CHALLENGE
Providing Dental Care to Low
Income Families
Brenda Diamond, Director Ministry Dental Center
Patsy Mbughuni, Senior Planner CAP Services Inc.
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Culture
Barriers to Dental Care
Effects of Oral Health on Overall Health
History of Ministry Dental Center
Community Benefit
AGENDA
Culture is defined
as learned behavior
which has been
socially aquired1
1Park K. Social sciences and medicine. Park’s textbook of preventive
and social medicine. 17th ed. Jabalpur India; M/ s Banarsidas Bhanot
publishers: 2002: pp 459-488.
CULTURE
 Number of people with dental Insurance?
 Seen a dentist in the last 6 months for preventative
care?
 Children should be seen at age 2 for their first dental
exam? True or False
 Believe you have “soft” teeth.
 Want to see a dentist but cannot.
• 65% of people who have dental insurance, utilize it
annually.
• 46% with commercial insurance, have completed a yearly
check up (re-care appointment). (Paid at 100%)
• On average, 30% of children in Wisconsin covered by
Badger Care has seen a dentist in the last year. Children
should be seen by age 1.
Myths Unveiled
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There is not such a thing as “soft” teeth. Teeth that break
down easily could be a result of diet (sugar drinks),
brushing habits, other oral habits such as smoking, chewing
tobacco and drug therapy as well as lack of professional
dental care. Fluoride and genetics do play a role in the
enamel make up of your teeth.
Access to comprehensive dental care continues to be a real
problem in the state of Wisconsin.
Based on utilization rates today, studies indicate there will
be enough providers to cover the demand for care in the
future. Should community demand increase, dental access
could be constrained.
Myths Unveiled continued
• 44 percent of American children will suffer from pediatric dental disease
before they reach kindergarten.
• 73 percent of preschoolers and 48 percent of primary school age children
have unfilled cavities
• Only 1.5 percent of 1-year-olds have had a dental office visit compared with
89 percent who have had an office-based physician visit. (Question of value
placed on oral health)
National Statistics
• Fear
• Embarrassment
• Expense of non covered
treatment
• Work Schedules
• Transportation
(Reliable)
• Mental Health
• Limited providers
Barriers to Seeking Care
• Commercial Insurance
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Co Payments
Out of Pocket Costs
Maximum benefits reached
quickly
• Non-Insured
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Initial $200 plus for
appointment
Tight Budget, no extra cash
for care
Chronic needs
• Public Assistance
Programs
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Limited providers
Travel Long distance
Wait list for care
Chronic needs
In/Out of Eligibility
INSURANCE BARRIERS
Smiles and laughter strengthen your immune system, boost your energy,
diminish pain, and protect you from the damaging effects of stress and
prevent heart disease. Both are powerful mood changers as they reduce
stress hormones, release endorphins and relieve tension. Smiling
releases Serotonin into your blood stream so when you smile you
release feel good hormones which raise your mood and lift your spirits.
OVERALL HEALTH
• Recent scientific research suggests a very
strong correlation between chronic oral
infections from periodontal (gum) disease
and systemic health.
• Medical conditions may be complicated
by bacteria from the mouth.
Oral Systemic Connection
• Cardiovascular disease
- Inflammatory response to oral bacteria
contributes to cardiovascular disease, heart
attacks or strokes.
• Pulmonary Disease
- People with chronic periodontal disease
(10% of the general population and 50% of
all seniors) are most affected by pneumonia.
Improving the state of poor oral health may
reduce the number of pneumonia cases and
decrease patient mortality.
• Diabetes
- 1/3 of all people with diabetes have
severe periodontal disease. Untreated,
periodontal disease can disrupt diabetic
control. Periodontal disease may be
considered a complication of diabetes.
• Orthopedic Implants
- Infections originate from oral
bacteria may lead to failure of the
prosthesis. Dental evaluation before
surgery could decrease the potential
risk of infection.
• Cancer
- Elimination of all dental disease
prior to cancer therapy may minimize
or prevent the potential complicating
effects of chemotherapy.
• Fetus Development
- Risk of preterm birth was 3 to 8
times greater for mothers with
periodontal disease.
Medical Conditions
• Community-wide concern
• CAP Services’ community needs assessment 1995 and 1998
identify lack of access to medical and dental care
• Head Start dental assessments – no providers
• Hospital Emergency Room visits for dental issues
• Family Preservation and Support Initiative - Affordable Health
Care Task Force 1996- lack of dental care
Community Challenged
• Delta Dental of Wisconsin, Saint Michael’s Hospital,
CAP Services
• Each partner brought unique resources to the table:
• Delta Dental: financial resources
• Saint Michael’s Hospital: financial resources and
management/organizational medical infrastructure
• CAP Services: resource mobilization capacity, outreach to
target community. “Mission of CAP Services is to bring
about a permanent increase in the ability of low-income
individuals to become economically and emotionally selfsufficient.”
