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Dental Public Health Activities: Descriptive Summaries

Iowa Lifelong Smiles Coalition

Practice Number: 18009
Submitted By: Iowa Lifelong Smiles Coalition
Submission Date: March 2016
Last Reviewed: March 2016
Last Updated: March 2016
Best Practice Approach Example Iowa Lifelong Smiles Coalition

The Lifelong Smiles Coalition was formed to address access to oral health care for older adults in Iowa through community learning and engagement to form a collective action plan. The need for this effort is great:

  • There are currently 457,738 adults over the age of 65 living in Iowa.
  • One in three adults over the age of 65 in Iowa have untreated tooth decay.
    • Three in four adults over the age of 65 do not have dental insurance, which is often a barrier to access to care.
    • In 2011, 74% of Iowans on the Medicaid Elderly Waiver program did not receive a dental service. This was even higher 84%, for Medicaid-enrolled Iowans age 65 an older who were not on the waiver program.
    • Twenty percent of long-term care facilities currently offer oral exams and screenings, but poor oral health can impact the health and well-being of nursing home and homebound elderly.
    • Left untreated, diseases of the mouth can lead to systemic health problems, especially in those with compromised immune systems.

The Coalition was formed following meetings sponsored by the Delta Dental of Iowa Foundation to begin discussions about the issue. The Delta Dental of Iowa Foundation has committed to funding a consultant to facilitate Coalition activities and cover meeting costs.

The Coalition works through an actionable knowledge process with the end goal of building capacity and large scale social impact. The mission of the Coalition is to increase the access to oral health care for older frail Iowa adults.  Through the collective action plan, the Coalition addresses barriers to oral health care with three strategic subcommittees: 1) Education and Training, 2) Coordination and Outreach, and 3) Program Policy and Outreach.

The focus of the Education & Training Committee is to develop and promote training opportunities for oral health professionals, the direct care workforce and those providing care to older adults. The focus of the Coordination and Outreach Committee is: 1) to expand the current I-Smile program to reach older Iowans through the I-Smile Silver pilot program in three Iowa counties 2) maintain the Iowa page on the  site and 3) develop health promotion programs on the importance of oral health. The focus of the Program Policy and Reimbursement Committee is to stay abreast of legislative and policy activities related to oral health care and aging and examine innovative payment models including: development of dental product informational brochures for nursing facilities, residents and caregivers (already completed) and hosting legislative educational sessions ( 2 completed).

The steering committee is comprised of each of the committee chairs and an elected Chair and Co-chair. Coalition membership is broadly focused with leaders and advocates that serve the aging population, oral health care organizations, and public health organizations. Individual oral health professionals are actively engaged in the coalition. Partners include: Iowa Caregivers Association, The University of Iowa College of Dentistry and Dental Clinics, Delta Dental of Iowa Foundation, Iowa Health Care Association, Iowa Department on Aging, Iowa Dental Hygienists’ Association, LeadingAge  Iowa, Iowa Department of Public Health, Iowa Department of Human Services, Iowa Medicaid Enterprise, Iowa Primary Care Association/Safety Net Collaborative, Iowa Association of Area Agencies on Aging, The University of Iowa College of Nursing, and the Iowa Public Health Association. Each member of the Lifelong Smiles Coalition is expected to actively participate without personal biases. Each coalition member is expected to annually sign and abide by the Commitment Letter.

Lifelong Smiles Coalition has three Two Year Project Grants funded by the Delta Dental of Iowa Foundation:

• University of Iowa College of Dentistry - Establishment of an Office for Education and Training (OET) to coordinate, develop, and evaluate continuing dental education programs for dentists, hygienists, and assistants, specifically targeted at geriatric oral health care. In addition, the OET will support the Iowa CareGivers Association to develop an educational program for DCW (Mouth Care Matters) through a cadre of oral health professionals to provide oral health care training to Iowa's Direct Care Workforce (DCW).

The Iowa CareGivers Association - Oral Health Education for Direct CareGivers (OHEDC) pilot project – Mouth Care Matters will be implemented and tested as Oral Health Specialty training for direct care professionals over the next two years. Through a partnership with the University of Iowa College of Dentistry and the College of Nursing, the Oral Health Specialty Training curriculum will be piloted and will become the first state recognized specialty under Iowa’s new Prepare to Care curriculum designed for those who work in direct care in a variety of settings. This training will increase access to and improve oral health care of older Iowans who are homebound or living in nursing homes, improving their overall health, comfort, and dignity.

Iowa Department of Public Health - I-Smile Silver pilot project will be based on the innovative I-Smile dental home initiative for children, which has been integral in nearly doubling the number of Medicaid-enrolled children receiving care from dentists. Several guiding principles of I-Smile are used for I-Smile Silver, most importantly employing local program coordinators in established public health settings with dental/outreach expertise who will develop local systems that help older Iowans access dental care. The coordinators are community liaisons between older Iowans and dental offices, civic and other organizations, medical providers, nursing/long term care facilities, businesses, and the Milestones Area Agency on Aging in southeast Iowa. The goal is to develop a community-based system of care to improve the oral health of Iowans age 60 and older. The pilot project will work to prevent dental disease, increase access to oral health care, and maintain overall health for homebound and nursing home residents in Scott, Lee, and Van Buren Counties(includes both rural and more urban counties).

The outcomes of these three grants are being coordinated by an independent contractor hired by the Delta Dental of Iowa Foundation, including: 1) # of direct care professionals who obtain oral health specialty training 2) pre/post testing 3) pre/post oral evaluations of residents that are impacted by the training 4) # of nursing facilities and care agencies who have direct care professionals trained, and 5) # of dentists, hygienists and assistants who attend supported CE programs. I-Smile Silver project plan includes oral health surveys (open mouth) to assess oral health status and dental needs of older Iowans. Results will provide a baseline that can be used to help determine project impact. This will also improve the ability to design appropriate project activities now and in the future. 

The Coalition has a consultant that facilitates and coordinates activities and meetings and also ensures progress and effective communication. Lifelong Smiles Coalition has a wide variety of members/organizations participating, which helps to provide a comprehensive approach to collective action planning.  Due to the fact that it has been less than a year since the coalition was formed and endorsed projects funded, lessons learned from the field are still being gathered. The many different Coalition partners and guidance from the subject matter experts will guide successful implementation.

Lessons Learned:

Lessons learned in coalition development include the development of an action plan, involving a variety of stakeholders, and having organizations committed to financially supporting coalition efforts.

Contact Person(s) for Inquiries:

Elizabeth Faber, Lifelong Smiles Coalition Consultant, 1420 West 6th Ave N, Clear Lake, IA 50428, Telephone: 641-425-7339, Email:

Dr. Howard J Cowen, Chair, Education & Training Committee, Lifelong Smiles Coalition & Director, Geriatric & Special Care Dentistry/University of Iowa College of Dentistry, W329, Iowa City, Iowa 52242, Telephone: 319-335-6961, Fax: 319-335-8788, Email: