Rural Maine has a shortage of dentists, and because of this many low-income families are unable to find a dentist that accepts MaineCare eligible patients. MDHO was founded to address this shortage and make dental care accessible to school-aged children that would otherwise go without care. MDHO provides care at school in a mobile dental hygiene van. This eliminates many barriers to care that low-income families face, such as inability to find care, transportation challenges to and from dental appointments, and missed appointments. MDHO also increases school attendance by reducing days spent at home due to dental pain. MDHO provides hygiene care to school children in 35 schools, an increase of 7 schools since 2010. We plan to enroll and perform services on approximately 800 students this school year.
Over the twelve years that MDHO has provided care, we have found sealants, which protect healthy teeth, and temporary fillings, which stop decay on teeth that have cavities, are necessary to improve the oral health of our students.
For example, MDHO began placing temporary fillings in 2004. Before this was instituted, many returning students with identified decay had not received the recommended follow up care from a dentist. At their next checkup, the size of previous caries had frequently increased and there were also new areas of decay. To date we have placed over 2,000 temporary fillings and this has significantly decreased the number of new caries and in turn has reduced the number of severe cases where the tooth must be referred for extraction. These findings are in agreement with the World Health Organization and the International Association for Dental Research, which recommends using temporary fillings in populations that have little access to traditional dental care and can if necessary function as definitive treatment.
Using these oral care strategies are necessary to achieve MDHO’s vision of a generation of Maine children with good oral health. Last year MDHO saw 548 children and placed 336 temporary fillings on 111 students. This year we anticipate seeing close to 800 students with the possibility of needing 400 temporary fillings. Although there is no mechanism for reimbursement from MaineCare, we are committed to stopping tooth decay through the placement of temporary fillings on this high-risk population who may never establish a dental home.
Sealants are one of the most effective strategies we have to prevent dental caries on risk surfaces and to arrest existing caries lesions. Based on this, MDHO has an aggressive sealant placement program. Last year alone MDHO placed 2,598 sealants. Since 2003, it has placed over 30,000 sealants. This number includes original sealants, touch-ups, and replacements. While many sealant placements are covered by MaineCare, some are not. Placement is based on child need rather than reimbursement.
Another focus of MDHO is dental hygiene education. MDHO spends 25% of the appointment time instructing the child in effective plague removal. Disclosing solution is used to show the child where their teeth are still dirty from their last brushing. With demonstrating correct brushing and flossing, and then having the child practice the technique, the child learns to remove plaque effectively. During this time they are also receiving nutritional counseling. MDHO’s goal is to have the children leave the appointment equipped to improve and maintain their oral health for their lifetime. It is very rewarding to see the results of our efforts. Senior students, who initially came to our program in elementary school with decay, now are graduating with healthy teeth.
MDHO continues to connect patients that need dental care with local dentists willing to provide care to these students. When children are in need of urgent dental care, direct referrals are made to these collaborating dentists. Without this referral to collaborating dentists, it is unlikely that families would be able to find dentists willing to provide care for their children. In the last school year, the direct referrals made by MDHO according to the student’s severity of need were:
- 26 students to an oral surgeon
- 20 students to a pedodontists (Under the age of 5)
- 74 students to a MDHO dentist for one time complete restorative care
- 4 students to their previous dentist
- 19 students to community dental clinics
- 5 students to an orthodontist
- 68 students’ parents were asked to call MaineCare to find a participating dentist for a dental exam
New students to MDHO’s program presented with 58% of the overall decay found last year (373 of the 648 cavities) and the previously seen students had 42% of the overall decay found. In returning students new decay attributed only 16% of the total decay found in all students (105 of the 648). Unfortunately, 24% of the total decay found this year was on previously seen students that had been referred but not treated in past years (158 of the 648), this previously identified decay accounts for 60% of the decay found on our returning patients (158 of the 265). If these students had received the treatment as referred, the spread of decay would not have occurred and the decay rate would be less than the 15%. It is satisfying to see that only 1/3 of the decay occurs in our returning students. However, it is very frustrating to see returning students that did not receive the recommended referred treatment present again with past as well as additional decay.
Since 2003 this program has provided 6,949 comprehensive dental hygiene appointments, placed 30,000 sealants, 8,000 fluoride treatments and 2,000 temporary fillings. Students received a dental screening, dental cleaning, oral hygiene instruction, fluoride or MI paste application, temporary fillings, dental sealants, nutritional counseling, and referrals for further dental treatment if needed.
- 548 total students
- 286 students previously seen by MDHO
- 260 were new to our program
- 383 students received 2,598 dental sealants
- 111 students received 336 temporary fillings
- 165 students referred for further treatment
MDHO has several distinct qualities that set it apart from other programs:
- MDHO is able to reach and treat this high risk population because it delivers services at schools in our mobile van.
- MDHO provides temporary filling placement.
- MDHO spends 25% of the appointment time on dental hygiene education. Children are instructed in effective plague removal and given nutritional counseling.
- MDHO has a very aggressive sealant placement program. While many sealant placements are covered by MaineCare, some are not. Placement is based on child need rather than reimbursement.