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Dental Public Health Activities: Descriptive Summaries

Future Smiles Dental Program- University of Arkansas at Little Rock Children International

Practice Number: 05007
Submitted By: Future Smiles Dental Clinic, University of Arkansas at Little Rock
Submission Date: March 2016
Last Reviewed: March 2016
Last Updated: March 2016
Best Practice Approach Example -
 

The Future Smiles Dental Program (FSDP) of UALR Children International focuses on education efforts as well as preventative and restorative care interventions. Our primary objectives are to increase the number of children having sealants present and decrease the number of children with unmet dental needs during annual dental screenings.

Annual dental screenings serve as the gateway to accessing dental treatment services offered through our program. Through these screenings children with unmet dental needs are identified and referred to the other parts of our dental program.  Screenings are offered annually in the fall at all five elementary schools, three middle schools and at the two major UALR-Children International (UALR-CI) family events, one in the fall and spring. Consents are gathered at school registration in the fall. The screening includes a visual exam of the tooth surfaces by a licensed dentist or dental hygienist. After each screening, a form is sent to the caregiver explaining the results of the screening and detailing the child’s oral health status: 1) Emergency care needed, 2) Routine care for noted problems or 3) no dental problems noted. This form also includes a reminder to parents on the importance of dental exams. At school-based screenings, a copy of this form is also sent to the school nurse. Since 2000, 31,808 screenings have been completed and have revealed that an average of 26.2% of children/youth screened have untreated decay at the time of screening. Annual dental screenings are critical in order to identify students who need to be seen in the Future Smiles School-Based Dental Clinic (FSDC) and students who are eligible to participate in the sealant project.

FSDC is coordinated by UALR-CI and is located in the Wakefield Elementary school building of Little Rock School District. It was the first school-based dental clinic in Arkansas. Complete restorative and preventative services are provided at Future Smiles in three dental units. The clinic is staffed by one dentist through a partnership/contract with Arkansas Children's Hospital, a clinic manager, dental assistant, and one dental services aide. Children identified as having unmet dental needs during the school screening in the fall are referred to FSDC for their restorative needs. All children referred receive the benefit of preventive dental care: x-rays, bi-annual cleanings, and fluoride treatments. Dental hygiene students from the University of Arkansas for Medical Sciences (UAMS) provide preventive care at the clinic two days a week from September through December and three days a week from January through April. They return for a Summer Rotation in June for six to nine clinical days. The Dental Services Aide transports children from partner elementary schools to the clinic one day per week. In 2014-2015, there were 1,574 patient visits at which 2,862 preventative procedures, 711 restorative procedures, and 71 extractions were performed. Since 2005, more than $2 million in dental care during over 13,000 dental visits has been provided to children at Future Smiles Dental Clinic at no cost to families.

Additional preventive services coordinated by the FSDP either at partner schools or Future Smiles Dental Clinic include sealants and fluoride varnish applications in conjunction with oral health education. When FSDP began screening children in 2000 only 2.5% of children had sealants present at the time of screening; in 2015 22.3% had sealants present. FSDP Sealant Project takes place every February, during National Children's Dental Health Month. Students having teeth eligible for sealants are identified each fall during dental screenings. These students are transported to FSDC three days each week from the partner schools. To increase the clinic’s capacity during this month, a portable dental unit is set up inside the clinic enabling the use of four dental units and additional UAMS Dental Hygiene students are scheduled to work at the clinic during this time. After sealants are placed, the children receive a fluoride varnish treatment, a toothbrush kit and basic oral hygiene instructions. In 2015, 226 students participated in the Sealant Project. To date, over 1,800 children have received sealants through our sealant initiatives.

FSDP implemented the fluoride varnish project to prevent dental decay during the 2006-2007 school year. With parental consent, children in Pre-Kindergarten through 2nd grade, attending  four elementary schools, receive a fluoride varnish application twice a year. Consents are again gathered during school registration. Dental assisting students from Pulaski Technical Community College apply the varnish and provide oral hygiene instructions. The first varnish application is administered in combination with the screening project in the fall. The second application in February occurs in conjunction with our efforts to recognize National Children’s Dental Health Month. In February, the dental assisting students go to EVERY classroom (Pre-K through 5th) in the four schools and provide an interactive lesson on proper oral hygiene. Each child is sent home with a toothbrush kit and educational information. In order to reach more children and youth, we began offering fluoride varnish applications at the two UALR-CI family events in conjunction with dental screenings and educational lessons in 2015.  Since 2006, 4,282 pre-kindergarten to second grade children in our partner elementary schools have received two applications of fluoride varnish through our program.

Each summer, we print an annual report outlining our screening, sealant and varnish outcomes. We track progress of children having sealants present, unmet dental needs, referred for routine and emergent care and children affected by carries. Our data dates back to 2000, when we initially began conducting screenings.  We also report the number of patient visits to FSDC, as well as the individual services received.

The annual budget of the FSDP is $272,705.00. Of this amount for 2015, Medicaid generated income covered 42%, UALR Children International contributed 25%, 20% was in-kind and 13% was covered by local fundraising/grant efforts. Children with no dental insurance and those with Medicaid are seen in at FSDC, regardless of their ability to pay. 

Lessons Learned:

Over the past 15 years of the FSDP, there have been many lessons learned and challenges faced. Primarily, these challenges revolve around parental involvement. In the beginning, we did not have an avenue to offer transportation to the dental clinic and asked parents to bring children to visits. This resulted in a high no-show rate of children who needed follow-up care. In order to combat this, we applied for a grant to purchase a van. We were funded and purchased the van, but then we did not have the personnel to transport. We had to work in funding for additional personnel in the form of a Dental Services Aide/driver. Initially, turnover in the Dental Services Aide position caused some outreach opportunities to be missed. However, for the past year, we have overcome this problem. We now offer transportation one day per week, but also offer after school appointments for middle and high school youth. 

Most importantly, we have learned the value of partnerships. The FSDP is only sustainable through  the key partnerships with the following agencies:

-       Arkansas Department of Health

-       Arkansas Department of Human Services

-       Arkansas Children’s Hospital

-       Delta Dental Plan of Arkansas

-       Heart of Arkansas, United Way

-       Pulaski Technical College

-       Little Rock School District

-       University of Arkansas for Medical Sciences

-       University of Arkansas at Little Rock

Contact Person(s) for Inquiries:

Jolene Perkins, Manager, Future Smiles Dental Clinic - UALR Children International, 2510 Fair Park Blvd., Little Rock, AR 72204, Phone: 501-447-6645, Fax: 501-663-5631, Email: jperkins@ualr.edu

Ryan Davis, Director, UALR Children International, 2510 Fair Park Blvd., Little Rock, AR 72204, Phone: 501-663-5541, Fax: 501-663-5631, Email: rddavis1@ualr.edu

Lindy Bollen, Jr., DDS , Director, Arkansas Department of Health - Office of Oral Health , Phone: 501-280-4111, Email: lindy.bollen@arkansas.gov

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