NPM 13.2 - Oral Health: 1) Percent of women who had dental visit during pregnancy; and 2) Percent of infants and children, ages 1 – 17 years, who had a preventive dental visit in the last year.
Oral Health Literacy
Healthy Montana Mouths: During FFY 2021, MCHBG and Oral Health Program (OHP) staff continued to collaborate on activities supporting NPM 13b. The programs promoted the oral health literacy campaign, Healthy Montana Mouths. These materials are designed for healthcare providers caring for infants, young children, and pregnant women. They include a 13-page flip chart containing information on oral health from preconception to pregnancy and through the child’s first dental visit. The book is available upon request, free of charge.
Additionally, a toolkit of resources is available on the OHP website at https://dphhs.mt.gov/ecfsd/oralhealth. The toolkit includes the American Academy of Pediatrics (AAP) Oral Health Risk Assessment, an example child dental referral, oral health guidance during the well-child visits, and an oral health goal setting form.
Healthy Montana Mouths was promoted by County Public Health Departments (CPHDs) serving as oral health “hubs”, and by those that selected NPM 13b. The materials were also disseminated through: WIC, the MT Hospital Association, MT Chapter of the American Academy of Pediatrics, Healthy Mothers Healthy Babies crib kits, and MT Medical Association newsletters. The OHP exhibited at the Montana Dental Hygienists Association Annual Session in September 2021, which included promotion of the materials. Lastly, the OHP collaborated with the National Maternal and Child Oral Health Resource Center to highlight the oral health literacy campaign in an upcoming publication.
National Oral Health Observances
The OHP continues to promote national observances relevant to oral health. To publicize National Children’s Dental Health Month (NCDHM) in February 2021, the OHP developed an electronic newsletter article providing background on the observance, discussing the campaign slogan, and providing ideas for easy-to-do activities to promote NCDHM. The newsletter was shared with all Early Childhood and Family Support Division (ECFSD) programs, Montana Oral Health Network (MOHN) members, and distributed to local stakeholders by the CPHD “hub” locations. Additionally, posters provided by the American Dental Association were distributed to CPHD partners. Furthermore, OHP staff presented on NCDHM and Oral Health in Montana during a WIC local agency conference call with approximately 45 local WIC agency staff.
To promote Oral Cancer Awareness month, OHP staff submitted a Health in the 406 article on the topic of human papillomavirus (HPV) and oral cancer. The article was distributed to all Montana DPHHS employees and posted on the Public Health and Safety Division website. Lastly, the OHP provided resources and information on World Oral Health Day to members of the MT Oral Health Network in March 2021.
Networks & Partnerships
Montana Oral Health Network (MOHN): The OHP continued to provide administrative support for the MOHN. The OHP collaborated with the MOHN on activities supporting NPM13b. This network is guided by the Montana Oral Health Strategic Framework, which has specific metrics related to the MCH population:
- By 2023, develop materials and educational programs to inform practicing health and human service professionals about the necessity of oral health care to systemic health, resulting in at least 50 non-dental providers appropriately including oral health preventive education, referrals, and/or services in their patients visits.
- Educate dentists, medical providers, WIC counselors, and parents that a child’s first dental visit should occur before one year of age and include a risk assessment. By 2023, infant dental visits prior to his/her first birthday will increase by at least 2 percent.
- Conduct an assessment to determine the number of schools and clinics that include oral exams as part of health screenings. Once a baseline has been determined, increase by 10% over the next five years.
- Work closely with the Office of Public Instruction to encourage Montana school districts to include oral health strategies and education as part of their district’s Wellness Policy.
During FFY21, the OHP organized two quarterly meetings of the Steering Committee, a team of 8-10 dental and non-dental stakeholders that provide leadership for the full network. Additionally, the OHP collaborated with a public health consulting organization to develop draft bylaws for the organization. The Steering Committee decided at the March 2021 Steering Committee meeting that the MOHN would no longer be supported in a leadership capacity by the OHP. The organization is currently stagnant until new leadership is identified.
