Although the state of New Hampshire has 12 federally qualified health centers (FQHCs), only two have on-site dental facilities. As a result, the state has been exploring new ways to provide dental care to low-income residents.
In 2000, public health dental hygienists began providing dental care to students in school-based dental programs. Currently, 21 school-based dental programs in 183 schools statewide and 13 dental centers offer a range of oral health services. Twenty-three public health dental hygienists working in non-traditional settings, including schools, provide dental care for 13,500 children in the school-based programs.
In 2010, Upper Valley Smiles, a school-based oral health program received additional funding to provide preventive oral health services during the summer months while students were out of school. A pilot project in a Women, Infants and Children (WIC
) site provided oral health care to infants and young children utilizing a public health dental hygienist and portable dental equipment. In nine dental clinics over the summer months, the dental hygienist provided oral health assessments, parent education, fluoride varnish application, and referrals to local dentists for children needing reparative dental treatment.
In 2011, with a variety of small grants the pilot program expanded to seven WIC sites where six public health dental hygienists offered the dental care services described above. In addition, parents were asked to select oral health goals that they felt they could accomplish within the next three months before their next WIC recertification appointment. The goal of the expanded WIC dental project was to obtain baseline data on the oral health of New Hampshire WIC infants and children, a population of children at risk for dental disease. Results of the data collection would be used for future program planning and allocation of limited resources.
In addition to preventive dental services for children, the public health hygienist maximized the opportunity to educate WIC parents in person about proper oral health practices for the entire family. Since families enrolled in WIC must be recertified every three months, the dental hygienist was able to follow up with parents and assess their child’s progress at regular intervals when families came to pick up food vouchers. Parents were counseled about proper feeding and brushing practices, and the importance of a visit to the dentist by the child’s first birthday. Referrals for treatment were made to local dental offices with the hope that the dental practice would become the child’s “dental home.” Since 80% of children enrolled in WIC are also enrolled in New Hampshire Medicaid, dental providers enrolled in Medicaid can bill for treatment for most WIC children.
The New Hampshire Division of Public Health Services, Oral Health Program, has recently received a notice of grant award to conduct an evidence-based demonstration project showing that preventive oral health services delivered at WIC sites are effective, efficient and sustainable over time.