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First Dental Home Project.doc
First Dental Home Project.doc
First Dental Home Project.doc
First Dental Home Project.doc
First Dental Home Project.doc
First Dental Home Project.doc
First Dental Home Project.doc
First Dental Home Project.doc
First Dental Home Project.doc
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  • 1. Health and Human Services Commission FREW Medical and Dental Strategic InitiativesProposal Attachment B: First Dental Home The United States Surgeon General identified tooth decay as the most common chronic childhood disease in his 2000 Report, “Oral Health in America.” Tooth decay is five times more common than asthma. In Texas, less than 1 in 5 children between 6 to 36 months of age who are covered by Medicaid access dental care until dental caries are severe or the child experiences other medical conditions. Dental caries is defined as “an infectious, transmissible disease in which bacterial by-products (i.e., acids) dissolve the hard surfaces of the teeth.” Early childhood caries (ECC) is “the presence of one or more decayed, missing (due to caries), or filled tooth surfaces in any primary teeth in a child 71 months of age or younger.” i According to the American Academy of Pediatrics (AAP), ECC can affect a child’s growth, may lead to malocclusion, could result in significant pain, and potentially life threatening swelling.ii Research shows that children who start having dental caries very early, will continue to develop and be more prone to additional dental health issues or procedures, such as restorative dental care in an operating room. The estimated cost of hospitalization for treatment of ECC is $2,000 per case.iii Some states, such as Washington, show that certain children with baby bottle tooth decay, also known as ECC, were treated in hospitals at a cost between $3,000- $5,000 per child in 1997.iv Another study in 2000 from Pediatric Dentistry concluded that after two years, 79 percent of children with ECC had developed Background: additional tooth decay, compared with 29 percent of children without cavities at the onset.v If proper oral hygiene is followed in early childhood, the incidence of caries can be reduced significantly later in life. A recent study found that over five years, Medicaid children who had their first preventive dental visit by one year of age incurred dental costs almost 40 percent lower than children whose first preventive visit was after one year of agevi. Fluoride is a safe and effective way to prevent and control dental caries.vii A child can receive fluoride through a number of sources including community water supply, toothpaste and varnish to name a few. The application of fluoride varnish is an effective method to use with small infants because it does not require special equipment, dental cleaning is not required prior to application, application is easy and requires little time, and the procedure is safe and well tolerated by infants and children with special health care needs. The AAP and the American Pediatric Dentistry Association have developed policies to address and support the establishment of a First Dental Home. 1 of 9 October 2007
  • 2. Health and Human Services Commission FREW Medical and Dental Strategic InitiativesProposal Attachment B: First Dental Home The United States Surgeon General identified tooth decay as the most common chronic childhood disease in his 2000 Report, “Oral Health in America.” Tooth decay is five times more common than asthma. In Texas, less than 1 in 5 children between 6 to 36 months of age who are covered by Medicaid access dental care until dental caries are severe or the child experiences other medical conditions. Dental caries is defined as “an infectious, transmissible disease in which bacterial by-products (i.e., acids) dissolve the hard surfaces of the teeth.” Early childhood caries (ECC) is “the presence of one or more decayed, missing (due to caries), or filled tooth surfaces in any primary teeth in a child 71 months of age or younger.” According to the American Academy of Pediatrics (AAP), ECC can affect a child’s growth, may lead to malocclusion, could result in significant pain, and potentially life threatening swelling. Research shows that children who start having dental caries very early, will continue to develop and be more prone to additional dental health issues or procedures, such as restorative dental care in an operating room. The estimated cost of hospitalization for treatment of ECC is $2,000 per case. Some states, such as Washington, show that certain children with baby bottle tooth decay, also known as ECC, were treated in hospitals at a cost between $3,000- $5,000 per child in 1997. Another study in 2000 from Pediatric Dentistry concluded that after two years, 79 percent of children with ECC had developed Background: additional tooth decay, compared with 29 percent of children without cavities at the onset. If proper oral hygiene is followed in early childhood, the incidence of caries can be reduced significantly later in life. A recent study found that over five years, Medicaid children who had their first preventive dental visit by one year of age incurred dental costs almost 40 percent lower than children whose first preventive visit was after one year of age. Fluoride is a safe and effective way to prevent and control dental caries. A child can receive fluoride through a number of sources including community water supply, toothpaste and varnish to name a few. The application of fluoride varnish is an effective method to use with small infants because it does not require special equipment, dental cleaning is not required prior to application, application is easy and requires little time, and the procedure is safe and well tolerated by infants and children with special health care needs. The AAP and the American Pediatric Dentistry Association have developed policies to address and support the establishment of a First Dental Home. 2 of 9 October 2007
