Webinar: Think Teeth: New Developments in Medicaid and Children’s Oral Health (9/26/13)


>>[ computerized voice ]
The broadcast is now starting. All attendees are
in listen only mode.>>Sandy Won
Hi everyone, this is Sandy Won with the Connecting Kids
to Coverage Campaign. Thank you so much
for joining us today for our Oral Health Webinar, Think Teeth. We are going to be starting
in just a couple minutes right on time at 1:30. We have a number of registrants today so we just want to make sure that we get as many
people logged on as we can, and we’ve got
a great presentation. So we will get started
in a couple minutes. Thank you for joining us,
and we will be back in just a minute. [ no audio ] >>Donna Cohen-Ross
Good afternoon everyone. And I guess for some of you
it is good morning. My name is Donna Cohen-Ross. I am a Senior Policy Advisor
at the Center for Medicaid and CHIP Services
in the Department of Health and Human Services,
and I want to welcome everybody today to our webinar
Think Teeth: New Developments in Medicaid Children’s
Oral Health. We are so excited today
for a number of reasons. One is that I think
this is the webinar that beats all
in terms of registrations. As of just a little while ago
we had 859 people registered to participate,
and that is a record for us. I think that emphasizes to us
all how important this topic is and how hungry people are
for information, materials, findings from research,
anything possible to help us in our work as we try
to improve the health coverage and health care
for young children. And we’re also going
to talk some about pregnant women today as well. I am going to get started
right away because we do have a lot to cover and we are going
to touch on all of those things. We are going to hear a little
bit about the value of Medicaid and CHIP and their role in oral
health outcomes for children. We are going to have
a research roundtable in just a little while. We have two researchers
who you’ll meet in a bit who have done some work
that we wanted all of you to hear about and get a chance
to talk with them a little bit. And then we also are going
to be sharing with you for the first time officially
new resources that can help you with oral health messages that
can be used with pregnant women and parents of young children. Here at CMS, we have been
working for a very long time to create these materials,
to perfect them, to think about the best ways
of getting them into your hands and into communities
where you’re working. So we are very, very excited. I want to just say a word
to get us all on the same page so to speak, or the same slide,
we can go to the next slide. And just talk a little bit about
where we are with children’s health coverage with respect
to Medicaid and CHIP, and we were very fortunate
about a week ago we received some new data
from the Urban Institute. The Urban Institute has been
tracking information about participation in Medicaid
and CHIP over the course of the last four or five years,
and so it’s really very helpful to us because the data
tells us that we are moving in the right direction. Now when it comes
to children’s health coverage, the right direction is
sometimes up and sometimes down. So first I want to share with
you that between 2008 and 2012, 1.7 million children gained
coverage in the United States, and mainly those children
gained coverage through the Medicaid and CHIP program. So we know that these programs
are doing their job picking up when, for example,
families may lose employer-based coverage because of economic
conditions or other reasons. Medicaid and CHIP are there to [ inaudible ] 1.7 million children
gained coverage. Also during a similar time
frame, between 2008 and 2011 the participation rate in
Medicaid and CHIP increased, and the participation rate
is defined as the percentage of eligible children who are
enrolled in the program. In 2008 when Urban Institute
first started looking at these numbers 81.7%
of eligible children were enrolled in the program,
and in 2011 the latest data that we have,
that number has jumped to 87.2%. If you go on to
the InsureKidsNow.gov website, and you’ll be hearing
more about that later, you’ll see a map
of the United States, you can click on your state or
any state that you’re interested in and find the participation
rate for your state. You’ll see that about
20 states now, actually it’s 19 states
and the District of Columbia, have participation
rates of 90% or higher. So we know that
there is still more work to be done in improving
those participation rates. And one thing I always
say to people, I like to point out that
those 90% rates are true for states all over the country,
in every region of the country we have a state,
at least one state that is 90% or higher
in participation. So no matter where you are
there is that incentive and that possibility to improve
participation rates and get more children
enrolled in coverage. But again, we all know
there is more work to do, we have millions
more children and teens who are eligible
but not enrolled. The numbers are improving
but we still see that there are about
4 million children, and of course we’re at
a very important moment in time where we can cover kids
and very shortly will be able to talk about new opportunities for
coverage for the whole family, and we’re very excited
about that, we hope you are too. Just going to the next slide,
I want to again just say one or two words to bring us
all on the same page. When we talk about