Montana Tobacco Use Prevention Program (MTUPP): The OHP partnered with MTUPP to sponsor a speaker at the Montana Dental Hygienists’ Association (MDHA) Annual Session in September 2021. The speaker presented on the implications of human papillomavirus (HPV) and vaping/e-cigarettes on oral health. This partnership supported the MCH population by educating dental providers on topics currently impacting the oral health of children and adolescents. Additionally, the OHP facilitated an introduction and meeting between the MTUPP and the mobile dentistry non-profit organization Smiles Across Montana to discuss strategies for incorporating oral cancer screening in mobile dentistry clinics.
Montana Healthcare Programs: The OHP collaborated with Montana Healthcare Programs on a potential project to increase the number of preventative oral health services provided. This project would specifically target services for members under 36 months of age delivered by Medicaid enrolled physicians, physician assistants, and nurse practitioners. If approved, the program would provide enhanced reimbursement for oral health services provided by enrolled primary care providers who have completed the Smiles for Life online curriculum. A decision brief was developed and submitted to Montana Healthcare Programs. However, all new projects are currently on hold do to reorganization within that division.
Oral Health Workforce
Known disparities, based on geographic locations and race in Montana, continued to drive targeted programming related to oral health. The OHP has several projects to support the growth of the oral health workforce in MT, which are supported by HRSA Grants to States to Support Oral Health Workforce Activities T12HP30538. The partnerships have contract agreements through August 2022, the end date of the HRSA funding. As data from these partners was received, rapid quality improvement was utilized to determine best practices for providing oral health services to the maternal and child population. The following map illustrates the location of oral health workforce activities throughout the state.
University of Washington School of Dentistry (UWSOD): The OHP has contracted with the UWSOD to promote workforce development for providers prepared to address oral health services in vulnerable populations of women and children. This program aims to improve access to oral health care in Montana by developing and delivering community-based training programs for dental students, focusing on rural and underserved pediatric populations living in a Health Professional Shortage Area. Faculty from UWSOD contact preceptor sites prior to student rotations to encourage them to have students treat children on rotation and inquire about off-site opportunities to treat children in the area. Furthermore, prior to departing, dental students rotating in Montana complete learning modules developed by the UWSOD’s HRSA grant-sponsored Early Childhood Oral Health Training (EchoTrain) Program. Since September 2018, 3859 dental procedures have been completed by 4th-year dental students, 913 of which were with pediatric patients aged 0-17 years old.
Montana State University College of Nursing (MSUCON): The aim of the program with MSUCON is to support innovative projects to increase oral health care utilization for American Indian (AI) children during early childhood. One activity is to implement an oral health program with the Northern Cheyenne Nation Head Start. Dental professionals accompany nursing students on rotations to provide preventative oral health services. The students gain interprofessional education and hands-on experience providing oral health services to young children. Following COVID-19 closures, the team was able to return to the Northern Cheyenne Nation in November 2020. Since September 2018, services provided include: 449 screenings, 296 cleanings, 418 fluoride varnish applications, and 811 sealants. Additionally, 139 referrals have been made, of which 94 have been completed to date.
Another activity is to test oral health messaging via GoodHealth Television (GHTV) to support increased utilization of dental care during early childhood and the use of Silver Diamine Fluoride (SDF). MSUCON developed a video featuring four Blackfeet families undergoing treatment with SDF. As GHTV is displayed in tribal health waiting rooms, this activity was significantly delayed during COVID-19 when waiting rooms were not being utilized. However, MSUCON was able to alter the implementation plan so that the message was played in facilities offering the COVID-19 vaccine. As of August 2021, over 100 viewer surveys have been completed and results are being analyzed.