  • 3. Health and Human Services Commission FREW Medical and Dental Strategic InitiativesProposal Attachment B: First Dental Home The United States Surgeon General identified tooth decay as the most common chronic childhood disease in his 2000 Report, “Oral Health in America.” Tooth decay is five times more common than asthma. In Texas, less than 1 in 5 children between 6 to 36 months of age who are covered by Medicaid access dental care until dental caries are severe or the child experiences other medical conditions. Dental caries is defined as “an infectious, transmissible disease in which bacterial by-products (i.e., acids) dissolve the hard surfaces of the teeth.” Early childhood caries (ECC) is “the presence of one or more decayed, missing (due to caries), or filled tooth surfaces in any primary teeth in a child 71 months of age or younger.” According to the American Academy of Pediatrics (AAP), ECC can affect a child’s growth, may lead to malocclusion, could result in significant pain, and potentially life threatening swelling. Research shows that children who start having dental caries very early, will continue to develop and be more prone to additional dental health issues or procedures, such as restorative dental care in an operating room. The estimated cost of hospitalization for treatment of ECC is $2,000 per case. Some states, such as Washington, show that certain children with baby bottle tooth decay, also known as ECC, were treated in hospitals at a cost between $3,000- $5,000 per child in 1997. Another study in 2000 from Pediatric Dentistry concluded that after two years, 79 percent of children with ECC had developed Background: additional tooth decay, compared with 29 percent of children without cavities at the onset. If proper oral hygiene is followed in early childhood, the incidence of caries can be reduced significantly later in life. A recent study found that over five years, Medicaid children who had their first preventive dental visit by one year of age incurred dental costs almost 40 percent lower than children whose first preventive visit was after one year of age. Fluoride is a safe and effective way to prevent and control dental caries. A child can receive fluoride through a number of sources including community water supply, toothpaste and varnish to name a few. The application of fluoride varnish is an effective method to use with small infants because it does not require special equipment, dental cleaning is not required prior to application, application is easy and requires little time, and the procedure is safe and well tolerated by infants and children with special health care needs. The AAP and the American Pediatric Dentistry Association have developed policies to address and support the establishment of a First Dental Home. 3 of 9 October 2007
  • 4. Health and Human Services Commission FREW Medical and Dental Strategic InitiativesProposal Attachment B: First Dental Home The United States Surgeon General identified tooth decay as the most common chronic childhood disease in his 2000 Report, “Oral Health in America.” Tooth decay is five times more common than asthma. In Texas, less than 1 in 5 children between 6 to 36 months of age who are covered by Medicaid access dental care until dental caries are severe or the child experiences other medical conditions. Dental caries is defined as “an infectious, transmissible disease in which bacterial by-products (i.e., acids) dissolve the hard surfaces of the teeth.” Early childhood caries (ECC) is “the presence of one or more decayed, missing (due to caries), or filled tooth surfaces in any primary teeth in a child 71 months of age or younger.” According to the American Academy of Pediatrics (AAP), ECC can affect a child’s growth, may lead to malocclusion, could result in significant pain, and potentially life threatening swelling. Research shows that children who start having dental caries very early, will continue to develop and be more prone to additional dental health issues or procedures, such as restorative dental care in an operating room. The estimated cost of hospitalization for treatment of ECC is $2,000 per case. Some states, such as Washington, show that certain children with baby bottle tooth decay, also known as ECC, were treated in hospitals at a cost between $3,000- $5,000 per child in 1997. Another study in 2000 from Pediatric Dentistry concluded that after two years, 79 percent of children with ECC had developed Background: additional tooth decay, compared with 29 percent of children without cavities at the onset. If proper oral hygiene is followed in early childhood, the incidence of caries can be reduced significantly later in life. A recent study found that over five years, Medicaid children who had their first preventive dental visit by one year of age incurred dental costs almost 40 percent lower than children whose first preventive visit was after one year of age. Fluoride is a safe and effective way to prevent and control dental caries. A child can receive fluoride through a number of sources including community water supply, toothpaste and varnish to name a few. The application of fluoride varnish is an effective method to use with small infants because it does not require special equipment, dental cleaning is not required prior to application, application is easy and requires little time, and the procedure is safe and well tolerated by infants and children with special health care needs. The AAP and the American Pediatric Dentistry Association have developed policies to address and support the establishment of a First Dental Home. 4 of 9 October 2007