the Medicaid and CHIP program, one of the things that
we always want to keep in mind is that these are programs
that have great value for families with eligible kids. About two years ago,
CMS conducted a national survey of families with
children who were eligible for Medicaid and CHIP. About a third of the families
had children who were enrolled in the program,
about a third had children who were eligible but not enrolled,
and the last third had children who were eligible but
did have private coverage. And we asked a whole range
of questions about what parents thought
about Medicaid and CHIP, about the health
coverage they had. And one of the things that
we learned is that more than 90% of parents whose children
were enrolled in Medicaid and CHIP say that
they are satisfied or very satisfied
with their children’s coverage. It had to do with
the kind of care their children were getting,
the range of benefits. They had a lot of good
things to say. And the families that had
experience with the program were the families that had the
highest rankings of the program. One of the things I want
to point out before we go on, and this is going to be
helpful to us as we move forward. In the survey we asked families,
what are the things that motivated you to enroll
your child in the program? And it’s really important for
our conversation going forward to understand that the
availability of dental care, dental benefits in the program,
is a top factor that motivated families to enroll. 68% of parents
chose dental care as a top reason
for enrolling their child. For Spanish-speaking parents,
it was even higher, 81%. So we think this is really
important and was one of the things that fueled
our interest in creating our Think Teeth campaign
which you are going to hear more about as we go forward. Right now I am going to turn it
over my colleague Laurie Norris, also Senior Policy Advisor
in the Center for Medicaid and CHIP Services [ inaudible ] … lots more to share with you. So Laurie, welcome. [ no audio ] >>Laurie Norris
… chart shows you the progress that we’ve been making
over the last decade. We started in 2000
at quite low levels. The green line shows
you treatment services, the red line shows you
preventive dental services, and the blue shows you
any dental services. And as you can see
we’ve been making steady progress over the last decade,
to the point now where about 47% of enrolled
children get some type of dental service
during the year. But we still have
a long way to go. And to support that progress,
CMS has launched an Oral Health Initiative,
where we are asking all the states to increase
the proportion of children who receive preventive
dental services as well as sealant services. And this just shows you
that we’ve asked for a ten percentage point increase in
the preventive dental services. Our national baseline
is a 42% rate, which was set in 2011,
and we’re shooting to get to 52% by 2015
as the national average. Every state also has its
own baseline and goal. You can see here that
there is a wide variation across states in terms of the level
of access or utilization of preventive dental services for
children enrolled in Medicaid. I know this is too small
for you to read on your screens probably, but I’ll just tell you
that Vermont is our top performer over on the left with
almost 60% of children getting preventive dental services,
and Florida is our low performer down on the right with
the whole gamut in between. So we can do only so much
here at CMS to move us toward our goals,
and we rely very heavily on our partners in state Medicaid
and CHIP programs as well as all of you who work in
delivering care and in policy and education,
finance, and other aspects of the system. And we want to engage all of you
by sharing some research results that can help you do your work
better and help all of us understand how to keep moving
in the right direction. Just to let you know
we’ll have some time for questions after
these next two presentations, so be sure to
type your questions into the question
box on your screen. First we’ll hear from
Dr. Mary Alice Lee about continued increases in dental
care utilization by children in Connecticut. Dr. Lee is a Senior Policy
Fellow with Connecticut Voices for Children,
a nonprofit organization that conducts research and public
policy analysis to promote the well being of Connecticut’s
children, youth and family. Dr. Lee is joining us today
from Connecticut. Welcome Dr. Lee.>>Dr. Mary Alice Lee
Thank you very much Laurie. I’m really pleased to be here
today to be able to tell you a little bit about our ongoing
performance monitoring in Connecticut’s HUSKY Program,
and to report on the results of our latest evaluation
of the impact of some major program changes in 2008. First, I’d just like to tell
all of the listeners that Connecticut’s Medicaid and CHIP
programs cover dental services for children and for the adults
in the program including parents and pregnant women. Families are covered
up to 185% of poverty and pregnant women
up to 250% of poverty. Connecticut also funds
independent performance monitoring in the HUSKY Program
and it’s done so since 1995. The work that we do here at
Connecticut Voices supplements, complements and enhances
the Medicaid agency’s program oversight. So what I’m reporting on today
is our assessment of the impact of major program changes. There were many steps taken
to improve access to dental care in our program including
