Dental Public Health Activities: Descriptive Summaries
Tooth Tutor Program
The Vermont Office of Oral Health (OOH) administers the Tooth Tutor Program (TTP), which aims primarily to help children who have not accessed dental care (those who have not been to the dentist or who are missing dental information on their health information records) in the previous year to find and connect with a dental home where they can receive dental sealants and other procedures (i.e. restorative treatment), as needed. Most of the children in this category are at higher risk for dental disease (i.e. low income, rural populations). In Vermont, Medicaid-eligible children have no cap for dental services through a program called Dr. Dynasaur. However, in spite of the availability of Medicaid benefits, these children have a higher rate of decay: decay experience is 1.6 times more prevalent and untreated decay is 2 times more prevalent in this group than in non-Medicaid children (2013 Burden of Oral Disease in Vermont). Although the utilization rate of dental care among Medicaid-eligible children throughout Vermont has been rising over time, there is still considerable room for improvement.
Public health dental hygienists (present in 5 of Vermont’s 12 district offices, as of 2016) provide support for the program by helping to advertise openings to dental hygienists interested in working as Tooth Tutors (TTs) and providing training, technical assistance, and monitoring. The OOH also provides screening and teaching materials for the program and coordinates two meetings per year. For the past two years, these meetings have included training sessions on cultural competence and motivational interviewing. Additional trainings have included a discussion group on issues related to cultural competence; for example, in 2015 we purchased the book “The Spirit Catches You and You Fall Down” by Anne Fadiman, and distributed it to all TTs. At our mid-year meeting in January 2016 we had a lively “book-club style” discussion. We plan on continuing this tradition at upcoming mid-year meetings and are currently selecting materials – books, films, short videos, and documentaries – for discussion at the January 2017 meeting.
Participation in the TTP is voluntary and dependent on the school determining the need for dental care access and wanting to improve oral health for the students. Other than the dental hygienists’ salaries, there is no additional cost for schools to participate in the TTP. Medicaid Administrative Claims/ Early and Periodic Screening, Diagnostic and Treatment (MAC/EPSDT) is the main source of funding for the program. Some schools run the TTP through funding from foundations and other organizations. The state Oral Health program provides basic supplies for TTs to perform classroom education and oral health screenings.
Surveys conducted with TTs showed that a significant barrier in accessing care for the program’s children is the lack of priority placed on routine preventive care by their parents or guardians. We have been working to overcome this barrier through cultural competency and motivational interviewing trainings for TTs.
We have learned that the greatest barrier to achieving program goals is the difficulty in engaging parents/guardians and, in some rare instances, school personnel. Cultural competency and motivational interviewing skills are valuable tools to effectively communicate with parents and guardians. We plan on continuing these trainings and have launched a cultural competence improvement “club” that will choose materials to read/watch and meet yearly for discussion sessions.
Moving forward, the TTP may transition into a school-based sealant program where sealants would be placed at the school, thus eliminating the need for parents/guardians to take the children to the dental office. This may be facilitated by the fact that starting in summer 2016, all dental hygienists licensed in VT will be able to enroll as Medicaid providers and bill directly for their services.
Lack of parent/guardian engagement and cooperation is the most significant challenge (see above); we address this issue by providing ongoing cultural competency and motivational interviewing trainings to Tooth Tutors.
These strategies have helped TTs to fulfill their responsibilities and benefited the achievement of the Tooth Tutor Program goals:
Contact Person(s) for Inquiries:
Debora Teixeira, DDS (not licensed in VT), M.Ed. Candidate, Oral Health Program Administrator, Vermont Department of Health, Office of Oral Health, 108 Cherry Street, PO Box 70, Burlington, VT – 05402, Phone: 802-652-4115, Fax: 802-651-1634, Email: firstname.lastname@example.org
Robin N. Miller, RDH, MPH, Oral Health Director, Vermont Department of Health, Office of Oral Health, 108 Cherry Street, PO Box 70, Drawer 38, Burlington, VT – 05402, Phone: 802-863-7272, Email: email@example.com