This section concerning the domain of Life Course includes the SPN #8 Improving Integration of Information Systems and the NPM #13 Oral Health. ESM 13.1 for oral Preventive and any dental services for children enrolled in Medicaid or CHIP (CMS-416).

Annual Report - NPM #13: 

1. Percent of women who had a dental visit during pregnancy and 
2. Percent of children, ages 1 through 17, who had a preventive dental visit in the past year 

Oral health is an important part of general health. The second selected NPM in the domain of Child Health is NPM #13A (Percent of women who had a dental visit during pregnancy) and #13B (Percent of children, ages 1 through 17, who had a preventive dental visit in the past year). Access to oral health care, good oral hygiene, and adequate nutrition are essential components of oral health that help to ensure children, adolescents, and adults achieve and maintain oral health throughout their lifespan. People with limited access to preventive oral health services are at greater risk for oral diseases. 

Oral health care remains the greatest unmet health need for children. Insufficient access to oral health care and effective preventive services affects children’s health, education, and ability to learn. According to the American Dental Association and the American Academy of Pediatric Dentistry, the dental visit should occur within six months after the baby's first tooth appears, but no later than the child's first birthday. Having the first dental visit by age 1 teaches children and families that oral health is important. Children who receive oral health care early in life are more likely to have a positive attitude about oral health professionals and dental exams. Pregnant women who receive oral health care are more likely to take their children for regular dental check-ups. 

State Title V Maternal Child Health programs have long recognized the importance of improving the availability and quality of services to improve oral health for children and pregnant women. States monitor and guide service delivery to assure that all children have access to preventive oral health services. Strategies for promoting good oral health include providing preventive interventions such as age-appropriate oral health education, promoting the application of dental sealants and the use of fluoride, increasing the capacity of state oral health programs to provide preventive services, evaluating and improving methods of monitoring oral disease, and increasing the number of community health centers with an oral health component.  

The New Jersey Department of Health is moving oral health access forward by piloting Fluoride Varnish programs, implementing for the first time a Third Grade Basic Screening survey (a measure recognized nationally as important to assess and gather data about oral health), and developing NJ’s first-ever 5-year state oral health plan. There are 24 Federally Qualified Health Centers with 136 locations in all 21 state counties. Fifty-eight locations provide dental services, eight centers have mobile dental units and there are 7 school-based locations in Newark and one in New Brunswick. In 2020 – 2021 FQHC dental providers provided 27,455 uninsured patients with dental services under the Uncompensated Care Fund. 

Notes: Sources: +National Survey of Children's Health (NSCH): 2007-2017 

*New Jersey Pregnancy Risk Assessment Monitoring System (PRAMS), Maternal and Child Health Epidemiology, New Jersey Department of Health, NJ SHAD: https://www-doh.state.nj.us/doh-shad/query/result/prams/PRAMS/Teeth.html. 

 **Annual EPSDT Participation Report, CMS-416, State Fiscal Year 2020: (12b. Total Eligible (1-18-year-olds) receiving preventative dental services/1a. Total individuals (1–18-year-olds) eligible for EPSDT. Total eligibility count used does not consider length of eligibility for EPSDT services.), NJ FamilyCare, Bureau of Dental Services, Department of Human Services, Division of Medical Assistance and Health Services, 2022.  

New Jersey has selected the following for ESM #13: preventive and any dental services for children enrolled in Medicaid or CHIP. The ESM was selected since all oral health education activities conducted in the school and community settings serve to improve the oral health status of school-age children. 

The Children’s Oral Health Program (COHP) has provided age-appropriate and developmentally targeted oral health education programs to school-age children covering all 21 counties in the State for over 35 years. It also provides oral health education programs for parenting and community groups and at WIC sites. During the 2020-2021 school year, approximately 37,851 students received oral health and /or hygiene education and oral health personal care items including toothbrushes and floss. School and community presentations are conducted in areas of high risk for dental disease and high need of oral health services by Registered Dental Hygienists and Dentists, who provide evidence-based oral health and hygiene information, including the oral disease process, tooth anatomy, healthy food choices, reducing the use of sugary foods and beverages, tobacco cessation and the dangers of vape and e-cigarette products, positive lifestyle choices to increase health and reduce systemic disease, and oral injury prevention education. As a result of COVID, the COHP revised their presentation education into online formats beginning in 2020 and continued to offer this option into 2021. Schools and community groups have the option of virtual recorded and virtual live oral health education increasing flexibility and access. The COHP operates under the direction of the State Dental Director, Division of Community Health Services, Oral Health Services Unit. 