the carve out of dental services from managed care,
risk based managed care. Great enhancements to client
and provider assistance that are provided telephonically
and also with outreach. And then last but not least,
significant increases in the reimbursement
for child services. Next slide please. So I’m showing here in this
slide some of the services and what was paid under the Medicaid
fee schedule before the program enhancements and after
the program enhancements. And what you can see is that
overall the increase in the reimbursement
for children’s services was quite significant,
100 to over 200% of what it had been. Because the adult fees
are pegged to the child fees as a percentage of
the child’s reimbursement, the adult fees also increased
although not quite as much. And I just want to take this
moment to remind everyone that experience in other states shows
that the fee increases are necessary but
not sufficient to increase provider participation
and access to care. So we believe here that
the program enhancements were very significant in terms
of turning the program around. Next slide please. What you’ll see in this graph
is the results of our monitoring every year in recent years. We saw a steady but largely
unremarkable increase in receipt of preventive care
and treatment over the years when the program was
a risk based [ inaudible ]. Using the enrollment data and
the claims data for the program, what we were able to show
in the post-2008 period was that there was
a statistically significant and meaningful increase
in preventive care of 20 percentage points,
a statistically significant and meaningful increase in the
percentage of children who got treatment as well,
and we think this is very good evidence that the program
enhancements have done what they were intended to do. Next slide please. We also looked for other
evidence that the program had improved access to care. So for example we looked
to see what the percentage was of children who were
age 1 and age 2, the very youngest children,
who got preventive care. And what we see are very
dramatic increases in the utilization of preventive care
for those very young children. We looked to see what percentage
of the children 3-19 received two or more preventive care
visits in a one year period. Our EPSDT schedule calls
for preventive care visits every six months. [ no audio ] … and had at least one sealant
placed during a visit that took place in …
[ inaudible ] … the calendar years
we were studying. Next slide please. We reasoned that the program
enhancements and the fee increases would also
affect access to care and utilization by parents and
pregnant women in the program,
so we examined their utilization rates under managed care through
2008 and then subsequently once the program was enhanced
and the fees were increased. And what we saw for the parents
was an increase in preventive care most recently,
in the most recent year we looked at,
although the increase was not dramatic after 2008. But we did see quite a dramatic
increase in the treatment rate, 9 percentage points or about
a third higher than it had been under risk-based managed care. And just a reminder again
the fees for care of adults increased by 75 to 200%
depending on the type of service because they were tagged to
the child fees that increased. Next slide. We’ve also been
tracking other factors that are associated
with utilization. The CMS 416 report shows us how
utilization is affected by age, but we have data on the children
and adults in the program that show us what the
[ inaudible ] factors that might affect
access to care. And what we’ve seen
over the years and reported is that there are racial
and ethnic differences in utilization rates,
and they’ve been very consistent in the years before
the program change and throughout the three years
since then, four years since then. Note that the scale here
on this graph has been expanded so you can see the pattern. We’ve seen a relationship in the
differences in the utilization among parents,
and in both children and among their parents,
Hispanic children and parents are most likely
to have gotten preventive care
during the past year. We are watching how
the rates change in relationship to each other. For example, you can see that
in 2011 it appears that the difference between White
and African American children narrowed a bit. And we are also seeking
additional funding for some additional analyses that
we think will shed light on what the underlying factors
are that contribute to this higher utilization among
Hispanic children and what we can do to narrow
the gap here. I thank you for this opportunity
to report on our work, and I look forward to hearing
Dr. Chi’s presentation.>>Laurie Norris
Thank you very much Dr. Lee. Next we’ll hear from
Dr. Donald Chi about recent findings on
the relationship between medical well baby visits
and the first dental checkups for young children in Medicaid. Dr. Chi is an Assistant
Professor of Oral Health Sciences at the University of
Washington School of Dentistry. He is dual board certified
in pediatric dentistry and dental public health,
and he has an extensive research and publication portfolio. Dr. Chi teaches public health
to pre and post-doctoral students and devotes his
clinical practice to treating Alaska Native children
in remote areas of the state. And in fact,
he is joining us today from one of those
small rural villages in Alaska, Chevak on the
