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Capitol Dental Care's Virtual Dental Homes

Summary 
  • Need: Dentists in Polk County, Oregon who accepted Oregon Health Plan were booked out for months, causing patients with dental needs to have to wait for an appointment or travel to an adjoining county for dental care.
  • Intervention: Capitol Dental Care began a Virtual Dental Home teledentistry model to bring preventive dental care to 3 elementary schools and several Head Start programs.
  • Results: Through this program, over 700 students have received dental care in their schools.

Description

Polk County, Oregon, a Dental Health Professional Shortage Area (HPSA), has few dentists who accept patients insured with the Oregon Health Plan (Oregon's Medicaid program). Those who do are often booked out for months, causing patients with dental needs to have to wait for an appointment or travel to an adjoining county for dental care. A sense of urgency led one dental clinic to take action.

Capitol Dental Care Logo

In September of 2015, Capitol Dental Care, Inc. (CDC) began a teledentistry pilot project to bring preventive dental care to Polk County. Three elementary schools in the Central School District and several Head Start programs signed up. Many of students came from low-income, migrant families. At the time, only one-third of the county's students reported having annual dental visits and 66% were experiencing tooth decay.

CDC's school-based Virtual Dental Home (VDH) model has allowed students to see an oral health service integration team of expanded practice dental hygienists and dental assistants for routine dental visits. Portable dental chairs are set up in makeshift dental offices in various locations throughout the school. The team uses teledentistry to consult with remotely located dentists and share photographs and radiographs through a secure server. From there, the dentist can develop a treatment plan and determine if a patient needs to be seen for further treatment.

Capitol Dental Care VDH Teledentistry
Dentists off site can create treatment plans for patients after viewing photographs and radiographs through a secure server.

This model allows students to stay in class longer, parents don't need to take time off work, and the service frees up space in the dental offices for more urgent cases. The team works at each school for a 3-month period before moving to the next school. A dental follow-up team comes into the school several months later for students who need follow-up care.

Capitol Dental Care's VDH model is a part of the newly-formed Oregon Telehealth Network for Oral Health, a collaboration of teledentistry programs across the state that mainly serves rural areas. The project is based on a similar model developed by California's University of the Pacific Innovations Center and is supported by the Oregon Health & Science University. Capitol Dental Care received a 2-year Oregon Health Authority's Federal State Innovation Model (SIM) grant, administered by the Oregon Office of Rural Health.

Services offered

Capitol Dental Care's VDH model provides dental case management for youth who need further dental care. The service integration team sends information home with the students or coordinates between the parents and dentist to set up an appointment. Those in pain can see a dentist within 48 hours. Other services offered in the school settings include:

  • Dental exams
  • Fluoride-releasing fillings, a procedure that doesn't require drills or inflict pain.
  • Routine cleanings, including:
    • X-rays
    • Intraoral photographs
    • Fluoride varnishes
    • Sealants
    • Diagnostics

Results

Since the start of this teledentistry project through July 2018:

Capitol Dental Care VDH Treating Students
The Virtual Dental team sets up in makeshift dental offices in schools to treat students.
  • 966 students have received dental care
    • 779 Elementary students
    • 150 through the Oregon Child Development Coalition
    • 37 at Community Action Head Start

From 2017 to 2018:

  • 820 students received dental care (more than one third of these were repeat patients with the program)
  • 53% had untreated decay
  • 5% of students were considered dentally "healthy," meaning they did not need follow-up work at a dental office
  • 82% of parent consent forms were returned with 70% of them approving their children to participate in the program
  • 95% service rate for students whose parents have given consent

For more on the program:

Barriers

  • Gaining initial support from the schools and helping them understand the importance of the dental follow-up teams.
  • Restorative treatment for some students was necessary following their initial appointments. Calls to parents to coordinate these follow-up appointment with local dentists were not always returned.
  • Limited space at the schools made it difficult to secure spots for the portable dental offices, but each school was able to find some space, including a stage, a cafeteria, a nurse's office, an upper-level room accessible only by elevator, and a corner classroom.
  • The VDH program was initially offered to Head Start programs, but it was a challenge due to the young ages of the patients, limited time for exams, and lack of parent consent. Because of these factors, serving Polk County's elementary schools instead became the primary focus.
  • Capitol Dental Care began a duplicate project in Yamhill County with the hopes of bringing dental services to the developmentally disabled. However, CDC had difficulties identifying people who met these qualifications and getting referrals from professionals who work with them.

Replication

  • Because the Virtual Dental team spends 3 months at a time working at each school, having a mutual understanding with administration was crucial for productivity and communication with parents. Teachers whose principals took proactive steps to coordinate with the CDC were more likely to adequately prepare their children for the dental exams.
  • It is important to keep in mind that this VDH model doesn't work for every dentist or dental team. Dentists who don't have the training or experience with telehealth may have a harder time giving a comprehensive exam to a patient virtually.
  • Provide incentives and a deadline for students to get their dental care permission slip signed by their parents.
  • Plan to meet with the entire school staff to familiarize them with the VDH interworking and with the service integration team.
  • Perform a financial outcomes assessment on your VDH model in order to evaluate its long-term sustainability.
  • After replicating the project in Yamhill County, the team realized that the training offered by the University of the Pacific Innovations Center was a critical piece to helping a dental team understand the importance of the program and commit to the mission. Consider sending your dental team to a similar training before launching the program.

Contact Information

Linda Mann, Director of Community Outreach
Capitol Dental Care
503.917.2604
mannl@interdent.com

Topics
Children and youth
Oral health
Schools
Telehealth

States served
Oregon

Date added
November 16, 2017

Date updated or reviewed
November 16, 2018


Please contact the models and innovations contact directly for the most complete and current information about this program. Summaries of models and innovations are provided by RHIhub for your convenience. The programs described are not endorsed by RHIhub or by the Federal Office of Rural Health Policy. Each rural community should consider whether a particular project or approach is a good match for their community’s needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep in mind that changes to the program design may impact results.