Young child receiving care from a health professional.
1994
- Medical providers begin delivering preventive oral health services
Background
Realizing the important role that medical providers can play in improving children’s oral health, the American Academy of Pediatrics developed a policy statement recommending that by age 6 months every child should receive an oral health risk assessment conducted by a qualified pediatrician or pediatric health professional. The American Academy of Pediatric Dentistry also supports this recommendation.
In 1994, a group of concerned dentists and dental educators and representatives from public health agencies, the state dental association, and Washington’s Medicaid program came together to address lack of access to oral health services for young children at high risk for dental caries (tooth decay). The solution was the development of the Access to Baby and Child Dentistry (ABCD) program. The program focuses on preventive and restorative oral health care for infants and children from birth to age 6 who are eligible for Medicaid, with emphasis on enrollment by age 1. The program is based upon the premise that starting dental visits early will yield positive behaviors on the parts of both parents and children, thereby helping to control caries and reduce the need for costly restorative work. The first ABCD program opened for enrollment in Spokane, WA, in 1995 as a collaborative public/private effort. Its success led other county dental societies and health districts in Washington to adopt the program and prompted interest from other states.
The ABCD program is a collaborative effort of the Washington Dental Service Foundation, the University of Washington School of Dentistry, the Washington Department of Health, the Washington Department of Social and Health Services, the Washington State Dental Association, local dental societies, and local health jurisdictions.
The delivery of preventive oral health services by medical providers was also embraced early in North Carolina. The Into the Mouths of Babes (IMB) program was based on a successful pilot project conducted in 15 locations with providers from 26 medical offices beginning in 1999. The program is designed to train pediatricians, family physicians, and providers in community health clinics to provide preventive oral health services (e.g., risk assessment, screening, referral, fluoride varnish application) to children and counseling to parents and other caregivers. Providers enrolled in the program are reimbursed by the North Carolina Division of Medical Assistance, the agency that administers Medicaid in the state.
The IMB program was expanded statewide in 2001 thanks to a major contribution from the North Carolina Division of Medical Assistance and additional funding from the Centers for Disease Control and Prevention, the Centers for Medicare & Medicaid Services, and the Health Resources and Services Administration.
Impact
The ABCD program is making progress toward increasing the number of children who receive oral health care before their second birthday, the best time for early intervention. Receiving oral care during this period is consistent with the best practice goal of ensuring that all children receive oral health care be age 1. The program has demonstrated that early prevention reduces future oral health care costs and that ABCD is an effective, cost-saving method of improving the oral health status of infants and young children enrolled in Medicaid.
Children who receive preventive services through the IMB program have fewer caries-related treatments in dental offices than children who do not receive IMB preventive services. Children who have four, five, or six IMB visits before they turn 3 benefit the most.
Currently, across the country, all 50 states and the District of Columbia have Medicaid programs that reimburse medical providers for the application of fluoride varnish.
Sources
Access to Baby and Child Dentistry. No date. Results [webpage].
American Academy of Pediatric Dentistry, Council on Clinical Affairs. 2009–2010. Policy on the dental home. Pediatric Dentistry 31(Suppl. 6):22–23.
American Academy of Pediatrics. 2021. Medicaid Payment of Preventive Health Services. Itasca, IL: American Academy of Pediatrics.
Grant JS, Roberts MW, Brown WD, Quinonez RB. 2007. Integrating dental screening and fluoride varnish application into a pediatric residency outpatient program: Clinical and financial implications. Journal of Clinical Pediatric Dentistry 31(3):175–178.
Hale KJ; American Academy of Pediatrics, Section on Pediatric Dentistry. 2003. Oral health risk assessment timing and establishment of the dental home. Pediatrics 111(5 Pt 1):1113–1116.
North Carolina Department of Health and Human Services. No date. Into the Mouths of Babes—Medical Providers: Partner with Us to Improve Your Child Patients’ Oral Health. [webpage].
Pew. 2011. Reimbursing Physicians for Fluoride Varnish [webpage].
Rozier RG, Sutton BK, Bawden JW, Haupt KH, Slade GD, King RS. 2003. Prevention of early childhood caries in North Carolina medical practices: Implications for research and practice. Journal of Dental Education 67(8):876–885.
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