Educators, dentists consider mobile dental vans, Dan River

February 2012

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Educators, dentists consider mobile dental vans, Dan River (02.08.2012)

Educators and dentists in Rockingham County are working together to try and provide a way to reach the population of Medicaid-eligible children who are still not seeing a dentist on a regular basis.

Several groups approached Rockingham County Schools three years ago wanting to come in and provide dental services to students. Dr. Jean Steverson, assistant superintendent for instructional services, said the service was initially turned down when they said they would only offer cleanings, X-rays and sealants. She said they wanted a more comprehensive program.

She said they were particularly interested in one that offered restorations because their goal is to provide the most comprehensive care for county students.

“We wanted to help because 36 percent of Medicaid-eligible students are not receiving dental care,” she said. “As much service as local people can provide with the dental clinic, Give Kids a Smile and other programs…we still have kids that aren’t seeing the dentist. There has to be a way to address those concerns.”

She said the conversation among local dentists and officials with the health department is having a positive impact on the problem.

“We’re thinking about what we can do with the resources we already have to make a difference,” she said. “We’ve set a common goal and it’s critical for us to come together on this. We don’t have a complete answer now – maybe it’s a mobile dental van – but we need to continue this dialogue.”

A dental clinic to serve the Medicaid and N.C. Health Choice patients in Rockingham County was created more than a decade ago. Due to concentrated efforts to bring in dentists who accept more Medicaid patients, 64 percent of Medicaid-eligible children ages six to 14 enrolled in school for at least six months used dental services in 2010. This is up from 23 percent in 2005, according to the N.C. Child Health Report Card released by the Institute of Medicine.

Glenn Martin, director of the Rockingham County Department of Public Health, said everyone is working toward the same goal; it’s just a question of how they get to that goal.

“We’ve worked hard to achieve a goal of working to build a permanent dental home infrastructure in Rockingham County,” he said. “There will always be a number of people who may not get there, but I don’t want to do anything to jeopardize that permanent infrastructure.”

Martin initiated the idea of health check coordinators who gain access to dental records and add dental visits to their list of duties. Health check coordinators work with students to increase the number of children who maintain a proper immunity schedule and well-child physicals. They also work to solve barriers that might prevent students from gaining access to medical care.

Coordinators already have access to Medicaid billing, so Martin thought they could check on dental records to make sure students visited the dentist regularly.

“The coordinators can encourage those families to seek dental services through providers accepting new Medicaid patients, and there are some available in the county,” he said. “We provide them with a list of dentists in Rockingham County and hope that it will be beneficial in increasing the percentage of families accessing dental services.”

Martin said through the health check coordinators, guardians and parents will have a chance to see a Rockingham County dentist.

“It’s a work in progress and we’ve still got things we have to tweak,” he said. “I don’t want to think we’re solving one problem and creating another. We have to keep Medicaid dollars working in our community. And at the end of the day, everyone deserves to have a community with a permanent infrastructure.”

Some issues dentists have concerning the mobile dental van service is follow-up care. Reidsville dentist Dr. Cynthia Bolton said there could also be some issues of quality control.

“When the mobile dental vans talks comprehensive care, we still don’t know exactly what that means,” she said. “They have to have someone following care…and we work a month on follow-up care after any Give Kids a Smile event. The van will be gone and possibly won’t return for six months. If we do the follow-up, we won’t get paid because Medicaid has already been billed for those services.”

She said in other counties, people have experienced mobile dental vans that have used sealants and sealed decay into the tooth.

“We’ve got a great infrastructure, although it is fragile,” Bolton said. “We have at least four to five practices in Rockingham County that are specifically seeing Medicaid patients because it’s part of their business model.”

The Rockingham County Dental Society recently passed a resolution during its last meeting not to support bringing mobile dental vans into the county. President Scott Vines said they feel like they’ve been addressing the issue of underserved kids and have gained some real ground.

“We feel like we already have all these positive things going on in the community in helping take care of our young people here,” he said. “We don’t necessarily need anything from the outside to come in and help with that.…Creating dental homes for the kids is really the best way to go forward long-term – to be able to be seen by a local dentist, treated by a local dentist and to be able to go back to a local dentist whenever they need to is important.”

Steverson said a decision has still not been made on whether to allow the mobile dental van to serve students in the county. She did say she will continue to work with other dentists and health officials to find other means of serving the 36 percent of Medicaid-eligible students not seeing the dentist.