Yukon-Kuskokwim (Y-K) Delta. Welcome Dr. Chi.>>Dr. Donald Chi
Thank you very much Laurie, and thank you Dr. Lee. Welcome from the great
state of Alaska. I’m here in Chevak, Alaska,
so you’ll have to excuse me if there are noises
in the background. I’m actually camped out
in the middle of the library, so every now and then there is a
herd of kids that comes through. Thank you very much. I am here to present today
on some exciting findings that were published in
the February 2013 edition of the American Journal
of Public Health, and we’re really excited
to present our findings. So we’re on the slide where
we’re going to present our research hypotheses. So we know that the American
Academy of Pediatric Dentistry recommends that all children
have their first dental visit by age twelve months. We know that children do have
multiple medical well baby visits by age twelve months,
but that relatively few children have their first dental visit
by age one. Previous studies
have shown strong links between medical
and dental care use. However, there were no studies
before we conducted our study that examined the relationship
between medical well baby visits and the timing of the first
dental visit for young children. Now we do also know that
by age 36 months there are a total of ten well baby visits recommended
by the American Academy of Pediatrics,
and conceptually well baby visits really are a conduit
by which earlier first dental visits can take place
for infants, especially vulnerable
infants in Medicaid. So with this study,
which was conducted with the help of funding from
the National Institute of Health and National Institute
of Dental and Craniofacial Research (NIDCR),
we tested two hypotheses. One, that the frequency
of medical well baby visits would be associated with
earlier first dental visits. And that earlier first medical
well baby visits would also be associated with earlier
first dental visits. Next slide please. We focused on children in Iowa
for forty-one continuous months, and our main outcome variable
was the age at which the child’s first dental visit took place. We had two main
predictor variables. The first predictor variable
was well baby visit frequency, which was broken up into three
age periods: Birth to 12 months, 12 months to 24 months,
and 24 months to 41 months. And we can see here on the slide
that there are a total of ten well baby visits that a child
could potentially have. And our second predictor
variable was the age at which the first
well baby visit took place. Next slide please. We can see here based
on our study population that, consistent with the literature,
most kids in Medicaid, most infants in Medicaid,
are getting most of their well baby visits. We can see here on the first bar
graph to the very left of the slide that between the
ages of birth and twelve months that very, very few children
were getting zero medical well baby visits. So we know that during
this early stage in the life course,
most kids are getting multiple medical well baby visits. And these trends also
continue on through ages one,
two, and three. Next slide please. In terms of our
regression model results, we see here our main findings
that the number of well baby visits that took place before
age twelve months was not related to earlier
first dental visits. However, a larger number,
a greater number of well baby visits that took place between
ages twelve months and thirty-six months as well as
the number of well baby visits that took place between ages
thirty-six months to forty-one months was significantly related
to earlier first dental visits. The age at first
well baby visit was not significantly associated with
the time of first dental visit. So essentially this slide tells us,
what the study told us was the number of well baby
visits that took place after age one through
age three were significantly, the number was significantly
associated with earlier first visits,
whereas the number of well baby visits before age
twelve months was not related to the timing of
the first dental visit. Next slide please. So we see here that
in terms of clinical, policy and public health
implications of the study is that there is a need
for emphasis on earlier first dental visits
that can take place in terms of emphasizing
early life well baby visits. In other words, there is a need
for emphasizing earlier first dental visits during
these early well baby visits. And this is really a great
opportunity I think for medical and dental
collaboration to take place to ensure that
there is consistent oral health messaging aimed
and directed at parents. Now one of the limitations
is that we were using data from 2000 from this study,
but stay tuned. We are actually looking at data
from subsequent years to see how this relationship
between medical well baby visits and first dental visits,
how this relationship plays out in subsequent years. And if you’re interested,
on the slide before this there is a citation for our American
Journal of Public Health paper. And my email address
is on slide number one if you have any questions,
any follow up questions. Thank you very much.>>Laurie Norris
Thank you Dr. Chi. So we do have a few minutes
now for questions, and we do have some questions
that have been posted. So I’ll go ahead and ask those. But keep those questions coming. So the first question
is for you Dr. Lee. Can you explain to what
extent the increases in the reimbursement rates for
dental services in Connecticut are supported by state general
