Oral Health America Webinar Series
Baby Teeth Matter: Oral Health Collaborative
November 28, 2017
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/Oral Health America
@Smile4Health
HOUSEKEEPING INFORMATION • •
Please remember to MUTE your phone. Questions are welcome! We’ll allow 10-15 minutes after the presentation for questions. • •
• •
Questions will be accepted in writing through the control panel on the upper right hand of your screen. Submit questions at any time; we will address them at the end of the presentation.
Webinar is being recorded; for rebroadcast on OHA’s website – OralHealthAmerica.org Your feedback is important to us. Please take our brief webinar evaluation after this session; link will be sent via email.
CE Credit Available
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CAMPAIGN FOR ORAL HEALTH EQUITY Addresses oral health inequities in our society and identifies possibilities for closing the oral health divide in America.
The campaign strives to: Educate and engage the public, including policymakers, about the importance of oral health for overall health Emphasize the need to prioritize oral disease alongside other chronic health conditions
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Sarah Borgida, MS
Director, Children’s Programs and Tribal Partnerships ARCORA—The Foundation of Delta Dental of Washington
Rachael Hogan, DDS Dental Director, Swinomish Clinic
BABY TEETH MATTER: ORAL HEALTH COLLABORATIVE
Northwest Tribal Dental Support Center Washington Dental Services Foundation
Just the Facts: 2-5 year olds 60
54%
50 40
37% 28%
30 21% 20 10 0 AI/AN
US
Decay Experience Untreated Decay
Two is Too Late! Percent of AI/AN Children with Decay Experience by Age, 2014 80.0
Percent of Children
70.0 60.0 50.0 40.0 30.0 20.0
10.0 0.0
18.1
39.4
59.9
69.4
75.6
54.1
1 Year
2 Years
3 Years
4 Years
5 Years
1-5 Years
Age
Treatment alone does not stop ECC 

IHS has estimated that it costs thousands of dollars to treat each child with ECC and $8,000 or more if they are treated under general anesthesia. 40-50% of children treated with severe ECC have new decay within 4-12 months.
Assumptions •ECC is both preventable and manageable if we can see children regularly beginning soon after the first tooth erupts. •IHS/Tribal dental clinics are the best dental home for young children and dental treatment under general anesthesia should be avoided if possible.
New FDA Safety Warning

The U.S. Food and Drug Administration (FDA) is warning that repeated or lengthy use of general anesthetic and sedation drugs during surgeries or procedures in children younger than 3 years or in pregnant women during their third trimester may affect the development of children’s brains.
Baby Teeth Matter: Objectives 
Increase the number of 0-5 year olds who receive dental access, with an emphasis on 0-2 year olds.

