By Becca Matusovich, Executive Director, Children’s Oral Health Network (COHN), and Emilie Knight, Virtual Dental Home Program Coordinator, COHN
Background
At a recent Virtual Dental Home (VDH) site visit, a group of stakeholders met to learn about and observe the program. Several parents whose children are enrolled in VDH care sat with program funders, policymakers, and public health professionals to share their family experiences. One mother reflected on how her 3-year-old daughter, who is autistic, had struggled with any type of medical or dental in-office care. Invariably, the unfamiliar and sterile environment aggravated her sensory issues to the point that she had never been able to have her teeth properly cleaned and screened despite her parents’ and providers’ best efforts. Through the VDH model, now offered in the local Head Start program, the hygiene team was able to successfully clean and screen this 3-year-old’s teeth for the first time in the comfort of her familiar child care setting, and they created an ongoing treatment plan that accommodates her sensory challenges to keep her mouth healthy. This little girl is one of approximately 150,000 Maine children who have not had access to regular preventive and diagnostic dental care, although they have dental coverage either through Medicaid or private dental insurance.[1]
Barriers to care can lead to costly interventions
The barriers to care are many. They include a lack of traditional dental providers, a shortage of providers who accept Medicaid insurance, caregivers’ inability to take time off of work for routine dental appointments, limited training for and capacity of providers to work with neurodivergent patients, and transportation barriers exacerbated by Maine’s rurality. When early oral health issues go unnoticed, the outcomes for children only worsen as they grow up and can lead to serious oral health and overall health concerns. It is well documented that dental decay gone untreated can lead to more costly interventions down the road that could have been avoided with early prevention and diagnosis. Coaching mouth-healthy habits and educating parents and their kids on the reasons treatment must be timely are the cornerstones of the VDH model.
The Children’s Oral Health Network model and vision
The Children’s Oral Health Network was founded five years ago as a network with a shared vision of making Maine a place where all children can grow up free from preventable dental diseases. In 2019, COHN learned about the Virtual Dental Home, an innovative oral health care delivery model that was being implemented on the West Coast. This model was developed by Dr. Paul Glassman, professor and associate dean for research and community engagement, at the College of Dental Medicine at California Northstate University. As depicted in Figure 1, a dental hygiene team delivers preventive and minimally invasive restorative care in a community setting where people already spend their day – daycare centers, schools, community centers, elder care facilities, and the like. This community-based dental hygiene team shares images, charts, and notes with a dentist back in the office via a secure platform. The dentist reviews all the patient’s records to complete a remote exam and create a treatment plan, which will involve a visit to the office only if care is needed that cannot be provided in the community setting. This model has shown to keep upwards of 80 percent of patients healthy in the community without having to visit the dentist’s office.[2]
After an initial Maine field test was interrupted by the pandemic closures in the spring of 2020, a small pilot of VDH implementation was launched in three Head Start districts. In 2021, encouraging results from this initial pilot dovetailed with the approval of COHN’s AMCHP Replication Project proposal. This support enabled COHN to partner with Dr. Glassman as a replication coach, launching a series of VDH workshops and learning collaboratives to support six newly formed Local Implementation Teams (or LITs). Each LIT consists of clinical providers and community site staff. In addition to having statewide learning opportunities, our AMCHP Replication Project allowed COHN staff and Dr. Glassman to attend regular LIT planning meetings to assist and provide feedback to regionally customized clinical workflows and implementation planning processes.
Figure 1. Maine Virtual Dental Home Implementation Process
Collaborating and Leveraging Regional and Federal Funding Resources for Expansion
Foundational support from local and regional funders allowed COHN to invest in the initial field test and early pilot, leveraging this early experience to engage in AMCHP’s Replication Project and access Dr. Glassman’s expert coaching. Subsequently, this investment from AMCHP prepared COHN to work with Maine Senators Susan Collins and Angus King and Representative Chellie Pingree to successfully access federal funds through the 2022 Congressionally Directed Spending process. This substantial federal investment has fueled an expansion of the Head Start VDH pilot to nine Maine counties, with about 600 Head Start students receiving VDH care during the 2022–2023 school year. The Congressional funds also extended Dr. Glassman’s coaching through spring 2024; invested in a comprehensive statewide evaluation of the model; explored VDH integration into primary care and school settings as well as into university curriculums for the next generation of dental clinicians; and supported the development of an interactive online toolkit to promote the ongoing expansion of the VDH initiative in Maine. These combined efforts will offer continued support to active pilot regions and integration partners while also cultivating further interest in and knowledge of the VDH model and its proven impact on increasing access to quality, comprehensive oral health care.
Aroostook County Community Action Head Start program partnered with the St. Apollonia Dental Clinic to launch a new Virtual Dental Home initiative in one of Maine’s most rural counties. The Aroostook pilot, which reached a limited number of sites in the 2022–2023 school year, will expand in fall 2023 to provide care to more Head Start students.
These parents were able to observe their sons during a Virtual Dental Home clinic led by Mainely Teeth at Magic Years, a Head Start site managed by the Southern Kennebec Child Development Corporation. Head Starts have provided a wonderful foundation of family support and engagement for Maine’s VDH pilot.
References
[1] Preliminary analysis of 2018–2020 dental claims data from the Maine Health Data Organization’s All-Payer Claims Database (analyzed by the COHN and University of Southern Maine’s Cutler Institute).
[2] Virtual Dental Home implementation results in other states supported by Dr. Paul Glassman, DDS, MA, MBA, Professor and Associate Dean for Research and Community Engagement, College of Dental Medicine, California Northstate University, Oral Health Innovation Consulting
