1. Oral Care for School-Aged Children:
WKRC In Cincinnati
(Why Kids Receive Care)
Lawrence F. Hill, DDS, MPH
November 11, 2008
NNOHA Annual Meeting

3. School-based Dental Sealant Program

4. Sealants

5. Sealant Program Findings
34 – 47% of 8 year olds with untreated decay
Pre 2000, % received no care after one year

6. Case Management Program
Pilot time-limited project
Employed a social work grad student
Letters to the parents of all children found to be in need of follow-up care offering referral assistance, utilizing community tx resources
Letters followed by telephone contact
Telephone contact followed by home visits
Results: Of those in need of treatment, approximately 25% received care + value added (sibs and other family members)

7. 2004 Pilot Programs Shuttle Dentistry (Take the kids to the dentist)
The Dental Road Crew (Take the dentist to the kids)
Interesting “middle class” bias

8. Shuttle Dentistry
Move 3-4 dentists to a 6 chair dental clinic and have a dentist at each of 4-5 of the chairs and a dental hygienist at one chair
A shuttle bus picks up a load of kids and drops off enough kids to fill the chairs and the waiting room
As a child is completed they go to the waiting room and a child who has been waiting goes to a dental chair for treatment
In the meantime, the shuttle has gone back to the school for another load and then returns the first load

9. Shuttle Dentistry: Advantages and Disadvantages
Utilizes existing clinics (no capital)
Utilizes existing staff
Very efficient for clinical operations
Disadvantages
Requires intensive coordination
Travel time
Waiting time
Treatment time
Adds NO new capacity to the system – displaces current patients
Cost for transportation

11. The Dental Road Crew

12. The Dental Road Crew 2-chair complete mobile dental office
The van arrives at a school 30 minutes prior to the beginning of classes
Parks immediately adjacent to the schools
The school nurse and the appointment scheduler on the van work together to assure that both chairs are filled at all times
Use electronic records and digital x-rays
Kids are called from class to the van when the staff is ready for them

13. The Dental Road Crew Advantages and Disadvantages
Minimizes time out of class
Adds capacity to the dental tx system
Great acceptance by kids, parents, school personnel and school nurses
One van can serve multiple schools
Disadvantages
Capital expense
Added capacity = added operational costs
Storage, fuel, insurance

15. Treatment Rooms
Fixed site
Mobile
vehicle

16. Inside of Van

17. dentalclinicmanual.com

18. Growing Well Cincinnati
Collaborative Cincinnati Public Schools Cincinnati Children’s Hospital (pediatrics) Cincinnati Health Department (school nurses) Community Health Centers (primary care) Mind Peace (mental health/Junior League) CincySmiles Foundation (oral health) Lens Crafters (vision)

19. Growing Well Oral Health Partners
CincySmiles Foundation
Cincinnati Health Department
Office of Community Dental Programs (dental clinics)
School Nursing Program
Cincinnati Children’s Hospital Medical Center
Pediatric Dentistry Residency Program
Cincinnati Dental Society
Community Health Centers
Private practices (individual and corporate)

20. Next Steps for Growing Well
Geo mapping
School centered maps with dental treatment resources plotted in concentric circles
Dental treatment resource centered map with schools plotted in concentric circles
Consider school preferences and existing relationships
Match schools with appropriate tx resources and models
Cost modeling utilizing dental interactive spreadsheet

21. School Nurses/Oral Health
2005/2006 school year incorporated oral health assessments with vision and hearing screenings for kids in grades K,1,3,5
2006/2007 school year screened more than 10,000 kids and found 28% in need of tx
89.6% received care
Has stressed the system to the limits
No ongoing preventive maintenance

22. WKRC Sealant Program Favorable ratio of school nurses to students
Very efficient and capable coordinator
With parental consent, presence not required
Treatment resources
Community Health Center Dental Clinics (3)
Cincinnati Health Department Dental Clinics (5)
Children’s Hospital Dental Residency
Corporate Medicaid dental practice

23. Challenges Most communities do not have the treatment resources
Requires significant school nurse cooperation
Some FQHC’s try to stretch out the number of visits
Dentists not comfortable doing as much tx as possible at the initial and subsequent visits
Coordination intensive (shuttle program)

24. Consensus of What Works Best for the Kids, parents and School Staff ?
Several mobile vehicles that could each have a case load of schools and Head Start programs, the ratio of which would be determined by the number of children, the annual number of new students and disease prevalence, and that each van be responsible for assessments, fluoride varnish, sealants and treatment

25. Knowing the Market Beware of the Entrepreneurs Be Competitive!
“We provide care to all children”
Do they cherry-pick Medicaid?
Do they skim the quick, profitable procedures and leave the treatment to you or nobody
Be Competitive!
Don’t be afraid to sell your program

29. Lawrence F Hill DDS MPH CincySmiles Foundation 635 West 7th Street, Suite 309 Cincinnati, Ohio