WIC-Dental Partnership for Prevention

State: FL Type: Model Practice Year: 2008

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The WIC-Dental Partnership for Prevention of Early Childhood Caries represents an intra-agency collaboration focused on improving the oral health of low-income children in Palm Beach County. Due to lack of knowledge on oral health and limited access to dental care, vulnerable populations (such as infants who are eligible for WIC) develop dental problems much earlier than others. Since the program's inception in May 2006 at the West Palm Beach Health Center, this early intervention and prevention program has worked to counterbalance oral health disparities by increasing access to dental care for WIC children while providing nutritional guidance for their caregivers. The WIC-Dental Partnership for Prevention program focuses on reducing the prevalence of Early Childhood Caries (ECC) in WIC-eligible infants. ECC (“baby bottle tooth decay”) is one of the most common diseases affecting infants and young children. ECC is a distinctive pattern of tooth decay present in an estimated 5-10% of all infants; but the disease is more prevalent in low-income infants. ECC is a severe, rapidly developing form of tooth decay in infants and young children. It affects teeth that erupt first, at about 6 months, and are least protected by saliva. This is a multi-factorial disease linked to diet and oral hygiene. ECC is now recognized as an infectious disease, and these decayed teeth require professional treatment to remove the infection and restore tooth function.

The 2000 Surgeon General's Report revealed that there are still oral health disparities in America. Children from racial and minority groups have disproportionately higher prevalence for ECC than do whites. In addition, infants and children participating in federal supplemental feeding programs such as WIC are at an increased risk for dental caries and ECC. Though the burden of disease is greater among WIC children by virtue of the fact that they are poor, these children are five times less likely to receive treatment than their wealthier counterparts. The WIC-Dental Partnership for Prevention program specifically targets this vulnerable population by providing children with access to risk assessments so that appropriate interventions can be introduced to prevent the onset of oral and other nutritionally related disease. The WIC-Dental Partnership for Prevention Team developed and implemented a program model that considered the educational goals of WIC as well as the Healthy People 2010 Oral Health Objective. An Oral Health Group, which is part of the WIC curriculum, was designed to meet both these objectives. The target population of this program were infants ages 6-18 months. WIC nutritionists and clerks promoted the weekly Oral Health Group to parents whose children were in the target population. A dentist and hygienist provided oral hygiene and nutritional counseling for parents during this group. All children received an oral health examination, fluoride treatment and, when necessary, referrals for dental care.

This program approach fulfills the Surgeon General Report's suggestion that oral health education should be included within prenatal and early childhood education and offered synchronously with programs targeting improved nutrition. Of the 4,313 WIC eligible infants who are seen at the West Palm Beach Health Center, approximately 981 have been reached. Of these children, approximately 40% have become patients in the dental clinic. An overwhelming majority of these children (85%) are caries-free and will receive dental check-ups every six months. The greatest success of the program is that it is a successful early intervention. Early access to dental care has been shown to result in a more than 50% reduction in future dental cost. Though there is no way to quantify it, the reduction in dental caries also reduces the morbidity (pain, suffering, cellulitis) and mortality from the disease.