Partnership Coalesced
January 2002 - Open
Our Mission is to continually
improve the health and well being
of people, especially the poor, in the
communities we serve.
We believe people have the right to
quality dental care services that are
efficient, effective and accessible.
We believe care should be
compassionate and delivered in a
dignified and respectful manner by
a culturally sensitive and highly
professional team of people.
Ministry Dental Center
Ministry Dental Center provides comprehensive general dental care for
infant, pediatric, adolescent, adult and geriatric patients.
Eligibility:Recipient of Badger Care Benefits in Portage & Waupaca Co
The patient population served is approximately
40% under age 20; 52% patients aged 20-59; and 8% 60 and older.
21% self report disabled.
Ethnicity:
Caucasian 81%,
Hmong 9%,
Hispanic 5%,
Asian 1%,
African American 3%,
Bi-racial 1%.
Demographics
The most prevalent reasons patients present for dental care are:
• Diagnostic (Oral evaluations, diagnostic imaging)
• Preventive (prophylaxis which includes scaling and polishing
procedures to remove coronal plaque, calculus and stains;
fluoride treatment; nutritional and dental disease counseling;
tobacco counseling for the control and prevention of oral
disease; oral hygiene instructions and sealant placement)
• Restorative (placement of amalgam, resin fillings)
• Emergency Treatment of dental pain (Open a tooth to drain
infection and/or extraction as necessary)
• Limited Endodontics, Periodontics and Prosthodontics
(Root Canal Therapy, treatment of gum disease and
replacement of missing teeth)
SCOPE & COMPLEXITY OF
PATIENT’S CARE NEEDS
Ministry Dental is staffed by Total of 13.4 FTE.
2.80 FTE Dentist. 2.4 FTE Dental Hygienists,
4.6 FTE Dental Assistants, 2.6 FTE
Schedulers, and 1.0 Director.
HOURS OF OPERATION:
Monday 8 a.m. – 5 p.m.
Tues-Thursday 8 a.m. - 6 p.m.
Friday 8a.m. - 4:30 p.m.
2013 Patients Seen By County
County
Patients
Seen
Portage
2796
6950
1454
645
1961
Waupaca
1424
3595
711
310
807
48
137
39
0
41
2013 Total
4268
10,682
2202
955
2809
2012 Totals
4281
10,227
2892
1001
2798
Other
Patient
Periodic New
Treatment
Encounters Exams Patients Complete
Patients Seen in 2013
Operational Philosophy
 Patients First
 Standardization
 Organization
 Lean-eliminate
waste
OPERATIONAL EFFICIENCY
• United Way of Portage
County
• Jeregan’s
• WI Department of Health
Services Dental Grant
• Manawa Telephone
company
• Delta Dental
• Wetherbee Donation
• Anthony Family
Foundation
• Saint Michael’s
Foundation
• Frame Memorial
Presbyterian Church
• Central Wisconsin
Community Foundation
*Average Annual Deficit of $460,000
Sustainablity_Filling the GAP
COMMUNITY BENEFITS
IMPACT TODAY
FUTURE IMPACT
• Children are seen next
available appointment
starting at age 9m – 1 yr.
• Fluoride Varnish
• Sealants
• Patient Education utilizing
teach back techniques
• Emergency & Restorative
Care
• Treatment plans are
completed in 90 days
• Over 15,000 persons seen
• Low income families have
dental home
• Decrease decay rates in
children
• Decrease adult dental
care needs
• Increase demand for
preventative recare
appointments to sustain
oral health.
• Community awareness of
the effectives of oral
health on overall health
• Improve overall health in
the Community
• Improving oral health in the community involves changing the
community culture around oral health. (learned behavior
which has been socially acquired)
• Way to impact community culture is through outreach and
education.
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New Moms groups
Pregnancy Fairs
Public nurses – education in-service
Primary care, OB-GYN, Pediatric physician forums on early
intervention and education.
• Physicians applying fluoride varnish during well baby checks.
Community Out Reach
Our Mission is to continually improve the health and
well being of people, especially the poor, in the
communities we serve.
We believe people have the right to quality dental care
services that are efficient, effective and accessible.
We believe care should be compassionate and delivered
in a dignified and respectful manner by a culturally
sensitive and highly professional team of people.
Back to the Mission
Making a difference in our community !
Patient Satisfaction
Questions
Thank you!