May 17th, 2010
Here is a sampling of what foundations and others are doing in the important area of oral health care.
The Cost of Delay: State Dental Policies Fail One in Five Children was released 23 February 2010 by the Pew Center on the States (part of the Pew Charitable Trusts). The report was funded by Pew, the DentaQuest Foundation, and the W.K. Kellogg Foundation. Pew graded the fifty states and the District of Columbia on eight “key performance indicators” (policy solutions), such as providing dental sealant programs in high-risk schools, “fluoridating community water supplies,” improving reimbursement rates for dentists under Medicaid, and “authorizing new primary care dental providers.” The results of this study? “Two-thirds of states are doing a poor job,” Pew says. However, six states were graded A: Connecticut, Iowa, Maryland, New Mexico, Rhode Island, and South Carolina. Want to find out how your own state did? Fact sheets are available for each state and D.C. See the report’s methodology section for data limitations that the researchers encountered.
The report points out that “most low-income children nationwide do not receive basic dental care that can prevent the need for higher-cost treatment [such as fillings and root canals] later.” It also mentions that “the consequences of poor dental health among children are far worse—and longer lasting—than most policy makers and the public realize.” For example, there are economic consequences, such as the fact that “42 percent of incoming [U.S.] Army recruits had at least one dental condition that needed to be treated before they could be deployed,” according to a 2000 study of the U.S. armed forces. And, of course, oral health affects overall health: The report cites a growing amount of research that gum disease “is linked to cardiovascular disease, diabetes and stroke.”
Pew suggests that four solutions to the crisis are “within states’ reach.” These are school-based sealant programs; water fluoridation; improvements to Medicaid; and innovative workforce models. In its discussion of workforce innovation, the report mentions the Dental Health Aide Therapist (DHAT) training program in Alaska (see p. 34 of the report); the DHAT program’s funders include Kellogg, the Rasmuson Foundation (a funder based in Anchorage, Alaska), Bethel Community Services Foundation, and Murdock Charitable Trusts.
In its conclusion, the report emphasizes that poor oral health among low-income kids “is not an intractable problem.” A variety of solutions already exist, “they can be achieved at relatively little cost, and the return on investment for children and taxpayers” would be great.
I asked Shelly Gehshan, who heads the Pew Children’s Dental Campaign and worked on the report, whether she was optimistic that the passage of the federal health reform legislation will help improve the oral health picture. She told me on 17 May 2010 that the “legislation indeed gives us room for optimism.”
Pew worked hard with leaders in Congress and the whole oral health community to win some important oral health provisions. Most important to Pew is the guarantee of dental benefits within new plans offered by insurance exchanges, sealant programs for all fifty states, and a program to evaluate new types of dental providers.
Going forward, she said that “Pew is now working in coalition with other groups to ensure that Congress provides funding for these new provisions.”
Denti-Cal Facts and Figures (second edition), released 11 May 2010 by the California HealthCare Foundation, discusses Denti-Cal (the fee-for-service dental program of Medi-Cal, which is California’s Medicaid program). Many of the data in the report have to do with the financing and organization of services in 2007; in July 2009, most adult dental benefits were eliminated in California because of the state’s budget problems. “Children’s services, as required by federal law, continue to be delivered” now, the foundation noted in an e-alert.
The report culls information from many sources. Among its key findings are that Denti-Cal reimbursement was “typically lower than reimbursement rates in other states” as of 2008. Another interesting statistic, in this case from the University of California, Los Angeles, is that in that same year, 73 percent of adults in California did “not know that cavities are infectious and can be spread from one person to another.”
A Guide to Improving Children’s Oral Health Care: Tools for the Head Start Community, a February 2010 “toolkit,” was published by the Center for Health Care Strategies (CHCS) and funded by the Robert Wood Johnson Foundation (RWJF). Written by Sheree Neese-Todd, Bonnie Stanley, and Lauren Marino, this guide was written “to help New Jersey Head Start staff establish dental homes and improve oral health for low-income children ages 0–3.” The publication contains a section called “What Is a Dental Home?” as well as a glossary of oral health terms. It is part of an RWJF initiative called New Jersey Smiles: A Medicaid Quality Collaborative to Improve Oral Health in Young Kids. Funding for the initial grant period (eighteen months) has ended; however, “the Collaborative is exploring additional funding to sustain and build upon the effort,” a CHCS spokesperson told me on 17 May 2010.