  • 5. Health and Human Services Commission FREW Medical and Dental Strategic InitiativesProposal Attachment B: First Dental Home The United States Surgeon General identified tooth decay as the most common chronic childhood disease in his 2000 Report, “Oral Health in America.” Tooth decay is five times more common than asthma. In Texas, less than 1 in 5 children between 6 to 36 months of age who are covered by Medicaid access dental care until dental caries are severe or the child experiences other medical conditions. Dental caries is defined as “an infectious, transmissible disease in which bacterial by-products (i.e., acids) dissolve the hard surfaces of the teeth.” Early childhood caries (ECC) is “the presence of one or more decayed, missing (due to caries), or filled tooth surfaces in any primary teeth in a child 71 months of age or younger.” According to the American Academy of Pediatrics (AAP), ECC can affect a child’s growth, may lead to malocclusion, could result in significant pain, and potentially life threatening swelling. Research shows that children who start having dental caries very early, will continue to develop and be more prone to additional dental health issues or procedures, such as restorative dental care in an operating room. The estimated cost of hospitalization for treatment of ECC is $2,000 per case. Some states, such as Washington, show that certain children with baby bottle tooth decay, also known as ECC, were treated in hospitals at a cost between $3,000- $5,000 per child in 1997. Another study in 2000 from Pediatric Dentistry concluded that after two years, 79 percent of children with ECC had developed Background: additional tooth decay, compared with 29 percent of children without cavities at the onset. If proper oral hygiene is followed in early childhood, the incidence of caries can be reduced significantly later in life. A recent study found that over five years, Medicaid children who had their first preventive dental visit by one year of age incurred dental costs almost 40 percent lower than children whose first preventive visit was after one year of age. Fluoride is a safe and effective way to prevent and control dental caries. A child can receive fluoride through a number of sources including community water supply, toothpaste and varnish to name a few. The application of fluoride varnish is an effective method to use with small infants because it does not require special equipment, dental cleaning is not required prior to application, application is easy and requires little time, and the procedure is safe and well tolerated by infants and children with special health care needs. The AAP and the American Pediatric Dentistry Association have developed policies to address and support the establishment of a First Dental Home. 5 of 9 October 2007
  • 6. Health and Human Services Commission FREW Medical and Dental Strategic InitiativesProposal Attachment B: First Dental Home The United States Surgeon General identified tooth decay as the most common chronic childhood disease in his 2000 Report, “Oral Health in America.” Tooth decay is five times more common than asthma. In Texas, less than 1 in 5 children between 6 to 36 months of age who are covered by Medicaid access dental care until dental caries are severe or the child experiences other medical conditions. Dental caries is defined as “an infectious, transmissible disease in which bacterial by-products (i.e., acids) dissolve the hard surfaces of the teeth.” Early childhood caries (ECC) is “the presence of one or more decayed, missing (due to caries), or filled tooth surfaces in any primary teeth in a child 71 months of age or younger.” According to the American Academy of Pediatrics (AAP), ECC can affect a child’s growth, may lead to malocclusion, could result in significant pain, and potentially life threatening swelling. Research shows that children who start having dental caries very early, will continue to develop and be more prone to additional dental health issues or procedures, such as restorative dental care in an operating room. The estimated cost of hospitalization for treatment of ECC is $2,000 per case. Some states, such as Washington, show that certain children with baby bottle tooth decay, also known as ECC, were treated in hospitals at a cost between $3,000- $5,000 per child in 1997. Another study in 2000 from Pediatric Dentistry concluded that after two years, 79 percent of children with ECC had developed Background: additional tooth decay, compared with 29 percent of children without cavities at the onset. If proper oral hygiene is followed in early childhood, the incidence of caries can be reduced significantly later in life. A recent study found that over five years, Medicaid children who had their first preventive dental visit by one year of age incurred dental costs almost 40 percent lower than children whose first preventive visit was after one year of age. Fluoride is a safe and effective way to prevent and control dental caries. A child can receive fluoride through a number of sources including community water supply, toothpaste and varnish to name a few. The application of fluoride varnish is an effective method to use with small infants because it does not require special equipment, dental cleaning is not required prior to application, application is easy and requires little time, and the procedure is safe and well tolerated by infants and children with special health care needs. The AAP and the American Pediatric Dentistry Association have developed policies to address and support the establishment of a First Dental Home. 6 of 9 October 2007
