January 27th, 2011
Use of fluoride is known to reduce tooth decay. Earlier this month, the federal government announced plans to lower the amount of fluoride in water because of concerns that some children were receiving too much of it.
This prompted me to revisit the subject of oral health and what some foundations around the country have been doing to help improve it. Please note that this is not a comprehensive listing.
Recent funding awarded:
Integrating Diabetes Screening in Dental Care Settings. In December 2010 the New York State Health (NYSHealth) Foundation awarded a $200,065 grant for this project, in which the grantee, Columbia University College of Dental Medicine, plans to put into place “a system-wide protocol for conducting diabetes screening” in its dental clinics; institutionalize a way to refer patients identified as having diabetes or a condition called pre-diabetes to a primary care provider; and disseminate and replicate “a protocol for routine diabetes screening in the dental care setting,” according to the NYSHealth Foundation website. The foundation explains there, “Multiple studies have shown that patients with diabetes are more likely to have periodontal disease and consequently suffer diabetes-related complications.” Please note that Improving Diabetes Prevention and Management is one of NYSHealth Foundation’s three funding priorities; dental care is not.
“W.K. Kellogg Foundation Supports Community-Led Efforts in Five States to Increase Oral Health Care Access by Adding Dental Therapists to the Dental Team,” W.K. Kellogg Foundation press release, Nov. 17. The foundation announced that it will invest more than $16 million by 2014 in the Dental Therapist Project (which includes efforts in Kansas, New Mexico, Ohio, Vermont, and Washington state) “as part of a larger effort to build awareness of oral health access issues and bring quality dental care to every community,” the release said. Community Catalyst, a nonprofit in Boston and lead grantee on Kellogg’s project, “will work with states to build coalitions and educate lawmakers on the dental therapist approach.”
Read in the December 2010 GrantWatch section of Health Affairs about an evaluation of a dental health aide therapist (DHAT) program in Alaska here (scroll down to “Oral Health”).
Results of Funding:
“Giving Voice to Oral Health in Kansas: Benefits of Long-Term Commitment,” Kim Moore, president of the United Methodist Health Ministry Fund (Hutchinson, Kansas), Aug. 23, Grantmakers In Health (GIH) “Views from the Field” series. Moore relates results of an $11 million fund initiative, which began in 1998. It launched a public awareness campaign about oral health under the Healthy Teeth for Kansas logo. “Nothing did more to make oral health a concern for Kansas policymakers, however, than the Kansas Mission of Mercy events,” which were annual, free dental clinics, Moore comments. The clinics had hundreds of people waiting in line “and dramatic stories of endured dental pain and suffering.”
The fund also provided a grant in late 2004 for “project support” for the state’s Bureau of Oral Health, which was re-established in the state health department in 2005. (Virginia Elliott, vice president for programs of the fund, told me Jan. 20 that the grant was for bureau projects, oral health materials, and staffers’ participation in state, regional and national meetings.) Moore comments that “workforce issues have dogged all our efforts.” The fund’s board, as well as those of other state and national philanthropies, “committed to support [mid-level dental] professionals to be able to deliver basic treatment and prevention services.” The decision to do this was a bit controversial, as the fund had to step out of its “neutral role”; however, that was the only “meaningful” solution to oral health access issues in Kansas, Moore states.
He cites fellow foundations’ good works on oral health, including those of the Kansas Health, Sunflower, REACH Healthcare, and Delta Dental of Kansas Foundations, as well as the Health Care Foundation of Greater Kansas City. Although the United Methodist Health Ministry Fund had a limited amount of resources to spend, it helped “produce sustainable change, in several ways, including expansion of the dental safety net” and increased use “of proven prevention techniques.”
Did the fund encounter challenges in its oral health work? Yes, it learned, for example, that “community water fluoridation is even more difficult than we envisioned.” (It did, however, achieve fluoridation of water supplies in ten communities, covering 130,000 people.) Also, Moore concedes, “an attempted replication of the successful Access to Baby and Child Dentistry [ABCD] program from Washington State floundered.”
Moore concludes that the fund’s twelve-year commitment, as well as that of other funders, to supporting oral health in the state seems to have resulted in an expanded oral health community in the Sunflower State “and a much higher recognition” on the Kansas public agenda, than there was before, that oral health is “critical to overall health,” Moore says. For more details and examples, see the GIH publication.
Elliott explained to me that “the fund is no longer funding new oral health initiatives,” but it “continues to support several key strategies as it transitions out of this area of focus.” She added, “The fund is developing a new initiative on children’s mental health.” (See GrantWatch Blog, Jan. 13.)
Addressing Children’s Oral Health in Buffalo, New York: Final Reports and Recommendations, Kavita P. Ahluwalia of Columbia University and Diane R. Bessel of Catalyst Research, LLC, March 2010 (released August 2010). This study was commissioned by the Community Health Foundation of Western and Central New York (CHFWCNY) to help it develop a strategy for increasing the number of low-income children in Buffalo who receive “appropriate and timely oral health care,” the report says. The study aided in the development of CHFWCNY’s new children’s dental health initiative, CHOMPERS! Grantees for the initiative will be announced soon, Denise Levy at the foundation told me.