Increase the number of 0-5 year olds who receive comprehensive dental care at their IHS/Tribal dental program.
Baby Teeth Matter: 8 Dental Programs Swinomish Puyallup
Grand Ronde Port Gamble Inchelium Nisqually NARA
Shoalwater Bay
BTM Structure
3-4 face to face meetings yearly Collection of baseline and quarterly data Quarterly conference calls Ongoing training and technical assistance
PDSAs: Plan, Do, Study, Act
Mini-experiments to see what does and doesn’t work to increase access and to keep young children in our IHS/Tribal dental programs.
Baseline Data: Jan-June 2013
Baseline Data: Highlights
Children 3 to 5 years old were twice as likely to access care as children 0 to 2 years old
Nearly 32% (n=229) of children receiving dental exams/screenings needed restorative care
Nearly 24% (n=44) of children who needed restorative care did not receive treatment and 9% (n=16) had an unknown' outcome
Three Year Results
What Works?
Minimally Invasive Dentistry
“Treat” while spot lesions and incipient dental caries with fluoride varnish and sealants
Use silver diamine fluoride to arrest caries
SMART: silver plus glass ionomers
Hall Crowns
Minimally Invasive Dentistry Variations
on the knee to knee
technique Distraction Keep
is key.
your cool☺
Building
this relationship early on makes for a more cooperative 34 year old dental patient.
Social Media Experiment
Thank You!
Small But Mighty Tribe - Located North of Seattle on Fidalgo Island - Approximately 1000 Tribal members - Passionate, Strong and Visionary Tribal Leadership
Priority of Health ▪ Passionate, Strong & Visionary Leadership ▪ Experienced Senate ▪ Chairman Cladoosby: President National Congress of American Indians ▪ Great Respect & Support Given to all Employees ▪ Driven by what is Good for the People, Prioritizing Youth & Elderly
“Best Job in the World”
Small But Mighty Clinic Swinomish Dental Clinic After Self Governance -Exercising Sovereignty
Old I.H.S. Provided Dental Trailer
Breathtaking Waterfront Views not an Accident!
A Glimpse Into Our Day • 3000 User Population (NA/AN)
• 5 Operatories • 1.5 Dentists, 1.5 Hygienists, 1 Dental Therapist, 3.5 Assistants, 1 Office Manager • All General Dental Services from Exams to Limited Implants
Baseline Data Gathered for Baby Teeth Matter was Shocking! • 80% of Kids 0-5 (& Even Older) with Signs of Decay Referred Out • Of those Referred: • Over 50% No Shows (too inconvenient or uncomfortable) • Many Over-Treated (General Anesthesia for just a few fillings) • Many Required Retreatment within 1 Year • Only 10% had a Good Experience • Many patients/parents had a bad experience
• Not Doing our Patients any Favors, Reinforcing Historic Fears & Trauma
- Goal to Become a True Dental Home
Increasing Dental Access & Care for Kids Under 5 Years Old 1. Collaborate with Medical Team and Spread the Word about “Open Appointment Policy� for Babies 2. Strengthen/Enhance Current Relationships & Programs with Youth Staff Utilizing Dental Therapist 3. Embrace Minimally Invasive Dentistry and Become More Kid Friendly
4. Establish Tribal Policy
#1 Collaborate with Medical Team &
Spread the Word about “Open Appointment Policy” - Re-trained Medical Staff on Fluoride
Applications - Trained Dental & Medical Staff to Encourage Families with Babies to be seen ANY TIME - Medical Staff Given “Tickets” to Share with Kids to Remind them to Discuss Oral Health and Send them to Dental
- GET EVERYONE ON THE SAME PAGE - Hep C Testing in Dental & Working to Set up Tobacco Cessation
#2 Strengthen/Enhance Current Relationships &
Programs with Youth Staff Utilizing Dental Therapist • Established Formal Quarterly Fieldtrip Visits, as Mandated by Tribal Senate, for Screenings of Preschool, Daycare, Waddlers, Toddlers & Babies • Dental Therapist Visits All AM/PM Programs Every Week for One-on-One Time with Kids • Required Health History for Childcare Enrollment includes Dental Consent Form DENTAL HEALTH: Do you have dental insurance?
Yes
No If yes, specify dental plan _____________________________________________
Does your child have a regular dental home?
Yes
No Dental Home Name: ____________________________________
Date of last visit ___________________ What was done?
exam
fluoride treatment
extraction
x-rays
filled cavities
The Swinomish Dental Clinic is an integral part of our program. We do quarterly fieldtrips to the clinic for preventative services as well as have Dental Providers visit the Daycare regularly. We do visual screenings, x-rays, cleanings, and place sealants and fluoride at these visits as long as the child is comfortable and cooperative. Please give permission for your child to participate by signing here: Parent/Guardian Printed Name__________________________________Signature/Date____________________________________ In addition, I also give permission for non-invasive treatment including simple fillings with no anesthetic and the use of Silver Diamine Fluoride (a super easy to apply medicine that stops cavities but stains the cavity black). Initial/Date here:_________________ If you do not want your child to participate or want limited participation please check here and note concerns:
_____________
#3 Minimally Invasive Dentistry • • • • • •
Scoop and Fills (ART) Silver Diamine Fluoride Soon to Implement Hall Crowns Fluoride Varnish every Patient Enhanced Sealant Program Less Referrals
#4 Establish a Policy - Programs Set and Repeatable - Programs Not Dependent on Vision or Enthusiasm of Who Started Them
• Open Policy for Babies • Dental Policy for all 0-5 Year Olds Enrolled in Youth Programs • Policy for Mandatory Current Exam Prior to Distribution Day Participation
Ongoing Efforts…
• Social Media • Referral Management • Reaching out to Providers beyond the Reservation… OB, Pediatric Offices
THANK YOU!
Contact Information: Rachael R. Hogan, DDS 17395 Reservation Rd La Conner, WA 98257 Office: 360.466.3900 Email: rhogan@swinomish.nsn.us
Question and Answer Session • Questions are welcome! This session may last for 10-15 minutes. • Write your questions in your control panel on the upper right hand of your screen. • Submit questions at any time.
CE Credit Available
Contact Information • Sarah Borgida • sborgida@arcorafoundation.org • Rachael Hogan • rhogan@swinomish.nsn.us • Eamari Bell • eamari.bell@oralhealthamerica.org