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Miles of Smiles Dental Program

State: NE Type: Promising Practice Year: 2019

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North Central District Health Department
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Miles of Smiles Dental Program

Access to oral care is identified as a significant problem facing citizens in the North Central District Health Departments (NCDHD) rural nine county health district of Nebraska, including Antelope, Boyd, Brown, Cherry, Holt, Keya Paha, Knox, Pierce and Rock counties, especially the Medicaid-enrolled population.  The area is a State-designated Medical Shortage area Pediatric Dentistry & Oral Surgery (2010).   According to 2010 Census data, approximately 16.2% of children residing in the nine counties live below the National Poverty Level. The fact that the nine-county region is served by 24 dental providers with approximately 4,700 children elementary and middle school age and approximately 2,759 children under the age of 5 illustrates the low availability of access to dental services.  A key factor illustrating the need for the project includes the situation of a shortage of dental providers, combined with the low number of dentists who will accept new Medicaid enrolled children.  This is coupled with the need to travel significant miles (14,454 square mile district)  to access dental care making it difficult for families to obtain adequate care.  The population being served is easily accessed at the schools during school hours, reducing the barrier of travel for families.

Current recommendations from the American Dental Association are that children have their first visit to the dentist at the eruption of the first tooth or by the first birthday followed by at least yearly dental visits, preferably every six months.  The oral health screening and prevention program, Miles of Smiles (MOS) helps bridge the gap between dentists and children, increasing access to care through screening, and fluoride varnish applications received in a school setting.  Miles of Smiles is also dedicated to making appropriate referrals should dental intervention be necessary.  Each child in elementary and middle school, as well as preschool and children not yet attending school  have the opportunity to access these services provided by a Public Health Authorized Registered Dental Hygienist.

Miles of Smiles

 Services offered during the Miles of Smiles Program are oral health education, oral screenings, fluoride varnish, dental sealants (in some schools) and the dispensing of home care supplies in a school-based setting.  All services are provided twice a year in the 38 elementary and middle schools within the nine counties served by NCDHD.

The children are served in the school setting and are seen once a semester by a public health authorized registered dental hygienist. Each child seen is sent home with a parent note stating if he or she received the screening and/or fluoride and the results of the screening.

Goals for this program were to be in all 38 elementary schools by the fifth year of the program. By going out and personally meeting with each school and all dental providers in the district to explain the program and build a relationship, we were able to have all 38 schools participating in the program by year two. Average of 50% of students across the district participate in this program each semester. 

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In 2016 a Nebraska State Oral Health Assessment was done studying our children's oral health in Nebraska. Of the rd graders that it focused, 81.3 percent of rural students were found to have had tooth decay by rd grade and only 53 percent of those kids would be treated. These numbers are significant in rural Nebraska because tooth decay is totally preventable with proper care. Tooth decay causes cavities and other dental problems that lead to further health problems. It effects a student's ability to eat, nutrition, their success in school due to pain which causes a lack of concentration, and increased absences. The largest issues as to why students are not getting the proper care are, lack of access to dental providers, lack of access to Medicaid providers, transportation and education.

North Central District Health Department's Miles of Smiles program has developed a relationship with the Nebraska Community Foundation. Miles of Smiles was created 7 years ago to address the concerns listed above and in the overview section of this application. The program is offered to all children ages 4-12 within the district, which is approximately 5,000 children. An average of 50 percent of these children participate in Miles of Smiles twice a year.  This program is a school-based dental program conducted in the 38 elementary schools in the north central district. The program provides dental hygienists to the schools twice a year to do a visual scan of each student's teeth, provide fluoride varnish,  dental education and sometimes sealants to those students whose parents volunteer them to participate along with dispensing of  toothbrush and toothpaste. The program has a suggested donation of $15 per student, but no student is turned away. North Central District also has the ability to bill Medicaid for the fluoride varnish applied if the child is covered by Medicaid.  The Miles of Smiles program is 60 percent self-supporting and the North Central District Health Department supplements the rest of the program costs.

The Nebraska Community Foundation has a donor advised fund who has provided a matching grant to the Miles of Smiles program in north central Nebraska. The match provides $25,000 each year for 5 years and challenges the Miles of Smiles program to match that $25,000 each year. This grant is to assist the Miles of Smiles program to develop relationships with private donors to help sustain the program, as well as allow it to expand to meet even more of the need. The grant also provides funding toward new mother's kits that are dental kits consisting of dental cleaning tools for newborns to young children. Miles of Smiles is working with hospitals and ob-gyn offices in the area to distribute the kits.

The Nebraska Community Foundation had seen the success the Miles of Smiles program had been doing in order to  address the children's oral health crisis in rural Nebraska, and North Central District Health Department is ecstatic for the opportunity to partner with such a great organization. 

The Miles of Smiles (MOS) program was started in 2012 from a business plan created by NCDHD that stated the following objectives:

Objective 1:  At least 9 dental hygienists will become Public Health authorized and agree to contract with NCDHD.