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Palm Beach County Health Department
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WIC-Dental Partnership for Prevention
The WIC-Dental Partnership for Prevention of Early Childhood Caries represents an intra-agency collaboration focused on improving the oral health of low-income children in Palm Beach County. Due to lack of knowledge on oral health and limited access to dental care, vulnerable populations (such as infants who are eligible for WIC) develop dental problems much earlier than others. Since the program's inception in May 2006 at the West Palm Beach Health Center, this early intervention and prevention program has worked to counterbalance oral health disparities by increasing access to dental care for WIC children while providing nutritional guidance for their caregivers. The WIC-Dental Partnership for Prevention program focuses on reducing the prevalence of Early Childhood Caries (ECC) in WIC-eligible infants. ECC (“baby bottle tooth decay”) is one of the most common diseases affecting infants and young children. ECC is a distinctive pattern of tooth decay present in an estimated 5-10% of all infants; but the disease is more prevalent in low-income infants. ECC is a severe, rapidly developing form of tooth decay in infants and young children. It affects teeth that erupt first, at about 6 months, and are least protected by saliva. This is a multi-factorial disease linked to diet and oral hygiene. ECC is now recognized as an infectious disease, and these decayed teeth require professional treatment to remove the infection and restore tooth function.  The 2000 Surgeon General's Report revealed that there are still oral health disparities in America. Children from racial and minority groups have disproportionately higher prevalence for ECC than do whites. In addition, infants and children participating in federal supplemental feeding programs such as WIC are at an increased risk for dental caries and ECC. Though the burden of disease is greater among WIC children by virtue of the fact that they are poor, these children are five times less likely to receive treatment than their wealthier counterparts. The WIC-Dental Partnership for Prevention program specifically targets this vulnerable population by providing children with access to risk assessments so that appropriate interventions can be introduced to prevent the onset of oral and other nutritionally related disease. The WIC-Dental Partnership for Prevention Team developed and implemented a program model that considered the educational goals of WIC as well as the Healthy People 2010 Oral Health Objective. An Oral Health Group, which is part of the WIC curriculum, was designed to meet both these objectives. The target population of this program were infants ages 6-18 months. WIC nutritionists and clerks promoted the weekly Oral Health Group to parents whose children were in the target population. A dentist and hygienist provided oral hygiene and nutritional counseling for parents during this group. All children received an oral health examination, fluoride treatment and, when necessary, referrals for dental care. This program approach fulfills the Surgeon General Report's suggestion that oral health education should be included within prenatal and early childhood education and offered synchronously with programs targeting improved nutrition. Of the 4,313 WIC eligible infants who are seen at the West Palm Beach Health Center, approximately 981 have been reached. Of these children, approximately 40% have become patients in the dental clinic. An overwhelming majority of these children (85%) are caries-free and will receive dental check-ups every six months. The greatest success of the program is that it is a successful early intervention. Early access to dental care has been shown to result in a more than 50% reduction in future dental cost. Though there is no way to quantify it, the reduction in dental caries also reduces the morbidity (pain, suffering, cellulitis) and mortality from the disease.
The 2000 Surgeon General’s Report "Oral Health in America," illustrated that oral health disparities still exist in America. Despite the decline in the incidence of dental caries (tooth decay) in the United States over the past several years, the condition remains a significant problem for the nation's poor children. It amounts to what the Surgeon General’s Report considers a “silent epidemic of oral diseases [that] is affecting our most vulnerable citizens – poor children, the elderly, and many members of racial and ethnic minority groups." Our practice addresses the issue of oral health disparities and seeks to increase access to care for WIC infants. A health department survey conducted in 2006 determined that oral healthcare was the greatest unmet need in Palm Beach County. Team members determined that this was a relevant public health issue for the center based on the volume of clients who had unmet dental needs. Simply through patient contact and observation, WIC nutrionist and staffs determined that WIC clients still had unmet dental needs, and many clients were not aware that their children should be seen by a dentist. The dental team noticed that they were treating an increasing number of young children who had ECC. In December 2005, a partnership was formed in order to better serve clients. The focus continued to be on educating clients in order to prevent dental caries and also establishing a dental home for continued oral care.
Agency Community RolesThe health department is an internal stakeholder. The WIC-Dental Partnership for Prevention seeks to provide early intervention in the disease process. Once established, dental caries require treatment. A cavity grows larger and more expensive to repair the longer it remains untreated. The program decided to focus on the prevention of ECC in order to potentially prevent this disease from ever occurring. Nutrition is a central theme in both programs and a common denominator of growth, development, and oral health. This program approach fulfills the Surgeon General Report's suggestion that oral health education be included within prenatal and early childhood education and offered synchronously with programs targeting improved nutrition. This program has been beneficial to both the WIC and dental staff because it uses their time efficiently by increasing the number of clients seen in WIC and decreasing dental staff clinic time. Moreover, it allows staff to function in their area of expertise. The dental staff serves as adjuncts for the WIC Health Educator and actually