Prepared by JSI Research & Training Institute, Inc.
August 15, 2017
Vermont Oral Health Coalition
2017 Annual Meeting Report
Summary of Meeting
The Vermont Oral Health Coalition (VOHC) held their annual meeting on August 3, 2017 at the Vermont Department of Health in Burlington, Vermont. The meeting was coordinated and facilitated by the Coalition’s contracted administrative support, JSI. The meeting was attended by 28 people representing oral health, public health and health care organizations around the state. The purpose of the annual meeting is to provide opportunity for networking and information sharing across oral health stakeholders in Vermont, share updates on oral health initiatives and surveillance data, review VOHC subcommittee activities and progress towards annual objectives, and plan priorities and objectives for the coming project year. Guest speakers from the Center for Technology Expanded Functions Dental Assistant Program, Fluoride Varnish Quality Improvement Project, Vermont Technical College Dental Therapy Program and the Ottauquechee Health Foundation provided brief overviews of their respective initiatives in oral health. A summary of guest speaker, data, and subcommittee information shared during the meeting follows, along with priority topic areas and subcommittee chairs defined for the 2017/2018 project year.
Meeting Objectives:
I. Share oral health updates, program information and data from members, coalition, and state
II. Define subcommittee focus areas & chairs for 2017/2018 project year
III. Define subcommittee goals and objectives for 2017/2018 project year
Meeting Attendees:
Meeting Facilitators/Staff:Fonda Ripley / JSI, VOHC Administrative Support
Anna Ghosh / JSI, VOHC Administrative Support
VOHC Meeting Participants & Organization
1. Maureen Mathews / Vermont Child Health Improvement Project (VHCIP)
2. Debora Teixeira / VDH Oral Health
3. Robin Miller / VDH Oral Health
4. Denise Kall / VDH Oral Health VDH Oral Health Surveillance
5. Linda Greaves / VDH Oral Health
6. Marty Hammond / Southern Vermont AHEC
7. Adrienne Sass / Ottauquechee Health Foundation
8. Susan Coburn / DVHA
9. Beth Ladd / Center for Technology @ Essex; Dental Assisting Program
10. Jenny Pitz / Vermont State Dental Society
11. Vaughn Collins / Vermont State Dental Society
12. Sue Offenhartz / VDH MCH Division
13. Mitch Couret / Northeast Delta Dental
14. Heather Blair / Vermont Dental Hygienist Association & Vermont Technical College
15. Clark Eaton / DVHA
16. Michelle Fay / Voices for Vermont’s Children
17. Julie Cole / UVM MC
18. Stephanie Pagliuca / Bi-State Primary Care
19. Ellen Grimes / Vermont Technical College
20. Devin Bevins / VDH
21. Nancy Dumont / Alice Peck Day Memorial Hospital
22. David Neumeister / DentaQuest
23. Kathy DeLucco / Center for Technology @ Essex; EFDA Program
24. Cheyanne Warren / Vermont Technical College, Dental Therapy Program
25. Kristin Fontaine / UVM MC
26. Ellen Gnaedinger / The Health Hub School Clinic Coordinator
News & Updates from Attendees
· Dentists can donate time to the Dental Lifeline Network which provides free comprehensive dental treatment.
· Vermont Technical College received a large grant for a van, the Molar Express, to go to schools, nursing homes and other public settings to provide dental care. Started purchasing equipment and hope to be up and running soon.
· All VTC dental hygiene students passed their boards this year.
· Bi-State Primary Care is the recipient of DentaQuest grant at federal level to bring expertise at FQHCs to integrate with primary care.
· DVHA is interested in efforts to reduce emergency room visits and how to promote preventive care. They are looking at activating the code for silver diamine fluoride for reimbursement by Medicaid, which will hopefully reduce the need for costly dental procedures in the long term.
· Bennington Oral Health Coalition continues to work on promoting benefits of community water fluoridation and the odds municipal CWF would be voted for the next time an opportunity presents.
· Vermont State Dental Society set the following priorities: public outreach and education; expand dental residency program; expand and protect community water fluoridation; dental recruitment; and the having dental extractions excluded from the Medicaid dental benefit cap.
