ADA News

Dr. Thomas P. Irwin Jr.

Johnston, Iowa—They're building a dental home for Iowa Medicaid children, professional and public partners who want to assure access to early and appropriate oral health care services.

An ambition born of professional advocacy and state legislative mandate, the children's dental home initiative will launch a demonstration project in Scott County with a $250,000 "earmarked" appropriation from the U.S. Congress "secured with the guidance of ADA Washington staff and the sponsorship of Iowa Sen. Tom Harkin (D) and Iowa Rep. Bruce Braley (D)," said IDA Executive Director Larry Carl.

The Children's Dental Home Demonstration Project has been approved for the period June 1, 2010 through May 31, 2011, said the June 8 grant award letter from the U.S. Department of Health and Human Services to the Iowa Dental Association.

"Our district is fully committed to this pilot program and looks forward to getting started in the fourth quarter of 2010," said Dr. Thomas P. Irwin Jr., a past president of the IDA Davenport District Dental Society who co-chairs a seven-member steering committee for the Dental Home Initiative.

The Mandate

The Iowa Legislature approved Medicaid reform legislation requiring that "...every recipient of medical assistance who is a child twelve years of age or younger shall have a designated dental home and shall be provided with the dental screenings, preventive services, diagnostic services, treatment services and emergency services as defined under the early and periodic screening, diagnostic and treatment program."

Although the Legislature "struggled to appropriate the necessary funding to provide the full dental home benefit to over 200,000 children statewide," IDA's Larry Carl said, state lawmakers "consistently funded a cadre of 23 dental professionals, I-Smile coordinators, throughout the state who are developing partnerships, establishing referral systems, providing training and education for health care professionals, ensuring completion of oral screenings and risk assessments, working within their [public] agencies to develop oral health protocols, ensuring oral health care coordination and providing gap-filling preventive services."

Unfortunately, the Iowa Legislature, since adopting the measure, has been forced to push back the date of full implementation, said Mr. Carl.

Public, Professional Partners

In response to the legislation, the Iowa Department of Human Services partnered with the Iowa Department of Public Health, the Iowa Dental Association, the Iowa Dental Hygienists' Association, Delta Dental of Iowa and the University of Iowa College of Dentistry to develop a proposal, which resulted in the I-Smile Dental Home Project.

The Iowa Dental Association, Iowa Dental Foundation and IDA Davenport District leadership partnered to advance the dental home by establishing the newly funded Scott County pilot project, which is designed to demonstrate the resources that will be necessary to fully implement the dental home initiative statewide. The initial demonstration pilot steering committee includes Dr. Joe D'Souza, Dr. Paul Smith, Dr. Mary Mariani and Dr. Alex Brandtner of Davenport, and Dr. Thomas P. Irwin Jr., Dr. Kyle Gagliardo and Dr. Ben Selden of Bettendorf.

I-Smile Dental Home Initiative

The I-Smile dental home uses a team approach, says the www.ismiledentalhome.org website. The dental home team includes dentists who provide treatment and definitive evaluation. Other health professionals such as dental hygienists, physicians, nurse practitioners, registered nurses, physician assistants and dietitians are part of a larger network and can provide oral screenings, education, anticipatory guidance and preventive services as needed.

I-Smile has four objectives:

• improve the dental Medicaid program;
• recruit and retain dentists in underserved areas;
• incorporate dental clinics within rural hospitals, and
• improve the dental support system for families.

"The outcome of the I-Smile Dental Home Initiative will be an integrated system that provides early identification of the risks of dental disease, prevention, improved care coordination and stronger parental involvement," the website says. "Ultimately, at risk children who are currently excluded from the dental care system will be reached and will have a dental home."

The I-Smile website offers additional resources and public service announcements developed with American Dental Association support as part of the Iowa Dental Association state public affairs activity. "Through the I-Smile system, dental offices will benefit by having the local CH [child health] agency as the primary provider of regular education and prevention services and the single point of contact for managing patient appointments and referrals," says the I-Smile oral health coordinator handbook posted at  http://www.idph.state.ia.us/hpcdp/common/pdf/oral_health/coordinator_handbook.pdf.

"This will provide dentists with more time to focus on treatment services," the handbook says. "In addition, patient non-compliance and 'no-show' appointments in dental offices will be reduced."

What is a dental home?

The American Academy of Pediatric Dentistry's definition of a dental home is the conceptual framework for the I-Smile initiative. The AAPD recommends children be referred for preventive and routine oral health care as early as six months of age and no later than 12 months of age with the frequency of re-appointment based on risk assessment.

A dental home is a network of individualized care based on risk assessment, which includes oral health education, dental screenings and preventive, diagnostic, treatment and emergency services, the I-Smile website says. I-Smile uses the concept of a dental home to ensure that Iowa’s children have access to treatment and early prevention.

ADA State Public Affairs Program

The ADA State Public Affairs Program works with state dental societies to develop and implement strategies for "effective advocacy" and "position" in the public policy arena.

Established in 2006 and operational in 2007 (ADA News Today 05/11/07 State dental leaders share public affairs progress reports), the SPA invites state dental societies to apply to the program annually for public affairs support. Volunteer leaders, member dentists, are involved in almost all phases of the SPA, and the ADA Board of Trustees and House of Delegates receive reports on the program. See also American Dental Association Strategic Plan: 2007-2010 PDF at www.ADA.org.