funds or from some other source?>>Dr. Mary Lee
Through an appropriation at the time of the settlement
in the general funds of the state of Connecticut,
and that level – so the funds are now part of
the Medicaid overall budget.>>Laurie Norris
So was that a yes, that they do come now
from the general fund?>>Dr. Mary Lee
Yes, they are from state funds and part of
the overall Medicaid budget.>>Laurie Norris
And I’m assuming that as with any other Medicaid
expenditure you’re receiving the usual federal match
for those expenditures?>>Dr. Mary Lee
That’s what I understand. I’m not part of the Medicaid agency,
but as I understand it the agency is submitting
all of these expenses for the federal match,
which in Connecticut is 50%.>>Laurie Norris
Thank you. The next question is for Dr. Chi. Dr. Chi, can you explain from
your results slide the largest numbers appeared in
the twelve month to thirty-six month age range. Can you explain why
your conclusion was that it is important to emphasize
dental visits during the zero to twelve month age range even
though the largest results you seemed to have was
in the twelve month to thirty-six month age range? Dr. Chi?>>Dr. Donald Chi
From the results slide, that yes, that the hazard ratio
is updated from the number of well baby visits
from twelve to thirty-six months is the highest. And our interpretation of these
findings is that that is a time when parents are starting
to recognize potential problems with the teeth. This is also a time when
physicians as well as medical providers may be noticing
problems with the teeth in terms of early childhood
caries or infection. So the reason why we really are
endorsing the need to ensure earlier dental visits
through these early well baby visits is that,
consistent with the guidelines, you know, we had hypothesized to
see a significant relationship between well baby frequency
between ages birth and twelve months and
the time of first dental visits. So really what these results
show us is that there is really a need to focus on oral health
messaging during these early well baby visits to ensure that
kids in fact are getting to the dentist by age twelve months
consistent with the American Academy of Pediatric
Dentistry guidelines.>>Laurie Norris
Thank you Dr. Chi. Next question for Dr. Lee. How does HUSKY inform parents,
especially those with infants, about the availability
of dental services?>>Dr. Mary Lee
I’m sorry, there was
a glitch here, could you just
repeat the question?>>Laurie Norris
How does HUSKY inform parents, especially those with infants,
about the availability of dental services?>>Dr. Mary Lee
Well, as I understand it the Medicaid agency’s
administrative services manager, it’s BeneCare that manages the
services under the Connecticut Dental Health Partnership,
conducts outreach to all new enrollees and of course that
would include infants coming into the program
and very young children. And then they reach out
to families when their analyses of claims data shows
a child is in need of services. So it is individualized,
it is targeted outreach, and then in addition to that
there are materials that go out to families on a regular basis.>>Laurie Norris
Thank you. Another question for Dr. Chi. Were you able to mine
the Iowa data to understand whether infants who got well
baby care in clinics with co-located
dental services were more likely
to get dental care? Were you able to break your data
apart in that way at all?>>Dr. Donald Chi
That’s a really great question. The analyses that
I’ve presented to date, no. These are actually
dental visits that took place in office based dental clinics. So yeah, this only includes
children who would have accessed dental care
from a dental office. So we did not look at that,
but that’s a really great, great question.>>Laurie Norris
And Dr. Chi, just following up on that. Are you aware of any particular
messages that are effective to reach pregnant moms in terms
of getting them primed to take their children to the dentist,
their babies to the dentist, at an early age?>>Dr. Donald Chi
Absolutely. We’re actually conducting some
studies here at the University of Washington through
a program called Baby Smiles, which is a program aimed at
motivating pregnant women in Medicaid in Oregon
to take their kids to the dentist earlier,
consistent with guidelines. And that approach actually
is based on a motivational interviewing approach
where our health workers in the community work with
mothers to motivate them, educate and motivate mothers,
to take their children earlier. In fact, in our study,
you’ll see this if you look through the results
section of the paper, we found that mothers
who had a prenatal dental care visit had kids
who had earlier, significantly earlier
first dental visits. So really there is
a relationship between oral health messaging I think
to pregnant mothers, not just after
the child is born but really during the prenatal period. If we can ensure that mothers
have adequate access or good access to dental care while
they’re pregnant, before they give birth,
that that leads to better utilization outcomes
for their children.>>Laurie Norris
Thank you so much. That’s a terrific segue to the
next part of our presentation, so keep typing your questions
in if you have any more. We will ask our presenters
to get back to you individually to answer any of
the questions we weren’t able
to get to online today. So we’re very, very excited