Caring Foundation of Montana (CFMT): The OHP has partnered with the CFMT, a non-profit organization administered as an in-kind gift by Blue Cross and Blue Shield of Montana. The aim of this program is to pilot the integration of access to preventive dental health services in mobile health clinics and non-traditional settings. The goals are to address dental needs, promote prevention, and increase the capacity of community-based preventive dental care for high-risk, high-need populations. The focus is on the early utilization of dental care and the establishment of a dental home for children. This activity utilizes dental professionals and mobile dental equipment to deliver preventative oral health services in a variety of settings, including Head Start, schools, and WIC clinics. Since September 2019, services provided include: 2432 screenings, 1415 cleanings, 2388 fluoride varnish applications, and 2742 sealants. All children served are provided an examination with a dentist either in-person or via teledentistry or referred to a dental provider for routine oral health care.
Health Department “Hubs”: The OHP has established task orders with four CPHDs: Valley, Pondera, Anaconda Deer-Lodge, and Custer. This program facilitates early childhood risk assessments, oral health education, and fluoride varnish application in the primary care setting. In the “Hub and Spoke” model, hub locations provide guidance and support for oral health activities to surrounding (spoke) health departments. CPHD staff met monthly to discuss successes, challenges and to collaborate on activities. Additionally, the OHP provided quarterly trainings on oral health-related topics and developed newsletter articles for the “hubs” to share with stakeholders in their area. The task order deliverables for this program compliments, but do not duplicate, Title V MCHBG requirements.
Alluvion Health: The OHP has partnered with Alluvion Health, a Federally Qualified Health Center (FQHC) in North Central MT, on a teledentistry pilot project. Alluvion Health secured outside funding to purchase a mobile dental clinic. The OHP provided financial support towards the purchase of additional equipment and in-kind administrative support. During FFY21, Alluvion Health completed the planning phase of program development and began project implementation. Alluvion Health plans to utilize the mobile dental unit to serve small, rural communities that do not currently have independent local dental providers. They plan to utilize the mobile dental clinic to offer oral health services to underserved populations in their area with an initial focus on pediatric populations. Pilot clinics with Alliance for Youth, and Vonn School were conducted in the Spring of 2021. Due to staffing shortages, the mobile dental clinic has not been utilized since the pilot clinics. The FQHC is hopeful to resume implementation once staff vacancies are filled.
Barriers due to COVID-19
Although most oral health activities resumed by Fall 2020, COVID-19 continued to significantly impact partners. The University of Washington School of Dentistry (UWSOD) student rotations resumed in Montana in July 2020. However, challenges presented by COVID-19 precautions persisted, such as COVID-19 testing prior to rotations, navigating potential exposures, and providing students with appropriate personal protective equipment (PPE).
Montana State University College of Nursing (MSUCON) was able to return to Head Start classrooms on the Northern Cheyenne Reservation in November 2020. This was their first visit in approximately ten months. During the September 2021 classroom visits, MSUCON reported a much higher rate of untreated cavities than prior to the pandemic. Oral health activities in county health department “hub” locations have resumed but were significantly reduced due to limited staff time from responding to COVID-19 cases and providing vaccinations.
The mobile dental unit purchased by Alluvion Health for a teledentistry pilot project was repurposed for COVID-19 testing during the second wave of COVID-19 cases, causing delays in program development. Lastly, with many people losing insurance, or simply not being able to get to a dentist during COVID-19, the Caring Foundation of Montana (CFMT) experienced an increased demand for mobile services.
Surveillance
The OHP attempted to conduct the Basic Screening Survey (BSS) of the Head Start population during the 2020/2021 academic year. However, the surveillance was ultimately postponed due to challenges associated with the COVID-19 pandemic. The BSS of the Head Start population was rescheduled and is being conducted in addition to the BSS of the Kindergarten population in the 2021/2022 academic year. The OHP elected to add questions to the 2021 BRFSS regarding fluoride testing of private wells and public perception of community water fluoridation. Although not specific to the infant and child population, the OHP also elected to add a question to the 2021 PRAMS questionnaire regarding obstacles to visiting a dentist during pregnancy, supported with Title V funds. Routine surveillance of the MCH population is vital to targeting effective oral health interventions.
