DiagnosticsUniversity Of Maryland Dental School Helps Doctors, Nurses Halt Infant Tooth Decay
Across the state of Maryland, there are now doctors and nurses, freshly trained in pediatric dental health care, who can help stem an alarming number of 3-year-old children who arrive for their first dentist visit with teeth "just melting away."
Many children are not seen by a dentist until they are age 3, says Norman Tinanoff, DDS, MS, professor at the University of Maryland Dental School. "And among those in low socioeconomic status, there is also often inadequate dental health education," says Tinanoff.
Dental caries disease starts in infants, as the cavity-causing bacteria are transferred from mothers. National surveys from 1988 to 2004 showed a sharp rise in the prevalence of dental decay in U.S. poor children under age 5.
More than 400 physicians and nurse practitioners who participate in the Maryland Medicaid Program have received training in infant and toddler dental health care through a program run by the Dental School. The training and Medicaid certification will directly lead to more young children being referred to dentists and introduced early in life to oral health care, says Tinanoff, who is program director of the Dental School"s Department of Pediatric Dentistry.
The training allows the physicians and nurse practitioners to be certified by Medicaid and then reimbursed for providing fluoride varnish treatments after conducting oral health assessments for young children and toddlers. The program Maryland"s Mouths Matter: Fluoride Varnish and Oral Health Screening Program for Kids began July 1 and covers children who are Medicaid recipients, ages 9 to 36 months, during their Medicaid scheduled well-child visits.
"If [dental caries disease] is not caught early, this is risky business," says Tinanoff. "We have parents come in [to the Dental School public clinic] and say my child"s teeth are just melting away. A child with dental caries is not easy for the parent. It"s not easy for me. It"s not easy for the child."
In addition to applying the fluoride varnish--a highly accepted decay prevention tool--physicians and nurses in the program can provide oral health screenings, risk assessments, and oral health guidance for parents or legal custodians.
Pediatrician Lisa Horton of Glen Burnie, Md., sent her nurse Tracy Kells, RMA, to the training soon after being trained herself. "There are children who really need this," says Kells. "I"ve seen children with really bad teeth. It"s a pretty good idea. I wish I had this when my children were young."
Ayanna Williams, RN, of Total Health Care, Inc., has also completed the training. "A lot of our patients are noncompliant and don"t see what they are supposed to do," she says. "They are the underserved and as Medicaid families have to be impoverished. They waited til the last minute. Mom may be too busy." THC is federally qualified to partner with Medicaid assistance and has eight locations in Baltimore.
More than 100 doctors and nurses attended the 10th and final training at the Dental School in June. Tinanoff told them, "The old way was to see these kids at 4 or 5, then it was drilling and filling. ò€¦ So you folks are really going to help with this big problem we have in Baltimore and across Maryland."
The Office of Oral Health (OOH), Maryland Department of Health and Mental Hygiene (DHMH), is funding the program, in partnership with the Maryland chapter of the American Academy of Pediatrics. The health department has contracted with the Dental School to administer the program statewide.
The training is the latest step, say officials of the School and DHMH, to prevent a repeat of the tragic death two years ago of a 12-year-old Maryland child, Deamonte Driver, from a dental infection that spread to his brain.
"This is one of the best things we can be doing," says OOH Director Harry Goodman, DMD, MPH. Goodman is also an adjunct professor at the Dental School. "It works at so many levels. There are only a handful of pediatric dentists in the state. And it"s a population not generally seen by dentists. It gets them in the whole paradigm of care."
Jane Casper, RDH, MA, former co-chair of an action committee set up by the DHMH in 2007 after Driver"s death, says, "This is oral health integrity medicine and dentistry as it should be. This is a time when the medical community and the dental community have come together."
Pediatrician Balbir Chauhan, MD of Joppatowne, Md., says that when he was in medical school he never thought he would train to do dental work. "Prevention is a very good idea," he says.
University of Maryland Baltimore