Perinatal oral health: Thinking outside the dental office

By the CDHP team

The Children’s Dental Health Project (CDHP) is always seeking to learn of new, innovative strategies for improving oral health. In September, CDHP released an issue brief about oral health and pregnancy—and the need for new approaches. The following guest article, written by Emily Norrix, a Michigan perinatal oral health consultant, explores the development and impact of the Michigan Initiative for Maternal and Infant Health.

Perinatal Oral Health: Thinking Outside the Dental Office

By Emily Norrix

We’ve made progress in Michigan over the past several years of our statewide Perinatal Oral Health initiative. We have educated thousands of providers and pregnant women about the importance of oral health care during pregnancy, and our state has developed statewide guidelines and messaging. As of July 1, the State of Michigan enhanced its adult dental Medicaid benefit for pregnant women.  However, complex challenges remain for pregnant women, especially surrounding access to care.

An elephant remains in the room regarding perinatal oral health and interprofessional practice: OB-GYN providers often do not have the time, resources, or ability to promote oral health during pregnancy aside from an admonishment to see the dentist. Who does have the capacity to not only provide needed dental preventative services but also educate women and help them navigate the system? The dental hygienist.

The Michigan Initiative for Maternal and Infant Health (MIMIOH) places dental hygienists within the OB-GYN departments of seven Federally Qualified Health Centers (FQHCs) to function as critical members of the primary care team. Oral health simply becomes part of the clinical workflow and, instead of an option, becomes the expectation.

More than 2,200 pregnant women have received comprehensive education and more than 1,000 have been given an assessment and referral for needed dental treatment.

Divesh Byrappagari, director of dental public health & outreach at the University of Detroit Mercy School of Dentistry, recently cited the mother-child connection. “To improve the oral health outcomes for high risk infants and young children,” he said, “we need to start looking at ways we can improve the perinatal oral health of the mother.” Thankfully, Michigan stakeholders didn’t need to reinvent the wheel.

This model of care was already being used by Grace Health, an FQHC in Battle Creek, Michigan—a model developed with help from an earlier Blue Cross Blue Shield Social Mission Grant. With funds from the Michigan Department of Health and Human Services (MDHHS), Detroit Mercy Dental began building the MIMIOH model with consultation from Grace Health and technical assistance from the Michigan Primary Care Association and MDHHS.

MIMIOH-participating FQHC sites utilize Michigan’s PA161 program. This program allows for remote supervision of dental hygienists and permits hygienists to provide education, preventative care, and referrals for necessary dental treatment outside of the traditional dental setting. A designated and fully equipped private dental room within the OB-GYN clinic leads to functional medical-dental integration.

Staci Hard, a registered dental hygienist and project consultant from Grace Health has praised MIMIOH for putting her in a position that “allows me to meet my patients where they are and essentially bring the dental care to them. Our innovative model of care has provided hundreds of patients access to dental care.”

The MIMIOH project has been funded for roughly one year, and the outcomes have been promising. Sites have either found it sustainable to deploy a dental hygienist in this role or they are approaching sustainability. We are pleased to report that more than 2,200 pregnant women have received comprehensive education and more than 1,000 women have been given an assessment and referral for needed dental treatment. In addition, MIMIOH has established a culture of medical and dental integration and normalized oral health in a medical setting.

Our health care system took the mouth out of the human body, and now we are attempting to put it back in.

Lindsay Sailor, integrated health program manager with the Michigan Primary Care Association, stated, “Our health centers that are involved with the project really see the value in the patient care they are giving. They are hoping to become the dental home for these patients and to educate the families about caring for the baby’s mouth in hopes to prevent early childhood decay.”

Although dental providers are not yet reimbursed for quality outcomes, Sailor reports that these changes are coming. She also notes that, thanks to this project, health centers are poised to be in an excellent position for moving from volume-based payment to value-based care.

As the project team looks into 2019, the MIMIOH initiative intends to expand to other FQHC sites and explore the progression of this model from pregnant women to the family unit as a whole. The success and proven sustainability of the MIMIOH has encouraged sites to delve into medical and dental integration within their pediatric clinics. In addition, this model might be used to expand into family practice in the coming months or years.

Our health care system took the mouth out of the human body, and now we are attempting to put it back in. Projects like MIMIOH show what that can look like in a way that not only benefits our neediest patients, but also our clinics and health care systems as a whole.

* * * 

Join CDHP’s webinar, Prioritizing Oral Health during Pregnancy, on November 15 at 2pmET to learn more about progress and challenges to supporting pregnant women's oral health. Panelists include Lindsay Sailor of the Michigan Primary Care Association and Dr. Rocio B. Quinonez of the University of North Carolina-Chapel Hill.

For details and to RSVP, visit http://bit.ly/RSVPNov15.

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Children with poor oral health were nearly 3x more likely to miss school due to dental pain.
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