Special school initiatives include the “Sugar-less Day to Prevent Tooth Decay” poster contest for 4th, 5th, and 6th grades, “Project BRUSH” for grades K and 1, and “Project Smile” for grades 2 and 3. Special initiatives are designed to engage the whole school community with positive oral health messages 

The “Save Our Smiles, voluntary school-based fluoride mouth rinse (FMR) program was permanently discontinued due to the lack of product needed for the program. The one manufacturer of the Fluoride powder pack and Fluoride unit doses ceased manufacturing these products in late 2019. This affected 150,000 participants in FMR programs nationwide. During 2020-2021 A Fluoride Varnish program continued to be piloted through COHP. Due to COVID restrictions, Fluoride Varnish programs were held outdoors or in large capacity spaces to ensure safety. Seven Fluoride Varnish events were held, providing education and fluoride varnish to 228 students. 

Interprofessional oral health training programs include “Project PEDs (Pediatricians Eradicating Dental Disease), an introduction to Caries Risk Assessment and the application of fluoride in the pediatric medical setting for physicians, nurses, and physician assistants, and Project REACH (Reducing Early Childhood Caries Through Access to Care and Health Education, for physicians and obstetric nurses to provide information on the importance of oral health care for pregnant women. 

The Home Visitation program, in collaboration with the Division of Children and Families, provides training to Home Visiting staff to encourage families to perform daily dental hygiene and the importance of establishing a dental home. Since its inception in 2014, 7,200 families participating in home visiting programs received oral health information and oral health care kits. This program was updated during the 2020-2021 fiscal year and developed into a series of three one-hour oral health trainings regarding vaping/tobacco, diabetes, and pregnancy. They were presented in January and February of 2021 and attended by a total of 256 participants. A Home Visiting newsletter for staff highlighting the education they received was distributed in Spring 2021, and 1200 oral health kits for families were distributed to Home Visitation agencies. 

Every 2 years, the NJ Department of Health directs the COHP to survey all State Health Officers and Dental Directors to update the Dental Clinic Directory, “Dial a Smile”. This directory, available online on the Department of Health website, serves as a public resource to identify providers of sliding scale, low-cost, and no-cost clinical dental services, increase access to care, and assist the public to establish dental homes and decrease Emergency Room visits for dental emergencies. Information about the “Dial A Smile” directory and how to find it online is regularly given to community stakeholders and included in COHP special initiatives, programs, and newsletters. The directory is edited periodically upon request and was updated during the Summer and Fall of 2021. The 2022 Dial A Smile Directory is available online at: https://www.nj.gov/health/fhs/oral/documents/dental_directory.pdf . 

The COHP newsletter, "Miles of Smiles" for school nurses is distributed annually each Fall to school nurses throughout the state. In the 2020-2021 school year, 3,229 were distributed. The "Oral Health Facts for Women, Infants, and Children" newsletter was emailed to State WIC Coordinators in April 2021. Both contain timely oral health topics for staff to communicate to the populations they serve, such as “The Effects of Covid on Oral Health”, “Breastfeeding and Oral Health” and where to find dental services and resources in New Jersey. Newsletters and other resources are updated to the COHP webpages on the DOH website. The COHP has an ongoing relationship with WIC offices to provide education to their participants, however, due to COVID, WIC sites were closed. In February 2021, a virtual presentation on oral health and pregnancy was given to WIC staff during their regular staff meeting.

The Oral Health Nutrition and Obesity Control Program reimburses fourteen Federally Qualified Health Centers and dental provider organizations to provide at dental visits, a minimum of three nutrition counseling sessions to Medicaid-eligible or uninsured children ages 6-11 who are determined to be in the overweight or obese range as calculated by Body Mass Index.

As of January 2022, 17,416 children were screened of which 6,913 have BMI in the overweight and obese range. A caries rate of 51 % was found in the eligible cohort. The goals of this program are to increase oral health literacy, provide information on proper nutrition and the benefits of physical activity, and improve dental and overall health for children and their families. Dental providers under this grant report that the impact of COVID on the oral health of pediatric patients have been severe with increases in cavities for this age range. Providers attribute this to the pandemic, during which regular care was delayed and children did not have the access to healthy foods as regularly would be due to school closures. In the 4th year of this grant food delivery of healthy foods to family households whose children have completed all three nutritional counseling sessions has been added as an activity commencing February 1, 2022. Funds for this grant are provided by a 4-year HRSA Support of State’s Oral Health Workforce Activities grant, awarded to the Division of Community Health Services commencing September 2018 and ending August 2022. Program deliverables are overseen by the Oral Health Services Unit. 

The Oral Health Services Unit has entered into an agreement with the NJ Learning Management Network to have oral health presentations developed for Doula and Home Visitation staff made available to public health professionals to receive public health continuing education credits. Four oral health webinars are now active on NJLMN, the three-webinar Home Visitation series for a total of 1.5 CEUs, and the Doula education for 1.0 CEUs. The NJ Learning Management Network is a free learning portal that provides public health education.