3 years of age Primary care medical providers are seen earlier and more frequently than dentists –Children have 13 well child visits from birth to age 5 45 states allow medical professionals to administer the varnish

Organizations and Agencies Supporting Fluoride Varnish American Academy of Pediatrics American Academy of Pediatric Dentistry American Association of Public Health Dentistry American Dental Association American Public Health Association Association of State and Territorial Dental Directors US Centers for Disease Control and Prevention

MassHealth Child Members (0 to 21) Receiving Fluoride Varnish SFY11: n=566,194 SFY12: n=563,247 FY 2011FY st Quarter Members: 0-21 years (Medical Provider) 2, Amount Paid $60,788$23,608 Unduplicated Members: 0-21 years (Medical Provider) 2, Amount Paid $59,912$23,426

FLUORIDE VARNISH UPDATE

105 CMR (K) (April 13, 2012) Non-licensed individuals, authorized by a registered individual practitioner registered pursuant to 105 CMR , may administer topical fluoride varnish or comparable fluoride agent approved by the Department for topical administration to prevent dental caries, provided that: –Non-licensed individual must successfully complete a MDPH approved training and any Department mandated refresher courses in proper administration, storage, handling, record keeping and reporting of adverse reactions; –FV must be administered in accordance with the order of a registered individual practitioner; –Non-licensed individual is supervised by a registered individual practitioner or his/her designee.

Medical Providers Who may administer fluoride varnish include: –Physician –Physician Assistant –Nurse Practitioner –Registered Nurse –Licensed Practical Nurse –Non-Licensed Individual (Medical Assistant)

BLOCK Oral Disease Toolkit –Oral Health 101 (CD 1) –Multi-lingual Anticipatory Guidance (CD 2) –A to Z Guide on Oral Health Implications of Systemic Diseases and Conditions –Examination Room Resources –Poster

BLOCK Trainings Established in 2009 In Office or Online –~60 minutes Includes information on –Oral Health 101 –Caries Risk Assessment –Fluoride Varnish –Tools

MassHealth reimburses BOTH medical AND dental providers to administer fluoride varnish to a member under 21 years of age who is moderate to high-risk for tooth decay MassHealth will reimburse a dental provider in addition to a medical provider one time per quarter to administer fluoride varnish to a member under age 21. Fluoride varnish costs no more than $2 per unit. MassHealth reimburses both the medical and dental provider $26 per administration. MassHealth requires a caries risk assessment and oral health education be provided to the member or member’s parent/guardian at the time the FV is administered. Fluoride Varnish Reimbursement

A New Partnership to Consider…

Public Health Dental Hygienist January 2009/August 2010 At least 3 years experience Medical Offices and Clinics, Homebound, WIC, etc. Provide all preventive dental services Must have dentist(s) for referrals May be reimbursed directly by MassHealth

Partnering with a PHDH The PDHD could be a valuable resource to child health providers by reducing barriers to implementing the AAP recommendations and supporting fluoride varnish administration. - Dental screenings - Caries Risk Assessments - Anticipatory Guidance -Oral Hygiene Instruction -Interaction with Medications -Chronic Disease Management -Proper Nutrition - Fluoride Varnish Administration - Establishing a Dental Home

Resources BLOCK Oral Disease Training and Toolkit MDPH SEAL and Dental Sealants Fluoride Varnish in the Medical Settings Information on Community Water Fluoridation Other Fact Sheets and Resources Public Health Dental Hygienists

Office of Oral Health 250 Washington Street Boston, MA