NPM 13.2 Counties
Staff from these counties were invited to participate in monthly Montana Oral Health Partners meetings to discuss challenges and successes to incorporating oral health services in the primary care setting. The OHP offered support, guidance, and resources to CPHD staff. These CPHDs leveraged partnerships to increase their reach and capacity for oral health education. This included collaboration with WIC, medical clinics, dental clinics, and community organizations that serve families.
Another main area of partnership involved the surveillance of kindergarten and 3rd-grade students, and appropriate referrals to local area dentists. Activities within health departments included distributing “oral health packets” to clients containing items such as toothbrushes, timers, toothpaste, and educational materials.
The following information in a report from Cascade CPHD gives good examples of MCHBG NPM 13.2 activities which took place:
“Staff from all our programs consistently encounter parents, foster parents, grandparents who do not know about the latest research and schedule for preventative oral health care for the children in their care, and how infant feeding behaviors can influence oral health. Many measures have been taken to help attain this goal including the following information to be shared at outreach events, clinic visits, and during home visits:
Access to Oral Health Care
- A list of dentists who take Medicaid patients and are currently accepting new Medicaid patients. This list was created by the Access to Dental Care Committee and reviewed by the 4th District Dental Society. It will be shared with parents and clients. The list will be kept current by the Dental Assistant teacher at the College of Great Falls.
- MCH Program Resource flyers were created and distributed to community partners which included the Oral Health Education program’s availability to help parents in need of finding dental care for their children.
Create postcard for outreach and education purposes with age specific oral health information to be shared with parents during outreach events, clinic visits and during home visits.
- We are currently sharing age-specific oral health information for expectant mothers and parents of babies/toddlers from postcards and brochures. Recently however, I was contacted by Katie Glueckert, (Oral Health Program Coordinator for Montana, DPHHS) who provided me with many oral health resources and current, research-based oral health information. She is currently sending samples from “Montana Healthy Mouths” (DPHHS). I have also been looking at Consumer Materials: OHRC.
Provide oral health education through PSAs and social media to create awareness of how feeding habits can influence oral health.
- Oral Health Lessons on Brushing and Flossing are being provided to 2nd and 4th grade students in Cascade County. Students are also being provided with toothbrushes, toothpaste, floss, and a corresponding information/activity page to take home.
- In February 2021, National Children’s Dental Health Month, Kindergarten classrooms in Cascade County will be sent a video link to Dr. Rabbit’s, “How to Have a Bright Smile” (Colgate). After watching video, they will be sent home with a “How to Have a Bright Smile” activity book, toothbrush, toothpaste, and How to Brush Your Teeth information page.
- We are currently working on a PSA to be used in February, National Children’s Dental Health Month, listing “5 Tips for Healthy Teeth” (America’s ToothFairy.org). This will be read by a child.
- Planning for February’s Parents as Teachers Zoom meeting has also begun. The theme will be Oral Health for Kids. Parents will be presented with Oral Health Information and Tips. Age appropriate activities will be given to parents either through the Zoom meeting or Home visits. These activities are to be completed with parents and child.
- 2 of 12 Monthly Face Book posts have been posted on the CCHD web page to create awareness of how infant feeding and the eating habits of young children can influence oral health.
- With schools reopening this fall and limited visitation access, promoting our goal of optimal oral health to Kindergarten, 2nd, and 4th grade students in Cascade County has been a bit of a challenge. However, with the help of Tracy Milton and her Business Professional’s Class at Great Falls High, we have created two easy to use and engaging You Tube video lessons for teachers to use in their classrooms. Using these videos are getting important oral health information out to the students who then can take corresponding materials home with them for independent use. These video lessons, along with toothbrushes, toothpaste, floss, and corresponding information/activity page started going out to schools starting in January. By teaching good oral health habits now, you help a child develop skills that can last a lifetime.”
During FFY 2022, the FCHB is contracting with and supporting six CPHDs who are interested in increasing the percentage of children who have an annual preventive care dental visit: Cascade, Custer, Deer Lodge, Granite, Lincoln, and Mineral. These counties are implementing and evaluating community-level activities. The FCHB is providing these counties with training, resources and support on evidence-informed activities, goal setting, and evaluation.
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