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G r a n t Wat c h
G r a n t Watc h R e p o r t
Delivering Preventive Oral Health Services In
Pediatric Primary Care: A Case Study
The Washington Dental Service Foundations investment has been
paying off.
by Dianne Riter, Russell Maier, and David C. Grossman
ABSTRACT: Dental disease, the most prevalent chronic disease of childhood, affects childrens overall health and ability to succeed. Integrating oral health into routine well-child
checkups is an innovative and practical way to prevent dental disease. The Washington
Dental Service Foundation is partnering with Group Health Cooperative, a large integrated
delivery system, and other providers in Washington State to change the standard of care by
incorporating preventive oral health services into primary care for very young children. This
paper describes systemic and policy changes for engaging primary care providers in oral
health, including provider training, expanding access to dental care, and reimbursement.
[Health Affairs 27, no. 6 (2008): 17281732; 10.1377/hlthaff.27.6.1728]
Dianne Riter (DRiter@DeltaDentalWA.com) is a senior program officer at the Washington Dental Service
Foundation (WDSF), in Seattle. Russell Maier is a family practice physician and residency director at Central
Washington Family Medicine in Yakima and is a WDSF board member. David Grossman is medical director for
preventive care and a senior investigator in the Center for Health Studies at Group Health Cooperative, in Seattle.
He is also a professor of health services and an adjunct professor of pediatrics at the University of Washington, in
Seattle.
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G r a n t Wat c h
Innovative Approaches In
Washington State
Childrens dental disease is a national problem, but innovative solutions are often best initiated by states and communities. In Washington State there has been a concerted effort to
develop new ways to improve oral health for
young children.
The states Medicaid program was one of
the first to reimburse primary care providers
for applying fluoride varnish on childrens
teeth. The Access to Baby and Child Dentistry
(ABCD) program, a collaborative effort of public and private entities at the state and local
levels, is increasing the number of Medicaideligible children under age six who are receiving dental care.8
Early preventive and intervention services
can yield positive benefits and lead to an increased likelihood of future preventive services and decreased dental-related costs.9
Some professional organizations now recommend that children have their first dental
screening by age one. However, traditionally,
few children have had access to preventive
dental care at that age, because many family
dentists are not trained, or confident enough,
to see infants and toddlers. Because primary
care providers see young children eight times
or more for well-child visits before age three,
they are well positioned to deliver basic preventive oral health services.
In 2000 the WDSF, a 501(c)(4) nonprofit
organization, began evaluating options for preventing dental disease among infants and toddlers. To achieve oral health impact at the population level, the WDSF advocates for
strategic systemic changes. Starting in 2001,
the WDSF funded three pilot projects in
Washington State that addressed oral health
during well-child checks: (1) Seattle Childrens
Hospitals Healthy Smiles Project; (2) ABCDExpanded, developed by Spokane Regional
Health District; and (3) Kids Get Care, operated by Public HealthSeattle and King
County. These initial efforts identified early
adopters willing to champion oral health and
led to the development of new materials for
H E A L T H A F F A I R S ~ Vo l u m e 2 7 , N u m b e r 6
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G r a n t Wat c h
a s e d o n t h e o utcomes of the
WDSFs initiatives to engage primary
care providers, it is clear that such providers are interested in oral health. A physician-champion is critical to gaining support
from other clinicians and staff. With efficient
office processes and procedures, appropriate
educational materials and training, and adequate reimbursements, providers can and
will include oral health in well-child checkups. Another key factor is that primary care
providers need to be able to easily refer patientsespecially those in Medicaidfor
follow-up dental care.
Integrating oral health into well-child visits
is both logical and practical, although evidence
of its impact is still needed. It is an opportunity to provide prevention services that can result in a lifetime of improved oral health. The
bottom line is that dental disease can and
should be prevented for every child at every
opportunityincluding at the medical office.
Highlights of the Group Health Cooperative
demonstration project were presented at the American
Academy of Pediatrics Peds 21 Conference, 10 October
2008, in Boston, Massachusetts. The Washington
Dental Service Foundation provides financial support
to Group Health Cooperative for implementing the
demonstration project described in this paper. The
authors acknowledge the organizations and individuals
that have contributed to the initiatives in Washington
State that are mentioned in this paper.
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