  • 7. Health and Human Services Commission FREW Medical and Dental Strategic Initiatives This project should be considered in conjunction with other Stand Alone Option Frew Strategic Initiatives X Other This project should be considered in conjunction with the “Oral Evaluation and Considerations Fluoride Varnish in the Medical Home” proposal in which physicians (general or family physicians, as well as pediatricians) provide oral health assessments and dental anticipatory guidance with the application of topical fluoride varnish at early well child visits when access to a dentist is limited.State and Federal 1115 Waiver Rules X Approval(s) Federal Other Waiver(s), State Legislation Required: State Plan Amendment Affected Stakeholders • Texas Dental Association, Texas Academy of Pediatric Dentistry, Texas Medicaid Association, Texas Pediatric Society, Texas Academy of Family Physicians, and Texas based dental schools and dental hygiene programs support this evidence based initiative. Medicaid recipients and their families would also be affected stakeholders. Systems & Resource Considerations • Texas Medicaid and the Department of State Health Services have available an American Dental Association developed dental procedure code (D0145) that could be used to implement this project. Other Considerations Implementation • A First Dental Home workgroup has already been formed and has met twice Considerations & via conference call with a third conference call and face-to-face meeting Timeframes: scheduled in the near future. • Texas Health Steps rules would need to be amended to expand preventive dental services to children under one year of age. • Dental policy needs to be developed to determine what type of documentation a provider needs to maintain in the client’s treatment record to support the claim. This activity can be accomplished in six months from approval of project. • Provider education efforts need to occur during the implementation of this project to ensure quality of care issues. This activity can be initiated within six months from approval of the project. • The THSteps outreach and informing contract may need to be amended due to additional printing and distribution of materials in support of the First Dental Home project.HHSC Interagency The workgroup was generally supportive of this proposal. The group cautioned 7 of 9 October 2007
  • 8. Health and Human Services Commission FREW Medical and Dental Strategic Initiatives about gradual roll-out versus statewide rollout of this proposal given provider and Workgroup client education issues that may develop throughout the state. In addition, theRecommendation: group highlighted the importance of a certification process for dental providers in order to bill for this service along with education and training. Of the 12 members present, there was a unanimous consensus that this project has Frew Technical high merit. In addition, even though the group was not presented with detailed Advisory information about the “Oral Evaluation and Fluoride Varnish in the Medical Home” Committee proposal, most of the Committee members recommended that HHSC implementRecommendation: both projects concurrently. 8 of 9 October 2007
  • 9. i CDC, MMWR, Recommendations and Reports, August 17, 2001/50(RR14);1-42; AAPD, Council on Clinical Affairs,2003.ii American Academy of Pediatrics Policy Statement, Oral Health Risk Assessment Timing and Establishment of the DentalHome, May 2003.iii Tewogabe A et al, Cost effectiveness of providing fluoride varnish to Medicaid preschoolers, IADR presentation, March2002.iv Oral Health Best Practices, ABCD Program, Spokane Regional Health District, Spokane, WA.v Galganny-Almeida A. Future Caries Susceptibility in Children with Early Childhood Caries Following Treatment underGeneral Anesthesia. Pediatric Dentistry 2000; 22: 302-306.vi Savage M et al, Early Preventive Dental Visits: Effects on Subsequent Utilization and Costs, Pediatrics, October 2004;418-423vii MMWR, Recommendations and Reports, August 2001/50 (RR14);1-14.viii The dental home provides comprehensive oral health care, assessment, individualized dental health program, anticipatoryguidance, plan for acute dental trauma, information about proper oral care, dietary counseling, referrals to dental specialists,and education about future oral health care treatments. Hunke, Phillip H. DDS, MSD. President, American Academy ofPediatric Dentistry. “The Dental Home and Age One Visit: The Centerpiece of Children’s Oral Health CareImprovement.” Presented to the Oral Health and School Readiness National Symposium, November 2-3, 2006.

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