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Innovation Spotlight: Dentist reinvigorates practice with simple walk across the street

August 18, 2014

By Kelly Soderlund

Editor's note: This is the first installment of an ongoing series, Innovation Spotlight, featuring dentists who are using innovative ways to change their dental practices. A 2013 environmental scan of the dental industry showed Americans have been visiting the dentist less frequently and spending less money on their oral health, pushing the profession into a new normal when it comes to U.S. dental spending, according to the ADA Health Policy Institute. The ADA News will spotlight dentists who are adjusting to this new normal and finding ways to prepare their practices and themselves for the future.

photo of Dr Schirmer
Dr. Schirmer
Corning, New York — It started with a simple walk across the street and culminated in thousands of children across New York receiving topical fluoride varnish.

After being in practice for more than 30 years, Dr. David Schirmer, 60, had accumulated a mature patient base.

Sure, he started out having kids as patients but most of them grew up, went to college or moved away. They were replaced by adults who needed more complex dentistry, and the few children he did treat were from higher-income families, needing very little except preventive care.

In 2009, Dr. Schirmer was looking for a way to revitalize his practice, both financially and in the type of dentistry he was offering. He was financially planning for retirement but also wanting to contribute to dental public health in some way, beyond just volunteering for charity events.

That was the same year the New York State Department of Health authorized the application of topical fluoride varnish for at-risk children ages 1-6 by medical personnel. It would be reimbursed through the Medicaid program at $30 per application, up to four times per year and could be applied during well child visits, sick visits or any encounter with a physician.

"I thought this would be an excellent way of reducing the scourge of early childhood caries and would open the door for pediatricians to talk about a dental home for these children," Dr. Schirmer said. "I knew many had no dental home and often, dental treatment was a trip to the emergency room."

But even after the health department's decision, not many medical offices were implementing the practice because they either weren't aware of it or they weren't sure how to go about it, Dr. Schirmer said.

"There was no level of education for physicians and pediatricians in terms of what it was about, how to do it, how to bill for it, how to code for it, etc.," Dr. Schirmer said. "That's really what we did."  

Dr. Schirmer walked across the street to Southern Tier Pediatrics and after a brief lunch and learn session, the nurses and doctors slowly began applying topical fluoride to their child patients' teeth.

"I'm not directly involved anymore other than they have a place they can send children who don't have a dental home," Dr. Schirmer said.

Southern Tier Pediatrics ultimately referred a few hundred children to Dr. Schirmer's dental practice, the majority of them Medicaid patients.

"It's not really difficult to treat children who are on Medicaid if you accept the fact that you cannot do all things for them," Dr. Schirmer said. "There are going to be some kids that you are simply going to have to refer to a specialist or to an educational institution that has the ability to sedate them. Though most kids can be treated by a general dentist, and they can be fun, some might need extra attention and care."

Dr. Schirmer not only implemented the practice locally, he took it statewide. After talking with the executive director of the Seventh District Dental Society, they put together a team of dental volunteers to bring the concept to pediatric practices in the towns in the Finger Lakes Region of New York. The word spread and now dentists are working in conjunction with medical offices statewide to apply topical fluoride varnish to children and help them find dental homes.

"Now that the pediatric medical practice across the street is tuned into oral health, there is a steady stream of kids coming into my practice," Dr. Schirmer said. "Yes, we have had to add staff and reconfigure our schedule. But what a nice way to energize your practice. I know my practice will have those children and parents and it will be ready for my successor one day."

If you feel you're an innovator in your own dental practice, or if you know a colleague who is, please contact the ADA News at adanews@ada.org.