Mobile dental health units: a model for improving access to care.
Dental caries affects children in the United States more than any other chronic infectious disease. Left untreated, tooth decay causes pain and infections that may lead to problems including difficulties in eating, speaking, playing and learning.(1) Perhaps underscoring access to care as a major concern, the incidence of dental caries is greater in rural communities.(2)
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Additionally, the National Institute of Dental and Craniofacial Research (MIDCR) reports that more than 51 million school hours are missed annually by school-aged children due to a dental problem or visit, with 117 hours missed per 100 children with missed hours, Further, individuals with family income less than $35,000 and those without insurance appear to have missed more school hours.(3)
According to the U.S. Department of Health and Human Services, there are 4,230 Dental Health Professional Shortage Areas with 49 million people living in them. Further, it is estimated that it would take 9,642 practitioners to meet their need for dental providers.(4)
One model for addressing these serious issues includes mobile dental health units. Western Kentucky University (WKU) received state funding in 2001 to purchase a mobile health unit. This unit was equipped with two operatories; one better suited to dentistry and the other better suited to routine physical examinations (Figure 1). Initially, WKU dental hygiene students went out on the mobile health unit two days per week and WKU nursing students went out on two different days of the week. Even though the second operatory was better suited to routine physical examinations, it was routinely used on days the unit was staffed with dental personnel. Over time, the demand for dental services grew to the point that a new dedicated dental van was purchased in 2008 (Figure 2).
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While WKU pays the salaries of a full-time dentist and dental hygienist, the availability of student dental hygienists has helped make this model cost-effective. When students are on the dental van, the focus at a given site is more preventive in nature, primarily the placement of sealants to second and seventh grade rural schoolchildren. When the dental care providers are the dentist and dental hygienist, the focus of care at a given site is typically restorative (Figure 3).
Sources of Funding
The costs associated with operating a mobile dental health unit can be prohibitive. According to Seal America, the cost of outfitting a van is more than 10 times greater than the cost of purchasing portable dental equipment, and the annual cost of operating a mobile van is approximately twice as high as using portable dental equipment in a school. In addition, movement of students to and from the van may be more complex than moving them within the school. (5) In addition to funds provided by WKU, other sources of revenue received on an annual basis include allocations from Delta Dental, the Health Resources and Services Administration (HRSA), the National Institutes of Health (NIH), and a local health department. Third-party reimbursement has typically not been sought as fewer than 7 percent of all individuals seen on the mobile health unit have some form of third-party coverage. Specific sources of revenue are outlined in Table I.
With three to four students on the mobile health unit, the dental team typically has enough personnel to provide sealants for all second and seventh graders in a school in one visit. On some occasions, a return trip to a school is scheduled to ensure all students are able to receive services. Students are required to write their reflections after each experience on the dental van in a journal. The nature of the writings of our students reflects maturation in the thought process regarding their roles as members of a global community. Examples of earlier reflective journal entries include: "I am glad I had the opportunity to help someone improve their oral health," "Before the rotation at this school, I had no idea kids were in such pain from their cavities," and "I truly enjoyed working with the kids to improve their chances of keeping their teeth." Later reflective journal entries include: "I will find a way to be instrumental in this crisis," "I will work in my community to develop low-cost alternative programs so that the underserved don't have to suffer," and "I now realize why I was placed In this position."
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Table I. Sources of Revenue 2008-2010 Entity Amount Amount allocated allocated academic academic year year 2009 2008-2009 -2010 Delta Dental $10,000 $10,000 Local health $8,000 $8,000 department Health $473,707 Resources and Services Administration (HRSA) National $58,941 Institutes of Health (NIH) WKU $63,202 $65,749 (non-personnel) Figure 4. Dental events 2008-2009, 2009-2010. 2008-2009 2009-2010 Community Events 80 94 Oral Exams 1099 1822 Sealants 433 364 Student Hours 1224 1483 Note: Table made from bar graph.
Benefit to the Community
In 2010, more than 1,800 individuals were seen on WKU's mobile dental health unit. Specific services provided by dental hygiene students are depicted In Figure 4. While family income of the specific individuals seen was not ascertained, the average annual income of families in the counties served by the mobile health unit is $27,643. (6) Since it has been well documented that income is directly related to dental health, the availability of dental services in these regions is of vital importance. Additionally, the availability of dental hygiene students makes the provision of services more cost-effective.
Mobile dental vans may not be appropriate for many dental hygiene programs due to institution-specific circumstances. WKU as a whole and the students of the Program of Dental Hygiene, however, have been able to effect a tremendous impact on the community as a result of this endeavor. It is believed that this model has been beneficial to both students and members of the surrounding community. Since rural children, individuals with family income less than $35,000, and those without insurance appear to have greatest dental need,(3) this model may be instrumental In addressing these issues.
(1.) Centers for Disease Control and Prevention. Children's Oral Health. Available at www.cdc.gov/oralhealth/topics/child.htm.
(2.) Milgrom P, Reisine S. Oral health in the United States: The post-fluoride generation. Ann Rev Public Health. 2000; 21, 403-36.
(3.) National Institute of Dental and Craniofacial Research Dentai, Oral and Craniofacial Data Research Center. Section 17: Social and economic impact of oral disease. Available at http://drc.hhs.gov/report/17_1.htm.
(4.) US Department of Health and Human Services Health Resources and Services Administration. Shortage designation: HPSAs, MUAs and MUPs. Available at http://bhpr.hrsa.gov/shortage/.
(5.) Seal America: The prevention generation. Available at www.mchoralhealth. org/seal/step4.html
(6.) US Census Bureau. Kentucky. Available at http://quickfacts.census.gov/qfd/ states/21000.html.
By Lynn D. Austin, RDH, MPH, PhD
Lynn D. Austin, RDH, MPH, PhD, is associate professor in the Department of Allied Health and Director of the Dental Hygiene Program at Western Kentucky University. A member of Sigma Phi Alpha, she teaches Community Dental Health and Research Methods. Research interests include oral health status of older individuals and factors associated with admission of dental hygiene students.