PC1169: An Innovative Medical-dental Collaboration to Address Barriers to Pediatric Preventive Dental Care Among Children with Medicaid Insurance

Background: Tooth decay, the most common chronic disease in U.S. children, disproportionally affects low resourced communities leading to poor long-term health outcomes (Children's Dental Health Project, n.d.). In Washington, DC in 2020, only 38.5% of Medicaid patients aged 1-20 received preventative dental care (Medicaid, 2021). This aims to describe the initial collaboration between a Community Dental Health Coordinator (CDHC) and an outpatient academic pediatric practice to support patient access to preventative dental care.

Methods: The CDHC role was modeled from the American Dental Association (ADA) (Grover, 2014). Key to collaboration was identifying a CDHC and an onsite physician to serve as the oral health champion; both receive protected funding and time and were co-located at a community-based practice in an under-resourced neighborhood. The CDHC is reflective of the community served, primarily Black children and families, and will integrate oral health information from an ADA-credential course into overall health. The CDHC will use the community's own language, culture, and value system to reduce barriers. Initial steps included compiling dental resource list by insurance and zip code; conducting informal needs assessment with families regarding barriers; and partnering with the physician champion to educate clinic staff and incorporate CDHC into the clinic workflow.

Results: Barriers for patients identified by the study team include difficulty in making appointments and limited availability of dental clinics. There are inadequate number of clinics that (1) provide specialty care while also accepting Medicaid and (2) are geographically close to the under-resourced neighborhood. Medical providers were often unaware of all barriers and did not have the resources to address without the CDHC. In the preliminary collaboration, CDHC outreached to 258 patients with 108 accepting services.

Conclusion: Incorporating a CDHC can be valuable tool in a medical home to address barriers; the CDHC model can provide universal screening for dental home needs, make appointments for participating families, and follow up after appointments. Next steps include using a quality improvement model to assess the success of implementation.