Public Health and Oral Health Bridging the gap between practice and policy

by ANDREW LAU L

ittle is known about how the dentists in Missouri perceived a handful of changes to dental policy coming from

Jefferson City this past legislative session. Over the summer, the Missouri Department of Health and Senior Services (DHSS) set off to find out how dentists perceive these changes. Developing a knowledge, attitudes, and practices survey allowed the agency to draw several conclusions on recent policy topics including: Medicaid reimbursement rates, the Fluoridation Notification Bill, teledentistry and dental sealant placements.

FLUORIDATION

Changes to fluoridation notification laws have improved transparency for Missourians. The law requires documentation if fluoride is added or removed from the community water source. Evidence supporting fluoride’s role in improving oral health is robust, and dates back more than 70 years.¹ • Nearly one out of two (46 percent) dentists did not feel informed about the Fluoridation Notification Bill

• Nine out of 10 dentists believe that adding fluoride to a community water source is a good use of local resources

MEDICAID

Medicaid reimbursement rates remain a discussion point among providers and insur- ers. With rates for child dental services in Medicaid dropping in the double digits be- tween 2003 and 2013, dentists are beginning to feel disdain for the program.² However, evidence supporting rate increases alone as a means to improve oral health outcomes in adults remains weak.³ • Nearly half (46 percent) of dentists in the state do not feel well informed about Medicaid reimbursement rates

• Eight out of 10 dentists believe Medicaid reimbursement rates are unfair

TELEDENTISTRY

A recent change to the way MO HealthNet providers can use teledentistry to improve access to vulnerable populations is now undergoing regulatory measures by the Missouri Dental Board. This tool first tested in the early ’90s, has garnered bi-partisan support here in Missouri. Aimed at improv- ing efficiencies, especially in those hard to reach parts of the state, teledentistry is a 21st century technology that has a promising evidence base.⁴,⁵ • Three out of five dentists do not feel well informed about changes made to state law regarding teledentistry

• Just over one third (37 percent) of den- tists believe teledentistry is an impor- tant resource to improve access to care statewide

DENTAL SEALANTS

Dental sealants remain a top priority for state and federal governments. The CDC hails school based sealant programs as not only cost-effective, but cost-saving for Medicaid.⁶ Missouri’s DHSS have been working hard to establish an oral health surveillance program, and will soon launch a school-based dental sealant program.

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• More than eight out of 10 dentists (86 percent) believe community dental sealant programs are a good use of state resources

• However, only one in 10 dentists place sealants on children between the ages of five and seven

Contrasts between attitudes and practice related to oral health policies remain an area of research for some as perceptions continue to change over time. The study was per- formed with 191 participants, administered through an online survey portal, with data analysis conducted in SPSS. Data suggests a more comprehensive approach to dissemi- nating policy changes in an attempt to keep transparency at the forefront of policy. f

Andrew Lau is an MPH Candidate 2017 at Washington University in St. Louis, Brown School of Social Work. He was a MO DHSS Intern, Summer 2016, when this survey was conducted as a part of his degree program. You may contact him at a.lau@wustl.edu.

DISCLOSURES & ACKNOWLEDGEMENTS

Funding for the study was provided by the Missouri De- partment of Health and Senior Services. A special thank you to the Missouri Coalition for Oral Health for provid- ing a small incentive for participants and to the MDA for their collaboration throughout. The author reports no personal or financial conflict of interest.