It Takes a Team: How New Dental Providers Can Benefit Patients and Practices, Pew Children’s Dental Campaign of the Pew Center on the States, released Dec. 6. The Pew Charitable Trusts (a public charity) published this report, which looks at the impact that hiring dental therapists and hygienist-therapists (new kinds of providers) “would have on the productivity and profits of a private dental practice,” according to a press release. Ninety-two percent of dentists in the United States work in that sort of practice, the report states. These new professionals are trained to provide a broader range of services than are dental hygienists, whose impact is also assessed in the report. The authors find that most private dentists who hire the new types of providers “can serve more patients, including more Medicaid enrollees, while maintaining or improving their financial bottom line,” the release notes. The authors use plenty of citations to buttress their points. The methodology includes use of a Productivity and Profit Calculator, which Pew commissioned Scott and Co., Inc., to develop. The calculator is available online; advocates, dentists, and policy makers may find it useful. Shelly Gehshan directs the Pew Children’s Dental Campaign.
Series of reports on oral health in California. Published by the California HealthCare Foundation with a “particular focus on improving access for the underserved,” according to the foundation’s website. The reports were published from March 2009–January 2011.
Related information/other entities involved in oral health:
An Electronic Compendium of Resources for Building Oral Health Coalitions, DentaQuest Foundation, released Apr. 26. Read more about this national foundation, which is located in Boston.
“HHS and EPA Announce New Scientific Assessments and Actions on Fluoride,” U.S. Department of Health and Human Services (HHS), press release, Jan. 7. HHS “is proposing that the recommended level of fluoride in drinking water can be set at the lowest end of the current optimal range to prevent tooth decay,” the release says. Also, the U.S. Environmental Protection Agency “is initiating review of the maximum amount of fluoride allowed in drinking water.”
The goal is to maintain fluoride’s benefit of preventing tooth decay, while preventing “excessive exposure” to fluoride. Getting too much fluoride (a mineral) may cause a condition called dental fluorosis. Young children, age eight and under, are most at risk of this type of fluorosis, which, in its “very mild or mild form” (most common in the United States), can cause tooth enamel to have markings or spots, although they are “barely visible,” HHS says.
Why is there a danger of too much fluoride now? Another question: how would it be possible to get enough fluoride with slightly lower levels of it in community water supplies? For one thing, the press release points out, there are more sources of fluoride (such as toothpastes and mouthwashes) now than there were in the 1940s when fluoridation of water started.
HHS published its recommendation about fluoride in the Federal Register on Jan. 13; the period for comments from the public and stakeholders lasts for thirty days.
Read much more about fluoridation and fluorosis on the Centers for Disease Control and Prevention’s web site.
My thanks to Jennifer Buschick in the Office of the Assistant Secretary for Health at HHS for clarifying some information.
“Racial and Ethnic Disparities in Dental Care for Publicly Insured Children,” Nadereh Pourat of the University of California, Los Angeles, and Len Finocchio of the CHCF, July 2010, Health Affairs. (This article is available full-text on the CHCF web site.)
The mission of the Sadie and Harry Davis Foundation, which is located in Portland, Maine, “is to advance the health of Maine’s children,” according to its website. The funder focuses most of its grant making on very young children’s oral health through a preventive care program it developed and piloted called From the First Tooth. (The program is modeled after one in North Carolina.) With Davis Foundation funding, MaineHealth, a health system, operates From the First Tooth in partnership with others. The program’s goal is to get primary care physicians to integrate preventive oral health care into well-child visits for kids ages six months through 3½. The statewide program, which has three components, aims to help all children, but there is an emphasis on the underserved, Sharon Rosen, executive director, told me in a telephone interview. The components are the following: (1) oral examination, (2) education of parents about care of their child’s mouth, and (3) application of fluoride varnish. Please note that the Davis Foundation only funds in Maine, and it does not accept unsolicited grants for the From the First Tooth program. (Read here, after Mar. 15, about how to apply for its Small Grants Program, focused on children’s health.)
West Virginia Partners for Oral Health is funded by the Claude Worthington Benedum Foundation through a grant, awarded in 2010, to the West Virginia Council of Churches, in Charleston. According to the partnership’s website, its mission includes compiling research results and other information on oral health in the state and publishing that on its website; educating policy makers and the public about the importance of good oral health, particularly for pregnant women; and addressing provider payment issues regarding oral health with the state’s Medicaid program, the West Virginia Children’s Health Insurance Program, and West Virginia Public Employees Insurance Agency. The Benedum Foundation focuses its funding on West Virginia and southwestern Pennsylvania only.
“What Philanthropy Is Doing to Promote Oral Health Care,” Health Affairs GrantWatch Blog, May 17. This post contains examples of foundations’ funding in that area.