jbozzonewednesday.ppt

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  • Methods. Random samples of Ohio general practitioner (GPs) dentists and pediatric dentists (PDs) and all Ohio safety-net dental clinics completed a mail survey regarding treatment of children aged 0 through 5 years. The authors categorized responses by provider type and further analyzed GPs’ responses by years since graduation and geographic character. Results. Few Ohio GPs (8 percent) recommended a first dental visit by 1 year of age. While 91 percent of GPs treated children aged 3 through 5 years, only 34 percent treated children aged 0 through 2 years, most often for emergency visits or examinations. Only 7 percent of all GPs and 29 percent of PDs accepted patients enrolled in Medicaid without limitations. Conclusions. Children’s being young (0–2 years of age) and having Medicaid as a payment source made GPs substantially less likely to treat them. Children’s being enrolled in Head Start made GPs somewhat more likely to treat them. Practice Implications. New strategies for ensuring dental care access for young children from low-income families are necessary. Such strategies may take the form of interpeer advocacy, education, practice incentives or creation of coordinated GP and PD teams. Methods. Random samples of Ohio general practitioner (GPs) dentists and pediatric dentists (PDs) and all Ohio safety-net dental clinics completed a mail survey regarding treatment of children aged 0 through 5 years. The authors categorized responses by provider type and further analyzed GPs’ responses by years since graduation and geographic character. Results. Few Ohio GPs (8 percent) recommended a first dental visit by 1 year of age. While 91 percent of GPs treated children aged 3 through 5 years, only 34 percent treated children aged 0 through 2 years, most often for emergency visits or examinations. Only 7 percent of all GPs and 29 percent of PDs accepted patients enrolled in Medicaid without limitations. Conclusions. Children’s being young (0–2 years of age) and having Medicaid as a payment source made GPs substantially less likely to treat them. Children’s being enrolled in Head Start made GPs somewhat more likely to treat them. Practice Implications. New strategies for ensuring dental care access for young children from low-income families are necessary. Such strategies may take the form of interpeer advocacy, education, practice incentives or creation of coordinated GP and PD teams.
  • jbozzonewednesday.ppt