to have this opportunity to share with you new resources
from CMS to support you in your work to get the word out
about the need for oral health and dental services
for young children. What you’re looking at now
is a resource guide that we just released last week,
we are now seeing it publically for the first time today. Keep Kids Smiling:
Promoting Oral Health Through the Medicaid Benefit
for Children & Adolescents. We hope that this guide will
help states and other oral health stakeholders improve access
to dental services for children enrolled in Medicaid and CHIP. It’s available at the link
on this slide. It’s most useful online
because there is a lot of terrific live links
to other resources. We’re trying to highlight
particular strategies that have worked in other states
across a range of topics including policies in state
Medicaid programs, maximizing provider
participation in Medicaid programs, how to directly
address children and families themselves to apprise them of
the availability of dental care and get them into the office
as well as partnering with other oral health stakeholders
in improving state programs. Next slide please. Another set of materials
that we are releasing officially today are our oral health
education materials. And speaking of educating
pregnant women about the need for dental care both for themselves
and their young children, these two materials
are targeted directly to them. They are formatted as
a tear pad meant sort of like a prescription pad for use
primarily by OBGYNs or family physicians,
people providing primary care to pregnant women. You see here only the graphic,
there is also educational information on them which
focuses on emphasizing the importance and safety
of dental care during pregnancy and the connection between oral
health and overall health both for the pregnant woman
as well as for her baby. These materials are available
at the link shown on the screen. We are also releasing
this piece which is both a poster or a flyer. So it comes in a large format
and a smaller format, it comes in both English
and Spanish. Think Teeth Every
Step of the Way. This one is targeted
to parents and caregivers of very young children,
children under the age of three. And the contents,
which I’m sure you can’t really read on your screen,
emphasizes the importance of the age one dental visit
we’ve been talking about as well as the fact
that caries is a transmissible
and preventable disease. We are really trying to get
the message across to parents that their babies can catch
caries from other members of the family and we give
prevention tips for how to prevent that from happening. All of these materials
are available as I’ve said in both English and Spanish. They can be downloaded
at the link on the screen. Limited copies are also
available for bulk order at no cost at the same link. We also have generated
a tremendous variety of materials for you to help us
promote the availability of these materials
and the idea behind this campaign to pregnant women,
to parents of young children, as well as to the organizations
that serve those populations through our
Think Teeth campaign. We have Facebook posts,
we have tweets, we have newsletter
and blog articles, we have this beautiful
web button for you to post on your website to link through
to the materials as well as a set of
distribution tips. All of these materials are
available to you at the link. And lastly, I just wanted to put
in a quick word for Text4baby which is another way
for pregnant women and new mothers to learn about
[ inaudible ] sponsored by the National Healthy Mothers
and Healthy Babies Coalition. It sends texts
to moms’ phones that are developmentally appropriate,
including oral health messages. On your screen you’ll see
a couple of the types of messages that they send
related to oral health. And you can sign up if you’d
like to pretend to be a pregnant mom and see what comes across the
wire by texting BABY to 511411. Next slide please. So I just wanted to take
a moment now to segue to our next speaker,
Dr. Diana Cheng, who is Director of Women’s
Health at the Maryland Department of Health
and Mental Hygiene and Vice-chair of the American
College of Obstetricians and Gynecologists
Committee on Health Care for Underserved Women. She will share a few words
with us now from the point of view of OBGYNs,
those who are perhaps in the best position
to educate pregnant women about oral health. Dr. Cheng.>>Dr. Diana Cheng
Thank you. We’ll go to the next slide. And I’m very pleased to be here
and to present this committee opinion that ACOG just released
last month on oral healthcare during pregnancy
and through the lifespan. I really think this committee
opinion reflects ACOG’s commitment towards
promoting oral health during pregnancy and in general
through a woman’s life. First I’d like to really
acknowledge that the reviews that were done
for this committee opinion by the American Dental Association,
Maternal and Child Health Bureau, the National Maternal and Child
Oral Health Resource Center at Georgetown University
for making this possible. And I also wanted to point out
that this committee opinion is available at www.acog.org,
and you’ll see on the left side if you click onto that website
a listing of committee opinions, and look over this committee
opinion on oral health care. Next slide please. What I tried to do is really
condense four major points that I thought ACOG wanted
to get across on this committee opinion. And I think first and foremost
