Oral Health

The Access to Baby and Child Dentistry program — ABCD — puts young children on a lifelong path to good oral health. ABCD connects low-income families with dentists who know how to care for young kids, preventing tooth decay early and educating parents about how to take good care of their children’s teeth.

Since 1999, ABCD has more than doubled the percentage of Apple Health-eligible (Medicaid) babies, toddlers and preschoolers in Washington who receive dental care. More than half of these eligible children, some 52 percent, are receiving care today compared with only 21 percent 17 years ago.

There are many reasons patients don’t make or keep dental appointments, including: lack of time, fear, challenges finding a provider- particularly if the patient is covered by Medicaid, transportation or child care issues, and work schedules.

In Thurston County, CHOICE Regional Health Network is working to improve access to care by expanding their care coordination services to include adult pregnant and diabetic patients. This work is part of pilot program approved by the Washington State legislature. Thurston County was selected because of the community’s successful work implementing innovative health care models, like the Access to Baby and Child Dentistry (ABCD) program. Pregnant and diabetic patients between 21 – 64 who are covered by Medicaid will be referred to dental care and receive care coordination support from CHOICE staff. Dentists who are Oral Health Connections (OHC) trained and certified will receive enhanced fees for certain procedures.

For the past year, CHOICE has supported over 125 oral health providers in becoming certified to receive these funds. CHOICE care coordination services include scheduling appointments for patients, resolving barriers to attending dental appointments, discussing patient fears and anxiety around oral health, and sharing health education materials. Statewide, the ABCD program has led to a huge increase in access to dental care. CHOICE is eager to translate those best practices to the adult Medicaid population through the Oral Health Connections program.

CHOICE Regional Health Network is working with Arcora Foundation to create a structured and comprehensive approach to reducing oral health disparities in Thurston County. Through a health equity lens, the Thurston County Local Impact Network (LIN) approach is organized around anchor strategies working toward the common goal of improving oral health. We aim to start with at least 5-7 anchor strategies.

Over three years, the anchor strategies will focus on:
1. Care coordination to assist vulnerable and at-risk children and adults in accessing dental care
2. Improving opioid prescription practices
3. Integrating oral health services for young children into medical well-child checks
4. Increasing access to dental services for people enrolled in Medicaid and seniors
5. School sealant programs in schools
6. Co-located and integrated primary care, behavioral health, and dental care
7. Community oral health education

The LIN is also working with a program evaluator and the Oral Health Clinical Advisory Committee to ensure the success of these strategies.

Anchor Strategies Overview

Connect Patients to Dental Care
CHOICE will increase utilization of dental services and patient satisfaction for Thurston County residents experiencing access barriers. CHOICE will utilize their long history of successful care coordination for children under age six through the Access to Child and Baby Dentistry program to support pregnant women and patients with diabetes.

Prevent Opioid Misuse and Abuse
The goal of this strategy is to reduce opioid prescriptions written by Thurston County dentists. It includes a comprehensive, lecture-based course for dentists, dental hygienists, assistants, and other front office staff. Following the course, offices will self-select to receive more intensive and individualized trainings, technical support, and follow up to improve opioid safety practices and align with current Washington State clinical guidelines

Increase Access to Dental Care
Olympia Union Gospel Mission (OUGM) will improve the oral and overall health of lower income, uninsured seniors with diabetes. Providing preventive and restorative services, volunteer dentists and a newly hired dental hygienist will increase patients’ knowledge of the relationship between good oral health practices and a reduction in the impact of their chronic medical disease on overall health.

Implement School Sealant Programs and Educate the Community about Oral Health
Thurston County Public Health Department is the lead organization for two strategies: School Sealants and Community Education. School sealant programs provide high quality dental sealants, and potentially fluoride varnish applications, along with referrals to needed dental care to families of school-age children through Thurston County public and private schools. Sealants are a protective coating that covers the chewing surface of molars to protect teeth from bacteria and decay.

The goal of the Community Education strategy is to promote the importance of oral health throughout a broad spectrum of organizations in Thurston County so that a higher proportion of county residents understand the connection between oral health and their overall health and adopt behaviors to prevent oral disease.

Working with the Medical Community
The LIN is developing additional projects around medical dental integration to provide oral health preventive services in medical settings and connecting patients to local dental providers for routine care. They are also developing projects to provide coordinated medical, dental, and behavioral health services in community-based settings.

Program Evaluation
Thurston Public Health, in partnership with Spokane Regional Health District, is the data/measurement and evaluation lead. The lead will develop and monitor a measurement model to ensure the goals and strategies are directed at the primary drivers of poor oral health.
• Establish a measurement framework to support evaluation and continuous improvement
• Strengthen linkages between outcomes and strategies within and across LIN strategies
• Support anchor strategy lead organizations with incorporating the measurement framework into their work

Oral Health Clinical Advisory Committee
Clinical/Subject Matter Experts will consist of representatives of the dental and medical communities and will offer clinical expertise, guidance, and feedback on LIN strategies from a clinical perspective.
• Provide clinical guidance and feedback to the leadership committee on LIN strategies
• Liaise with respective professional organizations/associations to promote the work of the LIN

Oral Health Clinical Advisory Committee: The Thurston Oral Health Network convenes the Oral Health Clinical Advisory Committee quarterly. This group, made up of local dentists and medical providers, generates ideas and insight on oral health programs in the Thurston County.

DentistLink: DentistLink is a free service that helps Mediciad enrolled children and adults find a dentist. If your practice is looking to expand their client base, DentistLink could be a great tool for you.

Other trainings: CHOICE works closely with the Arcora Foundation and The Thurston Mason Dental Society to offer a variety of trainings. Previous trainings have included: Motivational Interviewing, Trauma Informed Care, Opioid Safety Training for Dentists, and others.

Email chesoliK@crhn.org to get involved in any of these training opportunities.