March 1, 2013
Temple University’s Kornberg School of Dentistry, thanks to grants totaling $1.75 million from UnitedHealthcare and United Health Foundation, is starting a new program designed to help Philadelphia children gain greater access to oral health care. The program is called Project ENGAGE and will attempt to raise the percentage of children in North Philadelphia neighborhoods with access to oral health care from 30% currently to 60%. They plan to achieve this goal within two years.
Designed for children under six years old and their families on Medicaid, Project ENGAGE plans to improve children’s oral health by creating a registry of dental claims, along with operating and emergency department histories, to identify children at risk for other health issues as a result of dental decay. “A lot of parents don’t bring their children in [to the dentist] until about age three,” said Michael Weitzner, DMD and vice president, national clinical operations for UnitedHealthcare Specialty Benefits. “By that time, physicians have seen young children several times before a child has ever been to a dentist. So we can reach out to those children and identify those at risk.” Once this registry is created, community health workers will provide information, counseling, and assistance in scheduling dental appointments. In addition, public health dental hygienists will provide in-home care, including fluoride varnishes and sealants.
Project ENGAGE seeks to assist the neighborhoods in the five zip codes that surround the Kornberg School's North Philadelphia campus. These areas have the highest cost of care for children’s dental care in Pennsylvania. “Some parents tend to seek dental care only when it’s an emergency and then seek that care at a hospital, which can be expensive,” said Amid Ismail, DrPH and Dean of the Temple University Kornberg School of Dentistry. Therefore, the goal is to educate and promote preventive measures so these families can find a solution before there is ever actually a problem.
Physicians can also be trained through the program to provide preventive screenings and apply dental varnish. In addition, general dentists who do not currently provide care to children will be given the support and information they need to care for children. Since they’ll be working in federally qualified health centers, the program will educate dentists, hygienists, and assistants on how to work with small children, from how to prevent early disease from progressing to how to treat advanced oral diseases. “Removing the fear of how you treat the infant or young child is going to be the major emphasis of this program,” said Dr. Ismail.
The lack of access to oral health care is the result of many factors: lack of awareness, limited transportation, and access to qualified dental care providers. Even if some children are fortunate enough to live near a dentist who accepts Medicaid, that particular dentist may not feel comfortable treating very young children. This is another major obstacle Project ENGAGE is trying to eliminate, said Dr. Weitzner.
Treating the lack of awareness means working with parents, guardians, or other family members to educate them on their proactive role in their children’s oral health. The fact that dental decay is completely preventable isn’t often understood by some parents. “It’s related to education and a sense of fatalism,” said Dr. Ismail. “Some parents have this idea that ‘I can do nothing about my child’s teeth.’ If these parents knew they could prevent their children from having decay, then they would try to do it, and they would seek care earlier. It’s a matter of education and perspective."
Since these children receive Medicaid benefits, the issue isn’t so much cost, and the leaders of the program make that clear. “It’s a theory that baby teeth aren’t important,” said Dr. Ismail, referring to the mindset of some parents. “The idea of taking a child with one tooth to a dentist is novel. The first visit has to start at age one for education for the parents and early detection of disease. It’s important to prevent advanced decay. That’s information that’s not available to the public. For example, the use of sugared soft drinks causes tooth decay, but parents don’t realize that.”
Many factors – a lack of information and education, dental deserts, and the Medicaid factor, among other reasons – keep some parents discouraged from taking their children to a dentist. Long-term plans to rise above these factors are on the minds of those behind Project ENGAGE.
“Many parents don’t understand the importance of maintaining primary teeth because in their mind, they’re going to fall out anyway,” said Dr. Weitzner. “There’s also the issue of dental access. Dentists want to practice in an area where they’ll be successful.” That is understandable, considering most dentists start with a mountain of debt after graduating from dental school. The solution, according to Dr. Weitzner, is “to persuade those in government as best we can to encourage public policy so that dentists will want to accept Medicaid patients.”
It seems like baby steps that the program is taking: getting already-licensed public health dental hygienists to provide at-home care, training dental practitioners to work with children, and teaching parents that they must take a proactive role in their children’s health – but the result could be powerful for the pediatric population of Philadelphia.
“What we want to expand is the number of children who have access to care, while reducing the total cost of care,” concluded Dr. Ismail. “If we can keep kids from ending up in a hospital to receive care, we can expand access without increasing cost. With the same amount of money, we can improve more lives.”