State-wide expansion of oral health into the medical home in Maine

Objective: The most prevalent unmet need for MaineCare Medicaid children is dental. In 2009, lack of preventive dental care was highest among infants and small children, with 44% ages 1 – 5 having no visit in the past 12 months. From the First Tooth's goal is to embed oral health assessments, fluoride varnish and parent counseling for children aged 0-3 within the pediatric medical home. This initiative differs from other early childhood caries prevention initiatives in its scope (all Maine children between 6 mos –3 1/2 yrs), integration into well-child care standards of care, health system leadership, and funding sources (private foundation and commercial insurers). Methods: MaineCare provides data to document program reach, based on fluoride varnish claims, eligible children, and participating providers. Boston University School of Dental Medicine is conducting comprehensive implementation assessment to identify key factors that impede or facilitate adoption.

Results: Approximately 350 medical settings provide care to Maine children. Seventy three (21%) have been reached to date for training; 18 pediatric, 34 family medicine, 14 FQHCs and 7 RHC. Preliminary fluoride varnish data for 2010 first three quarters reports 1540 claims submitted by medical settings, a 59% increase from 2009 claims Clinical leadership, payment incentives, electronic medical records, standards of care, and quality improvement systems have been associated with early spread and dissemination of FTFT.

Conclusion: Early childhood caries prevention is critical to allay costly and painful problems in later childhood and beyond. For effectiveness and sustainability, interventions must take into account multiple critical systems issues.