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Say Cheese: Recent Dental Initiative Creating Healthier Smiles

June 23, 2010 By Nina Slupphaug, Health Care Policy Associate
As a child, what was your favorite part of the nightly routine: the bedtime story, picking out your PJs or brushing your teeth?  You don't have to answer statistics already have. While Minnesota does not collect dental data, national statistics show that 78 percent of children have tooth decay by age 17, making it the number one chronic disease in children. Even more importantly, among kids from low income families, almost 50%* go untreated for their tooth decay.

More than 70 percent of St. Paul School District students come from low income families, and many children go without regular dental care, some have never been to a dentist. In response to this growing statewide problem, Delta Dental started Smiles Across Minnesota in 2005. It partners with local dental care providers to establish clinics in schools and libraries to reach underserved populations. All kids in the district, even those with dental insurance, can access the services. Costs are assessed on a sliding fee scale, which means that for some it is entirely free. The providers also help families apply for public programs to cover costs.

Soon, this dental service will reach full saturation in St. Paul elementary schools -- 7,000 students. Currently, the program serves more than 3,100 St. Paul children.

Moving beyond the Twin Cities, Smiles is truly across Minnesota, offering services in Rochester, St. Cloud, and the Iron Range. In Duluth, the program serves all children ages 3-12, offering preventive services such as cleanings, fluoride and sealant. This fall, it will launch in Mankato and International Falls, a well-timed move. The Pew Center's latest report on Minnesota's dental policies found the state has fewer than 25 percent of high-risk schools offering sealant programs and just more than 37 percent of Medical Assistance-enrolled children receiving dental care.

Oral health is more than a pretty smile; it is an integral part of your overall health. According to Mayo Clinic, gum disease can be a port-of-entry for bacteria to enter the bloodstream. Research has found there may be a link between oral health and cardiovascular disease as well as a variety of other diseases and conditions, such as diabetes.

Smiles Across Minnesota targets schools with high participation in free or reduced cost lunch programs in hopes of reaching children with the greatest need. Around 30 percent of children in participating schools receive preventive care from locally hired hygienists. If more care is necessary, they are usually referred to a local partnering dentist.

It has been challenging to find local partner dentists, as reimbursement rates for treating children on state programs are less than 50 percent. Some dentists are simply unable to afford participation. So far, Delta Dental has spent $300,000 on the program, money that goes toward meeting the cost incurred by participating dentists. Almost 18,000 children have been treated statewide. The program's placement in schools has proven particularly important in reaching more children. It decreases the burden on parents who typically would miss work time taking their children to and from the dentist.

Fortunately, programs such as Smiles Across Minnesota fill cavities in our state's delivery system, especially in dental care; Smiles also provides a good revenue model for similar programs to consider - a sliding scale fee for services and private grants. Gracious donations of talent, time and money, help the medical community offer services to those most in need; however, "charity is not actually a health care system," according to Dr. Robin Loewen, a pediatric dentist from Rochester.  She's right! But as health care initiatives are cut from the state budget, such programs are becoming substitutes, not just supplements for Minnesota's state health delivery system. Instead of finding ways to cut costs and deliver services more efficiently, the governor's answer has been to cut programs altogether.  We need a comprehensive state health care system, not a patchwork of charity care. 


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* Ann Johnson, Co-chair Smiles across Minnesota

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