is misconceptions and questions that a lot of OBGYNs,
oral health providers, and our patients
have about getting dental work during pregnancy. And we’ve really done extensive
research in the literature and have found that
there have been no adverse effects to getting teeth cleanings,
dental x-rays, local anesthesia,
really all very, very safe during pregnancy. We really want to assure women
of that fact and assure OBGYNs that that they can actually talk
to women and have them see a dentist during pregnancy
and get their routine teeth cleaning,
and we also wanted to reassure dental providers that
they really shouldn’t delay any dental work that is necessary
during pregnancy, that doing so, if you do delay needed dental
work that it could be risky and we really think that
continuing normal checkups is really the way to go and really
want to advocate for that. The second point is the more
kind of realistic point, and that is that a lot of women
have Medicaid coverage during pregnancy for their health care,
prenatal care, and delivery, and in many states Medicaid
will cover oral health care during their pregnancy and
sometimes postpartum as well. I know in Maryland
we have Medicaid coverage of one third of our women
who deliver, and it does cover oral
health care during pregnancy. So it is important to really
check that out because it is a unique time that
a lot of women who aren’t eligible or can’t afford
dental care normally can actually use this time
to get it during pregnancy. The third point I thought
was the most interesting point I think, was very surprising
to a lot of practitioners, is the point that
I think was referenced before that you can actually
by taking care of your teeth during pregnancy,
before pregnancy, and afterwards, decrease,
the mother can decrease the amount of cavity-causing
bacteria in her mouth so that after the baby is born
when you have a lot of saliva sharing activity
such as tasting food, sharing your spoon,
things like that, you can actually decrease
the amount of bacteria that can go to
the child or baby and actually decrease
their risk of having cavities. So really, I think a huge factor
in getting a mother health care, oral health care,
during pregnancy, before and afterwards as well. And then the fourth point
I think in this committee opinion is just that
oral health is really part of medical health,
and it’s important, and really we do not want it
neglected during pregnancy. I think that’s, you know,
even outside of pregnancy we can see a lot of medical
disorders are linked to poor oral health
and are associated with it, so we really want
to emphasize that throughout a woman’s
life course. And I think in summary
I really to say the importance of this collaborative effort
with Maternal Child Health and with the Oral Health Offices
in promoting this message. I know in Maryland we’ve done a
lot of our activities together, and I think it’s made this
messaging much much stronger to have two offices combine and
really work on this message as one in promoting
oral health during pregnancy and outside of that. And that is basically
my summary points. I thank you very much
and I thought this is a great webinar to have
with such great information.>>Laurie Norris
Thank you so much Dr. Cheng. I’m going to turn the mic back
now to Donna Cohen-Ross to help us with our next steps. Donna?>>Donna Cohen-Ross
Great, thank you Laurie and thank you so much Dr. Cheng. We’re going to have a question
and answer period at the end of the webinar in
just a few minutes, and so anyone who might have
questions for Dr. Cheng please start sending them
through the chat box. I’m sure that there will be
folks that will want to talk to you about some of
the great tips that you shared. And I just want to say that
when you do have a chance to look at the materials
that Laurie talked about, you’ll see that
the messaging on those tear pads for pregnant
women reflect the advice and the tips
that Dr. Cheng talked about. So we’re happy to be
in sync with the best evidence and the best research. I also want to say
before moving on that Laurie, when she described
all of the materials, she gave you the link on
the InsureKidsNow.gov website, which is the right link. But I want to also share
with you a quicker way to get to all
of that information. When you go onto
InsureKidsNow.gov on the home page,
you will see a Spotlight box in the upper right hand corner,
and the first link in that Spotlight box will just
take you to those new oral health materials
with just one click. And we’re going to leave that
shortcut up there as long as we can so that folks
can get to the oral health materials just very quickly. We know that you are going
to be eager to take a close up look at them and start thinking
about how you might use them. And so we wanted to talk
a little bit right now about what that might be. Everyone, we have such a wide
range of participants on today’s webinar,
but everyone has an important role to play in helping
to spread the word about free and low cost health insurance
through Medicaid and CHIP, for pregnant women,
for children, for teens. We want to let people know
about the availability of health coverage
and how to apply. The materials on Insure Kids Now
have a lot of information about the program and
how to apply and have links to the application
process in each state. Also obviously the thing that
has drawn us all together today is an interest in letting