Objective 2:  Will secure agreement with at least 20 schools to provide services to schools by August 30, 2012.

Objective 3:  Will serve 30% of students in 20 schools in the first year.

Objective 4:   Increase number of participating schools by at least 5% in year 2.

Objective 5:   After 3 years will increase school participation to 40%.

Objective 6:   After 5 years will serve 40% of students in all 38 schools.

Objective 7:   Will increase student participation by 10% each year.

Objective 8:   By year 5, will reduce the need for dental restorative care by 10%.

With in two years the Miles of Smiles program succeeded in meeting six of these objectives, by securing agreements with all 38 schools within the district and an average of 50 percent school enrollment participating in the program and contracting with 9 Public Health Authorized Registered Dental Hygienists. 

The program coordinator wrote letters, made phone calls and held face to face meetings with all schools principals and dental providers throughout the district. The up front communication regarding the program to the dental providers helped to gain their much needed support towards Miles of Smiles.   

One of Miles of Smiles key stakeholders in the program is the Nebraska Community Foundation, whose partnership began when MOS was gearing up to start the sixth year of clinics in June of 2017. The Nebraska Community Foundation has a donor advised fund who has provided a matching grant to the program. The match provides $25,000 each year for 5 years and challenges the Miles of Smiles program to match that $25,000 each year. This grant has helped to assist the Miles of Smiles program to not only financially sustain the program but to develop relationships with the private donors to help promote and educate the public about the program throughout the district as well as allow it to expand to meet even more of the need. In approaching the private donors for the match dollars needed it was found that the public was very willing to help in anyway they can, even more so once educated on the program and understanding what it offers to their youth. MOS is wrapping up the first whole year of this matching grant fund and is very proud to say, the funding has already been met for the 5 year $125,000 with potential to receive more then the original amount received. With this new partnership the Miles of Smiles program has created new goals and objectives to expand.

The following measurable objectives are where Miles of Smiles plans to be within the next five years:

Objective 1: Hire one part-time public health authorized registered dental hygienist. 

Objective 2:  By year five, oral health education and marketing efforts will be done with school faculty and administration as well as with dental providers and parents.

Objective 3: By year five, increase direct services provided to 85% of students within each respective school.  Miles of Smiles currently serves approximately 50% of students in all schools and will look to increase direct services provided by 5%, 7.5%, 10%, respectively for years two, three and four, thus by year 5, reaching the 85% school participation mark.  

Objective 4: By year five, increase the number of sealant programs done each year. We are currently at two per year, but would like to increase to seven per year after five years.

Objective 5:   By year five, will reduce dental referrals given out after dental screenings by 10% or greater.

Objective 6: By year five, Miles of Smiles will begin the process of starting a Corrective Care Event” for children age 0-14, held once a year in NCDHDs office. All dental work done will be free of charge and all dentist and hygienist time will be donated. 

Below are the Miles of Smiles original objectives:

Objective 1:  At least 9 dental hygienists will become Public Health authorized and agree to contract with NCDHD.

Objective 2:  Will secure agreement with at least 20 schools to provide services to schools by August 30, 2012.

Objective 3:  Will serve 30% of students in 20 schools in the first year.

Objective 4:   Increase number of participating schools by at least 5% in year 2.

Objective 5:   After 3 years will increase school participation to 40%.

Objective 6:   After 5 years will serve 40% of students in all 38 schools.

Objective 7:   Will increase student participation by 10% each year.

Objective 8:   By year 5, will reduce the need for dental restorative care by 10%.

Like stated previously, with in two years the Miles of Smiles program succeeded in meeting six of these objectives. The results were tracked by the program coordinator collecting the returned forms from students and documenting the results of the childs screening on a tracking excel spreadsheet created by NCDHD. By year two all 38 schools where participating in the program and 50 percent of the schools enrollment were utilizing the program. With the newly formed partnership with the Nebraska Community Foundation, Miles of Smiles hopes to increase participation in the program through education and marketing.  

Over the past 6 years the Miles of Smiles program has asked for a $15 donation for the fee of service, and for those covered by Medicaid,  bill for the fluoride varnish that is applied. Through private donations and billing, the program is 60% sustainable and is running at roughly a 40% deficit, which has been coming out of the health departments general funds. 

When the partnership with the Nebraska Community Foundation started it was just the answer needed in order to keep this much needed dental program going. The foundation had a donor advise fund who is very passionate about preventing dental disease in children throughout the state of Nebraska, they have chosen the Miles of Smiles program to partner with to help prevent those concerns. Miles of Smiles is receiving $25,000 per year for five years from this donor as long as we match dollar for dollar the funding received.  Like stated before, with in the first year of receiving this match grant fund Miles of Smiles has already raised the full match funding needed for the 5 years (125,000). Through local community funds and county funds the match funding was met, with a promise of additional funding after the 5 years is up. The local communities want to see this program continue and are willing to help keep it going for the children in the district. With the additional funds, billing for services and the $15 fee of service donation this program is able to fully sustain itself. 

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