Dental Public Health Activities: Descriptive Summaries
Future Smiles is a 501(c)(3) Nevada nonprofit with a mission to increase access to oral health care in underserved populations. Established in 2009, Future Smiles is Nevada’s largest school-based oral health provider. Our contract with the Clark County School District (CCSD) enables Future Smiles to serve any school-enrolled youth, their siblings and their adult caregivers (parents, family members and guardians). Thus, Future Smiles serves CCSD "families" of all ages. Our focus is at-risk youth attending schools with greater than 50% Free and Reduced Meal Program (FRL) enrollment. By providing oral health education and preventative dental services in a unique, school-based setting, students receive critical healthcare support from Future Smiles throughout their academic lifespan. Since 2009, Future Smiles has provided dental services to more than 23,000 at-risk youths in Southern Nevada.
In Nevada participation rates, in Medicaid and Nevada Check Up, fall well below the national average. Nevada’s statewide data from the September 2013 Medicaid/CHIP Participation Rates Among Children: An Update documents that 69.8% of eligible children in Nevada participated in either Medicaid or Check Up in 2011, the last year for which we have national data. The national average was 87.2% in 2011.
According to the Children’s Advocacy Alliance’s report 2015 Children’s Legislative Briefing Book, “every child in Nevada should have the opportunity to grow up healthy, from the prenatal period to their teen years.” This report documents that Nevada’s children’s dental health falls short in terms of quality and adequate access to dental healthcare for its children receiving a report card grade of an F. This dental health grade of an F is based on two evaluation factors: 1) children who have had no preventive care visits in the last year, and 2) children whose teeth have been described as being in fair or poor condition. For these two categories the report found that 32.6% of the children received no preventive dental care and 12.3% of the children stated that they their teeth were in poor health. Collectively these findings ranked Nevada’s children’s dental health at the lowest in our nation at 50th and 51st in the country. Nevada can do better for its youth’s dental health! In order to improve oral health outcomes, it is critical that Nevada make investments in innovative school-based programs, like Future Smiles, that offer solutions to access to preventive dental healthcare and treatment of dental health issues.
2011-12 Survey of Nevada’s Oral Health Comparison to the Nation
During the 2014-15 school year, forty-one percent of our service population of 7,560 children had untreated tooth decay. During that school year alone, we applied dental sealants to 9,051 teeth, fluoride varnish/topical applications to 3,401 children and performed 1,694 dental cleanings. The average age of the children we served was 8 (third grade). The Medicaid value of these services was $531,800 as 41% to 50% percent of these students are not covered by any medical or dental insurance. Our service population in the 2014-15 school year of 7,560 students included 65% Hispanic youth, 17% African American youth, 7% Asian/Hawaiian Islanders/Native American youth and 16% Caucasian youth. These children typically lived in families of four with an average monthly income of $1,415. All of the families were estimated to be at or below the federal poverty level. Eighty-one percent of the children served by Future Smiles also participated in the Free and Reduced Lunch Program at their schools.
Our school-based model of service focuses on dental hygiene services which include: screenings, oral health education, dental cleaning, sealants, fluoride varnish, digital x-rays, case management through a referral system to CCSD Project Smile, Dental Care International and local dentist(s), plus restorative dentistry through the UNLV School of Dental Medicine. The team of professionals who treat the youth are Public Health Dental Hygiene Endorsed dental hygienists specially licensed by the Nevada State Board of Dental Examiners to provide dental hygiene treatment to the underserved without supervision from a dentist.
Future Smiles has 5 Set Locations called EPODs (School-Based Health Center for Education and Prevention of Oral Disease) which are operated on CCSD campuses. Three are staffed year-round and two are staffed for the ten-month school year. This is space provided to us at no cost by CCSD.
In addition, Mobile School-Based Locations (traditional dental sealant program) are operated using portable dental units at 18 schools without space for a permanent EPOD. Our Future Smiles dental hygiene team transports these portable dental units to the schools. The dental units are light weight (50lbs or less), on wheels, and fold into suitcase containers.
Long-term sustainable funding continues to be a challenge for public health programs that focus on a dental hygiene workforce. It is critical for Future Smiles, and other public health programs that address unmet dental health needs, to bring awareness to national and state policy makers to recognize dental hygienists as a viable solution to meet the public’s dental health needs!
Future Smiles has been able to contract with two out of the 3 Nevada Medicaid Insurance products (we have contracts with HP Enterprise and Amerigroup). United Healthcare’s Health Plan of Nevada (HPN) continues to decline contracting requests with Future Smiles. HPN states two primary reasons for their refusal to contract Future Smiles to include: 1) HPN has fulfilled their Nevada Medicaid contract’s provider to enrollee ratio meaning that the dental plan does not need more providers, and 2) Future Smiles operates without supervision by a dentist and therefore does not provide comprehensive dental exams by a dentist- this reasoning is in direct contradiction with Nevada’s Revised Statute 631.287 that authorizes a Nevada licensed dental hygienist to submit for a Public Health Dental Hygiene Endorsement to address unmet dental health needs of at-risk populations under an approved Nevada State Board of Dental Examiners’ public health program’s protocol, such as Future Smiles.
NRS 631.287 Dental hygienists: Special endorsement of license to practice public health dental hygiene.
1. The Board shall, upon application by a dental hygienist who is licensed pursuant to this chapter and has such qualifications as the Board specifies by regulation, issue a special endorsement of the license allowing the dental hygienist to practice public health dental hygiene pursuant to subsection 2.
2. The State Dental Health Officer may authorize a person who holds a special endorsement issued pursuant to subsection 1 to provide or cause to be provided such services for the promotion of public health dental hygiene as the State Dental Health Officer deems appropriate. Such services:
(a) May be provided at schools, community centers, hospitals, nursing homes and such other locations as the State Dental Health Officer deems appropriate.
(b) May not be provided at a dental office that is not operated by a public or nonprofit.
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