· 2 dental hygienists have received Medicaid provider status.
· Reminder: Please contribute to the newsletter!
Oral Health Initiatives – Brief Presentations
Expanded Functions Dental Assistant Program -- Kathy DeLucco, Center for Technology
Kathy DeLucco provided an overview of the Expanded Functions Dental Assistant (EFDA) Program. A handout provides information about prerequisites and available scholarships.
The program currently operates every other year with the next program running from June 25 to August 3, 2018. The next application deadline is December 1, 2017. A maximum of 8 students will be accepted. There has been considerable interest in the program so far and they anticipate many applications to be submitted.
Currently all graduates from the program are practicing as EFDAs. There is an interest-free loan through the State of Vermont and Vermont Department of Health for 3 students who are given loan forgiveness if they practice as an EFDA in Vermont for one year. There is coaching available for dental practices to learn how to work with an EFDA.
Fluoride Varnish Quality Improvement Project - Ellen Gnaedinger
Based on a concern about the number of children with dental caries as well as an ACA mandate to pay for fluoride varnish for children up to 5 years old, Ellen focused her doctoral work on a project to integrate fluoride varnish applications during well child checks.
She implemented a 4-month project focusing on well child checks at 4 time points: 9 months, 18 months, 2 years and 2.5 years.
A Caries Risk Assessment she conducted found only 39% of children 0-6 years old had dentists.
Successes include:
· Treatment integrated well with the patient flow and was accepted by nurses and providers.
· Billing problems were not experienced
· More than half of children in targeted ages received fluoride varnish
· 48% of all patients seen for well child checks received a fluoride varnish
· Extended age range for the program to include 6 months - 6 years old
Ellen created a brochure for practices to understand the step by step process of setting up a similar program. The brochure can be found here.
Kathy DeLucco commented that the program has had a positive impact by giving parents and others the message that they have to take care of teeth at early age.
Vermont Technical College Dental Therapy Program - Dr. Cheyanne Warren
Dr. Warren began her new position as the director of the program in May and has since been working on CODA accreditation in order to start the Dental Therapy Program at Vermont Technical College.
Coursework and time frames for the program have been outlined based on students entering with little experience to students who have advanced experience. Interested applicants can work with the program to determine needed prerequisite coursework.
The program has received a lot of interest from potential students. The goal is to admit 10 students from both entry level and experienced backgrounds starting in the summer of 2019.
Once a student graduates from an accredited dental therapy program they have to be under direct supervision of a dentist for 1000 practice hours. One dentist can supervise two dental therapists. After that point, with a collaborative management agreement, they can work under General Supervision with a dentist, meaning the dentist does not have to be on site but this has to be clearly spelled out in terms of the procedures the dentist is okay with when he/she is not present.
Ottauquechee Health Foundation - Adrienne Sass
Adrienne Sass, the Executive director of the Ottauquechee Health Foundation (OHF), spoke about its initiatives in oral health. The Foundation started out as an organization which awards grants to those who cannot afford health care. They soon found that 80% of their grants were for oral health care.
The SMILES program provides preventative oral health screening. The goal is to createan accessible, place-based program to address preventative oral health care in an effort to decrease the number of individuals responding to urgent oral health needs.
It had begun as the SMILES for Seniors program which connected seniors to an oral health home. As it became clear that the need went beyond seniors, the program was expanded to all adults and is now called SMILES.
The program provides education, oral health screenings and assessments, and fluoride varnish to adults in community venues. There is no charge to participants in this program. Once screened by the dental hygienist, the Care Coordinators connect those without dental homes to oral health services. The grant funding pays for salaries.
They have found that some people have insurance and just have not gone to a dentist. The care coordinator provides these patients recommendations for a dentist.
Most patients need some financial assistance or help connecting to a local dental practice.
Some dentists indicate they accept Medicaid patients, but often times patients with Medicaid have difficulty finding a practice that will accept their insurance. There is a 100% appointment show rate among patients who have participated in SMILES. This encourages dentists to accept patients with Medicaid.
People find out about the program through social media, flyers and word of mouth. One hundred and fifty people were served this year, and 90 last year.
The program always provides patients a connection to a dentist. A grant committee reviews the specific factors for each case; there is not a cut off in terms of the poverty line. All of the dentists provide a 15% discount.
The Upper Valley Public Health Council has decided to mirror the program in New Hampshire. OHF will expand its service area and own the NH program.
Office of Oral Health - Robin Miller
The mission of the Office of Oral Health is to promote oral health and reduce the burden of oral health for all Vermonters.
There are three foundational components that make up the program:
· Public health dental hygienists (PHDH) who work with families enrolled in the WIC program and with local health care providers to promote early preventative oral health. Specifically, they provide and promote fluoride varnish application, oral health risk assessment, and seeing a dentist starting at age 1.
· Tooth Tutor dental hygienists who work to connect children who have not accessed dental care in the previous year with a local source of dental care.
· A community water fluoridation communications plan which is being developed with the Health Department
Project Updates:
Representatives from the state oral health program, Vermont State Dental Society, Vermont Dental Assistants Association and Vermont Dental Hygienists’ Association came together to promote infection control in dental practice settings in Vermont. The goal is to promote the CDC infection control guidelines and increase dental practice enrollment in the Health Alert Network (HAN).
The elementary oral health survey of Vermont was conducted in the spring with children in grades K and 3 with a response rate of 80%. The survey incorporated questions about sugar sweetened beverages. The report will be finalized soon.
The program is working with DVHA and the Health Department’s Maternal and Child Health Division to update the state dental periodicity schedule, which is a set of recommendations for preventive pediatric dental services.
The Office of Oral Health is coordinating a training regarding silver diamine fluoride (SDF) and silver modified atraumatic restorative therapy (SMART). The trainings will be held on October 27, 2017. The morning session will be informational, while the afternoon will be more clinical. An email was sent to all VOHC members with an invitation to register.
The Health Department has launched a new initiative called 3-4-50 to promote the importance of chronic diseases. Three behaviors—lack of physical activity, poor diet and tobacco use—lead to four chronic diseases—cancer, heart disease and stroke, type 2 diabetes and lung disease—that cause over 50% of the deaths in Vermont. Oral health has obvious connections to this messaging. To that end, 3-4-50 Oral Health information sheets have been developed by Denise Kall to help connect oral health to the campaign messages. Denise Kall presented the information sheets which includes data showing the correlations between the 4 diseases and oral health indicators. The coalition discussed potential uses of the information sheets and the specific data. The data related to tobacco use and tooth loss seemed to stand out and could be highlighted to patients and in obstetric settings. This could also be used as a way to reach out to teenagers who might start smoking. The 802 Quit social media campaign is targeted to young adults in VT.
There is an opportunity for interprofessional collaboration in using the relationship between the campaign and oral health promotion. Robin plans to write a letter for upcoming VOHC newsletter with relevant information that can be used by any audience.
To view the Dental Health Surveillance and reporting page on the Department of Health website, go here.
Community Water Fluoridation Subcommittee
The goal of this subcommittee is to maintain and expand community water fluoridation in Vermont.
Dr. Bookwalter retired as the chair in June. The subcommittee is looking for a new chair and would also like to expand their membership. This group is active when they need to sustain, but don’t meet otherwise. It was suggested they re-name themselves as the Fluorides Subcommittee to expand their focus to include fluoride varnish and silver diamine fluoride, for example.
Dental Workforce Subcommittee
The goal of this subcommittee is to promote and expand a trained and geographically distributed dental workforce in Vermont to increase access and utilization of care.
Debora Teixeira services as chair for this subcommittee. There are 4 subgroups of the subcommittee:
Promoting EFDAs Subgroup
q By January 31, 2017, 6 new EFDAs will be performing expanded functions in Vermont
The subgroup achieved its goal of 6 new practicing EFDAs.
Promoting Dental Therapists Subgroup
q By June 30, 2017, there will be 2 sessions scheduled with Vermont dentists and/or community health teams (or similar groups) to explain the benefits of the utilization of dental therapists in their practice