    1. 1. Developing an Infant Oral Health Program ! Got Teeth? Get Checked! l Clinical and Financial Impact Janet Bozzone, DMD Director of Dentistry Open Door Family Medical Centers Ossining, Sleepy Hollow, Port Chester, Mount Kisco New York
    2. 2. General Disclaimers <ul><li>I am not a pediatric dentist. </li></ul><ul><li>This is not intended to be advanced training in pediatric dentistry. </li></ul><ul><li>This is not a dental materials course. </li></ul><ul><li>I have no financial interest in any material or product discussed. </li></ul>
    3. 3. Background <ul><li>AAPD first recommended a child’s first visit to the dentist by age one in 1985 </li></ul><ul><li>ADA concurs in mid 1990’s </li></ul><ul><li>American Academy of Pediatricians finally recommends in 2004: </li></ul><ul><li>“ Patients who have been determined to be at risk of development of dental caries or who fall into recognized risk groups should be directed to establish a dental home 6 months after the first tooth erupts or by 1 year of age (whichever comes first).” </li></ul>
    4. 4. Who’s Listening? <ul><li>Ohio dental care providers’ treatment of young children, 2002; Seigal & Marx, JADA, Nov. 2005. </li></ul><ul><li>Access to dental care for children in the United States: a survey of general practitioners. Seale & Casamassimo, JADA 2003 </li></ul>
    5. 5. Seigal & Marx (Ohio)
    6. 6. Practitioners’ Concerns <ul><li>Very young patients need a pediatric dentist. </li></ul><ul><li>GP offices not equipped to see infants and toddlers. </li></ul><ul><li>It is not financially rewarding to treat infants and toddlers. </li></ul><ul><li>It is too hard to for GPs to treat infants and toddlers. </li></ul><ul><ul><li>Not enough patience </li></ul></ul><ul><ul><li>Not enough knowledge or expertise </li></ul></ul><ul><ul><li>Too much disruptive behavior </li></ul></ul>
    7. 7. Change the Question…. <ul><li>Why should we provide preventive oral care for more infants in Health Centers? </li></ul><ul><li>Why wouldn’t we provide preventive oral care for more infants in Health Centers? </li></ul><ul><li>Consider providing preventive infant oral health as an opportunity for your Health Center, not a burden! </li></ul>
    8. 8. Lessons from Advanced Access Colaborative…. <ul><li>Demand = Capacity </li></ul>
    9. 9. Lessons from Advanced Access Colaborative…. Demand = Capacity
    10. 10. Press Release: <ul><li>WASHINGTON, Jan. 12, 2007 -- Agriculture Secretary Mike Johanns today announced USDA's plan to purchase up to 19.3 million pounds of grape juice to be donated to child nutrition and other domestic food assistance programs. </li></ul>
    11. 11. Infants and toddlers need a pediatric dentist
    12. 12. Do the Math! <ul><li>Over 20 MILLION Children under 5 </li></ul><ul><li>Approximately 4500 pediatric dentists (~1500 board certified) </li></ul><ul><li>4400 per pediatric dentist </li></ul><ul><li>They can’t do it alone! </li></ul><ul><li>Access for the underserved is even more limited </li></ul>
    13. 13. Got Teeth? Get Checked?
    14. 14. How can you start? <ul><li>Enlist pediatricians and family practitioners </li></ul><ul><li>Commit to first visit by age one </li></ul><ul><ul><li>Knee to knee exam (D0145 or D0120) </li></ul></ul><ul><ul><li>Toothbrush prophy (D1120) </li></ul></ul><ul><ul><li>Fluoride varnish (D1206 or D1203) </li></ul></ul><ul><ul><li>Parent education (part of D0145) </li></ul></ul><ul><li>Utilize a Chronic Disease Case Management Approach </li></ul>
    15. 15. Who can do this? <ul><li>Motivated General Practitioners </li></ul><ul><li>Registered Dental Hygienists </li></ul><ul><li>In some states: </li></ul><ul><ul><li>Expanded Function Dental Assistants </li></ul></ul><ul><ul><li>Pediatricians and Family Practitioners </li></ul></ul><ul><ul><li>Physicians Assistants </li></ul></ul><ul><li>Bottom line…you can! </li></ul><ul><li>and you can add to your bottom line as well </li></ul>
    16. 16. Armamentarium <ul><li>Mirror, explorers, spoon excavators </li></ul><ul><li>Toothbrushes and prophy angles </li></ul><ul><li>Tooth paste and prophy paste </li></ul><ul><li>High and low speed handpieces </li></ul><ul><li>Fluoride varnish </li></ul><ul><li>Modified glass ionomers </li></ul><ul><li>Etch, bond, self etching bonding agent </li></ul><ul><li>Flowable composite and sealants </li></ul>
    17. 17. GP offices not equipped to see small children
    18. 18. http://www.specializedcare.com/
    19. 19. It is too hard to for GPs to treat small children. Not Enough Patience
    20. 20. <ul><li>Small kids </li></ul>Small problems? BIGGER PROBLEMS! <ul><li>Big kids & adults </li></ul>
    21. 21. It is too hard to for GPs to treat small children. Not Enough Knowledge
    22. 22. Anticipatory Guidance <ul><li>Demonstrate brushing </li></ul><ul><li>Advise no tasting or sharing of eating utensils </li></ul><ul><li>Advise discontinuing bottle use by one year of age </li></ul><ul><li>Recommend no ad lib sippy cup use. </li></ul><ul><li>Reduce refined carb intake, especially juice! </li></ul>
    23. 23. Basic Knowledge & Expertise <ul><li>Vocabulary </li></ul><ul><li>Basic preventive dentistry </li></ul><ul><li>Sealant application </li></ul><ul><li>Atraumatic Restorative Treatment (ART) </li></ul><ul><li>Basic restorative dentistry </li></ul><ul><li>Behavior management </li></ul><ul><li>Watch Super Nanny or Nanny 911 </li></ul>
    24. 24. Knowledge: Preventive Dentistry 101 Sugar (fermentable carbohydrate) Plaque (bacteria) Tooth Acid Decay
    25. 25. Knowledge: Sealants & PRRs!
    26. 26. Knowledge: Atraumatic Restorative Treatment (ART) <ul><li>Identify decayed/cavitated teeth </li></ul><ul><li>No local anesthetic </li></ul><ul><li>Spoon or slow speed excavation </li></ul><ul><li>Clean and firm margins (if possible) </li></ul><ul><li>Gluma? </li></ul><ul><li>Fuji Triage (or other similar material) </li></ul><ul><li>Glass ionomer powder or finger </li></ul><ul><li>Glaze ~OR~ Fluoride varnish </li></ul>
    27. 27. Knowledge: Behavior Management <ul><li>Knee to knee exam is easiest </li></ul><ul><li>Inform parents </li></ul><ul><li>Be friendly </li></ul><ul><li>Crying is normal! </li></ul><ul><li>Fuggedabouit </li></ul>
    28. 28. Points to remember <ul><li>Recall frequency determined by need. </li></ul><ul><li>Recall generally payable every six months. </li></ul><ul><li>Modified glass ionomer sealants and/or restorations can be placed. </li></ul><ul><ul><li>Baby sealants not generally payable. </li></ul></ul><ul><ul><li>Cavitated lesions ~can~ be billed as composite restos. </li></ul></ul>
    29. 29. Summary <ul><li>Treating infants and toddlers is easier than you think. </li></ul><ul><li>Treating infants and toddlers is rewarding both clinically and financially. </li></ul><ul><li>Preventing caries is much easier than treating them! </li></ul><ul><li>We can’t wait for our colleagues to “get their shoes on”. </li></ul>

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