NPM 13 - 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. (We are using for Children’s Health domain.)

County Public Health Department Activities

Two County Public Health Departments are implementing activities for NPM 13.2 in FFY 2023, Cascade (MCH Population = 33,739) and Custer (MCH Population = 4,391).

The following is a snapshot of activities in Custer County from a recent FFY 2023 quarterly report:

• Provided oral health infographic/fact sheets to seven families of newly birthed/discharged babies in Custer County this quarter. 
• 134 WIC families were given the information regarding oral health, and the importance of screenings/preventative care: 14 prenatal; 17 post-partum; 27 <1yr olds; and 76 1-5yr olds

• The Dentist and Registered Nurse responsible for administering the oral health curriculum, went to the Head Start and did screenings, applied fluoride, and handed out information sheets.  There were 42 children who were screened and had fluoride applied; and each child and eight Head Start staff received the education materials.

• After staff assessed a daycare’s children and workers’ immunizations records, oral health education packets were provided to the 15 daycare families.
• This first quarter of the FFY24, clients of the home visiting program Supporting Positive Roots by Offering Unique, Teachable Strategies (SPROUTS) received oral health educational materials.

Cascade CPHD’s report included these insights into their work:

Performance Measure Activity #1: Provide oral health education in schools

Evaluation Plan and Goal for Activity #1:  The Oral Health Educator will provide education in 25 Cascade County schools, including rural schools and Hutterite Colonies during FFY 2023.

• So far this school year, they have delivered five oral health lessons to 730 students, grades two and three, in Cascade County. Classroom lessons have taken place in 47 classrooms at 19 elementary schools. All students taking part in the Oral Health Program receive toothbrushes and toothpaste to take home.

Performance Measure Activity #2: Provide oral health screenings in schools

Evaluation Plan and Goal for Activity #2: Oral Health Educator will coordinate with local dentists to provide oral health screenings in a minimum of 25 Cascade County schools during FFY2023.

• They have been busy facilitating visual dental health screenings in grades one, three, and four.  Dental screenings have been completed in 10 schools, and most schools will finish up next quarter. Any child who has been identified by the school screening in need of dental care, receives a follow-up call from their school nurse, offering assistance to parents in getting their child’s needs met, whether it be: helping to find a dentist to treat their child; making an appointment; or helping find financial assistance. The involvement of school nurses in this program has been a beneficial step in helping children receive the dental care they need.

In FFY24, the FCHB will contract with one CPHD who has chosen to focus on NPM 13.2.  They will implement and evaluate at least two community-level activities during the fiscal year.  Seven CPHDs working on SPM 1 have also chosen to implement an oral health activity for FFY24.  The FCHB will provide this county with training, resources, and support on evidence-informed or best-practice activities, goal setting, and evaluation.

Current Oral Health Program Plans for FFY 2023

The Montana Oral Health Program (OHP) received funding from the Health Resources and Services Administration (HRSA) Grants to States to Support Oral Health Workforce Activities.  The funding will continue to support OHP staffing and activities through September 1, 2026. The OHP is leveraging existing partnerships with Montana State University College of Nursing (MSUCON) and University of Washington School of Dentistry (UWSOD).  New partners committed to improving the oral health of Montanans include: the Montana Office of Rural Health/Area Health Education Center (MORH/AHEC); WIM Tracking; and Billings Clinic.

The OHP, in conjunction with its partners, began developing and implementing programs focused on Montana’s 38 Dental Health Professional Shortage Areas (HPSA) designated counties, which are home to underserved and under-resourced communities. These programs will increase access to dental care and strengthen the oral health workforce. They will meet the clinic priorities identified in Montana dental HPSAs, including: a lack of trained oral health providers; limited training opportunities for upcoming and existing providers; and, barriers to accessing care for populations that experience oral health disparities, including American Indian.

UWSOD and MORH/AHEC are collaborating on two programs aimed at addressing the dental workforce challenges by “growing our own.”  Created by UWSOD, the Inspire Healers Program (ISP), for indigenous high school students to learn more about the oral health profession, and college preparation, is being adapted to be Montana focused. MORH/AHEC will recruit MT American Indian health professionals to serve as mentors and to create a social media marketing plan to market the ISP to Montana’s American Indian High School students. The first cohort of students should be enrolled by the end of FY 2023. Additionally, UWSOD and MORH/AHEC are adapting the Community Health Professions Academy (CHPA) curriculum for Montana.  The CHPA targets 8th through 12th grade students.  The students are introduced and paired with a mentor who may be a dental student, faculty,or pre-health undergraduate student, with the goal to introduce the student to a healthcare career.

UWSOD 4th year students will complete their Rural and Underserved Opportunities Program (RUOP) rotation and 2nd year students will complete their five-week Service-Learning Rotations (SLR) in a HPSA designated county.  The 4th year students are able to provide preventive services, i.e. fluoride treatments and sealants and 2nd year students are able to provide services offered by a dental assistant.

As a modification to their year-3 existing Dental Education in the Care of Persons with Disabilities (DECOD) fellowship training for dental curriculum, UWSOD will provide: professional development; interprofessional education; and student training in the care of patients with special health care needs (SHCN).  This has been adapted for rural, frontier, tribal, and other underserved populations.

MSUCON will continue its presence at the Northern Cheyenne and the Blackfeet Head Start Programs to:

• Staff an interprofessional mobile clinic to provide fluoride applications, cleanings, sealants and Silver Diamine Fluoride (SDF) applications.  Oral health education materials are also provided to the staff and students and their families.
• Pilot a tribal pediatric oral health messaging campaign, “First Tooth First Visit” video across statewide network of American Indian clinics.
• Develop  a video illustrating the mechanism of action of SDF.

The funding is also supporting the expertise from Yarrow LLC and WIM LLC to produce the 2024 Oral Health Workforce Assessment, which will collect data to examine the distribution, workforce capacity and demographic characteristics of the current dental workforce in Montana.  The results will benefit the discussions determing the 2025-2030 MCHBG Health Priorities as determined by the MCHBG Needs Assessment.

Oral Health Program Plans for FFY 2024

Montana last conducted the Basic Screening Survey (BSS)  for third grade students during the 2017-2018 school year.   The BSS, a tool for oral health surveillance that was developed by the Association of State and Territorial Dental Directors (ASTDD) to help state and local public health agencies monitor the burden of oral disease. 

For FFY 24, Title V funds will be used  to fund the third grade BSS and the OHP will fund the technical assistance from ASTDD which includes the guidance for conducting, analyzing, and reporting BSS data.   Additionally, CPHDs and others who request oral health technical assistance, will be routed to the Oral Health Program.