Maximizing the utilization of the existing dental workforce assets is a key goal in early intervention. Dentists, dental hygienists, school nurses and other allied medical health professionals can play a significant role in delivering services through public health programs. Thirty five states now have policies that allow qualified hygienists to provide preventive oral health care in community based settings.¹ In Nebraska, hygienists can obtain a Public Health Authorization Permit (Child and/or Adult) which allows them to provide preventive services under the scope of their license in public health settings. In 2015, there were 80 hygienists with this permit. Nebraska can directly reimburse these hygienists once they obtain a Medicaid provider number.² Increasing the mobilization of these skilled public health dental hygienists could help provide needed preventive services in Nebraska’s projected dental shortages areas.

Public health programs need to collaborate to pool resources, share experiences, duplicate their efforts to promote oral health within their regions. With state support, community backing, local workforce and proper equipment these partnerships can expand preventive services into non-traditional settings that can deliver positive results. Close coordination of the statewide LPHDs with the OOHD through the Nebraska Association of Local Health Directors will be needed with constant communication.

Sources:

1. Department of Health and Human Service, Centers for Medicare and Medicaid Service. Keep Kids Smiling: Promoting Oral Health Through the Medicaid Benefit for Children & Adolescents; September 2013. Available at: http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Benefits/Downloads/Keep-Kids-Smiling.pdf.

2. American Dental Hygienists Association. States Which Directly Reimburse Dental Hygienists for Services under the Medicaid Program; June 2010. Available at: https://www.adha.org/resources-docs/7519_Direct_Re....

Current community based intervention projects occurring in Nebraska:

Oral Health Access for Young Children: The OHAYC program was first implemented in January 2011 in 15 LPHDs and FQHCs across Nebraska. The projects provided preventive dental screenings and supplies, fluoride varnish applications, oral health education and dental referrals to high-risk children and families with limited access to dental health care in WIC, Head Start/Early Head Start, and Day Care settings.

Elder Health Enduring Smiles: Through a sub grant between the DHHS, Division of Public Health Office of Oral Health and Dentistry and The University of Nebraska Medical College oral health training toolkits were created and distributed to senior center across Nebraska. The training module topics include: oral health care for senior residents, oral assessments, the oral effects of medications prescribed for residents and the oral-systemic link of diseases for elders. A new grant was issued in January 2015 to continue this work and a DVD will be left at centers to train new employees. The collaborators will also explore expanding this training to help people with disabilities.

UNMC Sealant Program: The UNMC College of Dentistry has operated the Dental Hygiene Sealant Program since 2003. This program pairs hygiene students with instructors who visit selected public elementary schools in Lincoln, Omaha and rural areas of the state on an annual basis. Traveling in teams, these providers go into the schools and set up portable equipment to hold a sealant clinic on site.

Building Healthy Futures: Building Health Futures is a non-profit organization that works with the Omaha Child Oral Health Collaborative. This group brings many local dental partners together to provide increased access to dental services for underserved children. They work with the Douglas County Health Department, One World Community Health Center, Charles Drew Community Health Center, Creighton University College of Dentistry and the UNMC Pediatric Dental Residency Program. These partners work together along with local private dentists to provide educational, preventive, and patient referrals to dental homes in several Omaha public schools.

Loup Basin Smiles Dental Program: In 2005, The Loup Basin Public Health Department started a dental disease prevention program that went into about 25 pre-school and elementary school settings. They offered oral screenings to over 1,000 children per year along with fluoride varnish applications performed by a dental hygienist. Based upon the screening findings, proper dental referrals were then made. A six year study from 2006 to 2012 found that there was a 35% decrease in the number of students who needed immediate referrals to a dentist.

Miles of Smiles Program: Miles of Smiles Program is a prevention project in O’Neill. The North Central District Health Department serves 48,000 people in nine counties in rural northern Nebraska. Six of these counties are designated as general dental shortage areas by the state. In 2012, they started the Miles of Smiles dental program that went into about 35 elementary and middle school settings. They offered oral screenings to about 35% of the students along with fluoride varnish applications and proper referrals. A dramatic decrease in children that required immediate dental referrals occurred between 2012 and 2014 (30% in 2012 to 19% in 2014), which demonstrates how large of an impact community oral health prevention programs can make.