Reimbursing Medical Providers for Preventive Oral Health Services: State Policy Options, by Carrie Hanlon, was published by the National Academy for State Health Policy (NASHP) in February 2010. The Pew Charitable Trusts funded the publication. The NASHP Web site states that “many state Medicaid agencies are working to increase children’s access to preventive oral health services by reimbursing primary care medical providers for fluoride varnish application, an oral examination or screening, and/or caregiver education about establishing good oral health habits.” This publication focuses on five states’ experiences “to help states considering adopting similar policies.”
Recent grant making:
The Caring for Colorado Foundation, in Denver, announced in fall 2009 that it had awarded approximately $100,000 to each of five grantees in Colorado. These grants are part of its ten-year, $10-million Oral Health Improvement Project, which aims “to increase access to oral health services for the underserved statewide,” according to a press release. Specifically, the grants “help increase the long-term capacity of the oral-health safety net and target oral disease prevention in children.” Click here for details of the foundation’s newest oral health RFP—the deadline is 25 June 2010.
The DentaQuest Foundation, a national funder located in Boston, announced that it had made “a major investment to improve oral health literacy and close the disparities gap among children and youth in Maryland,” according to a January 2010 press release. One grant, for $331,343, went to the University of Maryland for a statewide oral health literacy and awareness campaign. The university will conduct a survey of parents and health care providers, including physicians and dentists. The other grant, for $202,886, for the development of the Maryland Dental Action Coalition, was awarded to the Maryland State Dental Association Charitable and Educational Foundation (as a fiscal agent). This coalition will implement an oral health literacy plan throughout Maryland. Both grants fund a strategy for raising awareness about oral health, particularly within low-income groups and communities of color.
In addition, the DentaQuest Foundation awarded a grant to the Deamonte Driver Dental Project. Deamonte was a twelve-year-old boy in Maryland who became widely known after he died in 2007 as a result of an abscessed tooth; bacteria from the infection had spread into his brain. Read a Washington Post article about Deamonte and the problems that many children covered by Medicaid have in gaining access to oral health care.
Interested in what the DentaQuest Foundation has learned over a number of years, so you can avoid “reinventing the wheel”? Read its Lessons Learned from Eight Years of Oral Health Grantmaking (May 2009).
The United Hospital Fund recently awarded a $53,000 grant to New York University College of Dentistry “to develop and evaluate a community-clinic referral model that aims to increase” prevention and treatment of oral disease among older adults, according to an April 2010 press release. “Older adults have the lowest rate of dental visits of all adults over [age] 18 and face barriers to oral health care services—such as Medicare’s lack of dental care coverage, inadequate transportation, and a perception that the services are not needed by the older population,” the release explains. Read about the grantee here. The United Hospital Fund “is a health services research and philanthropic organization whose mission is to shape positive change in health care for the people of New York.” More information is also available here, on NYU’s Web site.
“Delivering Preventive Oral Health Services in Pediatric Primary Care: A Case Study,” by Dianne Riter, Russell Maier, and David C. Grossman, GrantWatch Special Report in Health Affairs, Nov/Dec 2008. This article is about a partnership of the Washington Dental Service Foundation, Group Health Cooperative, and other providers in Washington State.
“Establishing, Funding, and Sustaining a University Outreach Program in Oral Health,” by Jim Lalumandier and Kay Molkentin, GrantWatch Special Report in Health Affairs, Nov/Dec 2004. This article is about a foundation-funded, Case Western Reserve University program in the Cleveland public schools.
“Foundations’ Role in Improving Oral Health: Nothing to Smile About,” by Shelly Gehshan, GrantWatch Essay in Health Affairs, Jan/Feb 2008. Gehshan was working for NASHP when she wrote the article; she is now with the Pew Center on the States.
Funders’ Group on Oral Health Policy. Foundation staff who are interested in participating in this group may contact Ralph Fuccillo at Ralph.Fuccillo@dentaquestfoundation.org or Tracy Garland at email@example.com.
Grantmakers In Health’s Web site content on oral health.
Institute of Medicine’s (IOM)’s An Oral Health Initiative, supported by the U.S. Health Resources and Services Administration (HRSA) http://www.iom.edu/Activities/HealthServices/OralHealthInitiative.aspx.
Dr. Samuel D. Harris National Museum of Dentistry, University of Maryland, Baltimore. Affiliated with the Smithsonian Institution, this museum has on exhibit George Washington’s (ivory, not wood) lower dentures, among other things. I have been there and encourage you to visit.
Training New Dental Health Providers in the U.S., by Burt Edelstein of Columbia University and the Children’s Dental Health Project (which is located in Washington, D.C.), was funded by the W.K. Kellogg Foundation. The full report was released 27 January 2010.Email This Post Print This Post
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