WVU Institute for Health Policy Research

West Virginia Institute for
Health Policy Research

3110 MacCorkle Ave, SE
Charleston, WV 25304-1299

Phone: (304) 347-1382
Fax: (304) 347-1236

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Pediatric Preventive Oral Health Project (PPOHP):

Over 70 percent of West Virginia’s children have some form of dental insurance. The predominant insurer is Medicaid (38.9% covered). However, in the last six months only 40.4% of children in the Medicaid program had received dental care, and of those none were age three or younger.* By the time they are 8, approximately two-thirds of West Virginia’s children have had one or more cavities compared

to 52% nationally.** Finance is only one barrier to oral health care for children. According to a 2002 survey of dentists conducted by the West Virginia Bureau for Public Health, 75% of dentists accept Medicaid clients and 73% accept CHIP clients.

That still leaves 25% and 27%, respectively, of responding dentists who either do not accept or limit the number of publicly funded clients they serve. Further, while 64% of responding dentists said they see children younger than 3 years of age, over one-third (36%) do not.***

In 2000, the Office of Rural Health Policy, Health Resources and Services Administration, United States Department of Health and Human Services, provided the funding to develop and field test the Pediatric Preventive Oral Health Project (PPOHP). The goal of the project was to improve the oral health care of very young children, from birth through age three. The project employed three strategies to achieve its goal:

To address the issue of finance, the project worked through safety net providers, specifically the community health centers around the state.
To address shortages of oral health professionals, the project trained non-dental providers (physicians, nurse practitioners, physician assistants) to provide anticipatory guidance to parents/guardians of young children, assess risk for dental caries, and provide early dental screening. Non-dental providers were trained to apply fluoride varnish to the teeth of children over 6 months of age determined to be at high risk for dental caries. All children were referred to the dentist if a problem was identified or for a baseline visit by the time they are one year old.
To address issues of parental convenience and compliance (e.g., time away from work, transportation, etc.) the project built the activities listed above into well-child visits.

The Pediatric Preventive Oral Health Project (PPOHP) represented a collaborative effort between the West Virginia Institute for Health Policy Research (WVIHPR), the School of Dentistry at West Virginia University’s Health Science Center, and Valley Health Systems, a system of federally qualified Community Health Centers across the state. The project dental director, Dr. Dan Brody, is also director of dentistry for Valley Health Systems. Sally K. Richardson, Executive Director of the WVIHPR, was the project director. Year 1 of the project concentrated on the development of training materials for use with providers, identification of oral health education materials for use with parents, and the development of an oral health intervention checklist that guides the providers through each visit including assessment of risk and appropriate anticipatory guidance.

In year 2, the project was field tested in five centers around the state. The 21st Century Challenge Fund of the Southern Rural Access Project, the Robert Wood Johnson Foundation, and the Sisters of Saint Joseph Charitable Fund provided additional funding for the field test and for the support of this website. Staff at each center, professional and administrative, received training on-site. Dr. Kavita Kohli, a pediatric dentist, previously on the faculty of the WVU School of Dentistry, conducted the training with a PowerPoint presentation developed during year one.

Over the course of a 2-3 month period post-training, each center enrolled fifteen children into the project. These five centers participated in an evaluation of the field test to assess the utility of the checklist, the value of the materials, the sufficiency of the training, and the impact on their professional time of the added activities. Parents also participated in the evaluation. Changes to the program and materials were made on the basis of the evaluation results.

NEXT STEPS
Although the “project” phase formally ends on April 30, new partners have come on board and new funding made available to expand the program to other primary care centers around the State. A Pediatric Oral Health Advisory Group was formed in May 2002 to advise and guide the expansion. The West Virginia Primary Care Association is a charter member of the Advisory Group and is funding the expansion effort. The West Virginia Dental Association is also an active member of the Advisory Group. The expansion program differs from the original project in one way, non-dental providers will not apply fluoride varnish. The WVDA has committed to identify dentists willing to work with participating centers to see children referred to them by age one and to handle the fluoride varnish.

Over the next year the remaining centers around the state will receive training with funding from the WVPCA and the support of Valley Health Systems. The Pediatric Oral Health Advisory Group plans to pursue Medicaid and West Virginia CHIP reimbursement for costs associated with this new service. In addition, the Advisory Group will work with the state, the School of Dentistry, and other interested entities to monitor the impact of the project on the oral health of children served.

For more information about the Pediatric Preventive Oral Health Project contact Sally K.Richardson or Dr. Dan Brody.

*West Virginia Health Care Survey 2001. West Virginia Institute for Health Policy Research.
**The West Virginia Facts. West Virginia Office of Maternal, Child and Family Health, Bureau for Public Health, Department of Health and Human Resources, January 10, 2003.
***Attitudes of West Virginia Dentists toward Publicly Sponsored Patients and Children with Special Care Needs. Office of Maternal, Child and Family Health. Bureau for Public Health, West Virginia Department of Health and Human Resources. October 2002.

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