facilitate the Oral Health Group. In addition, team members were cross-trained in each program area. External Stakeholders. This program is an efficient use of clients' time because they receive oral health and nutrition education, WIC checks, and an oral health examination and fluoride treatment for their children in the same appointment. This increases access to care because children who would otherwise not have seen a dentist receive oral health examination, referrals, and follow-up care. The ultimate goal of this project is to provide a dental home for this vulnerable population. As far as fostering collaboration with community stakeholders, the program is always sharing its model with different agencies in an attempt to promote oral health. This unique program could potentially be replicated in other sites. To this end, several agencies have visited the Oral Health Group; they include Health Care District/ Comprehensive Services Nurses, Healthy Start Nurses, and the dental director for neighboring Martin County. The program improves upon a model used by HeadStart. In an effort to help that agency and to exchange ideas, the program conducted a Seminar at the 2007 Annual Florida HeadStart Conference. Costs and ExpendituresThe WIC-Dental Partnership for Prevention required monthly meetings of team members during lunch hours. Most of the activities and work effort to organize, plan, implement, and improve this program were performed by team members either in addition to their regular duties and responsibilities or on their own free time. The estimated cost of supplies (toothbrushes, gloves, oral health information, etc.) is $2,000. There is no estimated cost of staff time for facilitating the weekly Oral Health Group. The WIC staff, the dentist, and the hygienist are career service employees who are performing their duties during regularly scheduled working hours. ImplementationIn December 2005, the WIC staff and dental staff at the West Palm Beach Health Department discussed developing a partnership to prevent dental caries and determined that WIC clients still had unmet dental needs and many clients were not aware that their children should be seen by a dentist. A partnership formed in order to better serve clients. The focus was on educating clients in order to prevent dental caries and also establishing a dental home for continued oral care. Beginning in May 2006 as part of the WIC Oral Health Education Group, the program offered infant oral health screenings and fluoride varnish. Children who needed care were referred to the dental clinic or local dentists for treatment. The program model has been successful because it involved dental staff coming to WIC and working in that facility rather than relying on client referrals.
The program has served 930 families, screened 981 infants, and provided fluoride varnish to 716 children. The program has also succeeded in identifying over 160 children who need immediate or emergent dental care and has provided them with treatment or referral for dental care. However, success is not defined solely by numbers. The ultimate goal is to reduce health disparities by providing this vulnerable population with a dental home. Nearly 40% of the children screened in WIC have now become patients in the dental clinic. An overwhelming majority of these children (85%) are caries-free and will receive dental check-ups every six months. The greatest success of the program is that it is a successful early intervention. Early access to dental care has been shown to result in a more than 50% reduction in future dental cost. Though there is no way to quantify it, the reduction in dental caries also reduces the morbidity (pain, suffering, cellulitis) and mortality from the disease.
Because this is a pilot program, staff are very conscious of the need for sustainability. Fortunately, the program costs are low (approximately $2,000 per year) and the annualized revenue for 2007 was $53,000. Since its inception, our program has generated $83,000. One of the most important factors of sustainability is staff. Several changes in the composition of our team have occurred due to staff turnover; however, through the monthly meetings, the program has managed to remain a cohesive team focused on a goal of prevention. In addition, team members realized early on that in order to work well together, they had to be educated as to the role that each division plays at the health department. In March 2006, the dental staff conducted an Oral Health Education Workshop for the entire West Palm Beach WIC staff. In December 2006, WIC staff provided education about their program at the dental general staff meeting. To this end, members of the team have all received cross-training and staff rotate as needed. Members have also realized the value of this program and the need that it fills. Another factor that affects sustainability is the ability to gain broad based support from health department Leadership. In March 2007, team members shared the program with the Palm Beach County Health Department’s Executive Leadership Team. The program was well received and commended by Dr. Jean Malecki. Recently, the program was recognized by the State of Florida as a Best Practice and was awarded a $1,500 award, which was used to purchase over 1,200 MAM infant training toothbrushes. As part of a desire to sustain the program, team members constantly share the model with other organizations within the health department as well as in the community. Several representatives from the following organizations have observed our group: the dental director for the Martin County Health Department, nurses from the Healthy Start Program, nurses from the Comp Health Services Program/ Health Care District as well as dental and WIC staff from other health departments. To this end, team members are constantly receiving feedback about the program and can serve as ambassadors for oral health. As far as leveraging financial resources, the success of the program has led to financial support from WIC partners. Their program had a surplus budget last year, and the WIC members of the team were able to purchase supplies (toothbrushes) as well as some educational materials (e.g., "Dora the Explorer Goes to The Dentist"). In addition, as winner of the state's Best Practice Award, the program received a $1,500 award, which was used to purchase 1,200 infant toothbrushes, roughly an 18-month supply. Going forward, the program cost will decrease because budgeting money for these items will not be necessary for awhile.
 
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