everyone know about the importance of good oral
health habits for pregnant women and also children
up to the age of three. And you might ask why would
we stop at age three? Well we wouldn’t,
but that was the first bite that we took so to speak,
and as we go forward in our campaign we are going
to be developing materials for older children as well. So we are not done yet. If we go to the next slide,
I just want to give you a little bit of a view into another tool that we have on our website, which is a document that
provides some tips on how to best use the materials
that we’ve now posted and released to the public. We have tips for providers. We suggest displaying
the materials in clinics and in offices,
physicians offices. But also to send information
home with patients, and again that tear pad
is a great way to do that in a form that it’s easy
to just put in your bag and take home and look at later. The posters and flyers
also have important uses in public settings but also
the flyers for taking home for later reference. We want to work with local
OBGYNs and hospital networks to distribute the materials
in information packets that may go out. We think there is a tremendous
opportunity to share these messages through
visiting nurse services and other home
visiting programs. We think that this
really has a tremendous, there is a tremendous opportunity here not just to give person to person information to pregnant women and new moms,
but also to talk about enrolling in health
coverage as well. That is an activity
that sometimes takes a side by side conversation. We think that it is also
important to encourage childbirth or parenting classes
to share the materials in group settings as well,
so these are opportunities to do that. If we go to the next slide,
we know that health care providers are just one avenue
for getting this information to people who need it,
but also community organizations and state and local
government agencies can use the materials as well. We have as Laurie pointed out
materials that you can share on your own website,
your Facebook page. Lots of information
to blog about and, hold that thought,
we’re going to talk about that in just a second. We have provided drop-in
articles for your newsletters. Again, materials that can be
displayed in waiting areas, distributed at community events. Again we want to share with
professional networks, and also in local communities
create joint planning opportunities so that,
making sure that all of the people who care about
good oral health and good health in general for pregnant women
and young children are talking about these messages and how to get
them out to patients and to families that they serve. Again, encouraging pregnant
women and parents of young children who might be eligible
for Medicaid and CHIP to take a look at those benefits and
consider applying for those programs so that children can
get the benefits that they need. Here are some
additional helpful links. We’ve already talked
about InsureKidsNow.gov. For the Keep Kids
Smiling booklet that Laurie talked about,
that lives on Medicaid.gov but we’ll also be posting a link
to it from InsurekidsNow.gov so that you have one place
to go for everything. When you look at
InsureKidsNow.gov I hope you’ll click
on that shortcut link I just told you about to get
to the dental health materials, but I hope you’ll look
at our other educational materials as well,
our television PSA that talks about getting kids
enrolled in coverage is one that is topping
the charts of the Nielsen ratings lately in terms of,
it is being aired far and wide around the country. We have an electronic
newsletter. You can subscribe to updates
on what we’re doing with our Connecting Kids
to Coverage Campaign, and we also have a phone number
and an email address that we hope you will all use
to find out more about outreach materials and activities and
to talk to experts on activities that you may be planning and may
want a little bit of feedback or other good ideas,
connections to other things that may be going on. We are going to start
immediately with getting the word out about these
materials and these messages, and I want to take a moment
to thank the folks at the Children’s
Dental Health Project. They gave us a call several
weeks ago when we first announced this webinar and
offered to host a social media blitz that starts today,
it starts as soon as we hang up the phone today. It will be an opportunity
to post or send messages on Twitter or Facebook. To participate,
you’ll want to send an email to Matt Jacob at CDHP,
his email is right there, it’s [email protected] He has already gotten a whole
range of organizations involved and ready to tweet and blog and
post about these messages and materials,
and we’ve also found Matt within our range of about
500 participants in this webinar so in just a moment we’re going
to take the last few minutes of this webinar for questions
and answers and we have Matt available to answer
any questions you may have about the social media blitz. But we do really thank
the Children’s Dental Health Project for jumping
on this opportunity. As Laurie said earlier,
we certainly can’t do this alone,
we really rely on the great ideas, the good work,
the energy of all of you to be part of this campaign
in a very large but also very individual way,
so we really, we’re looking forward to what will come
of our media blitz. And if I’m not mistaken,
Matt is going to be able to tell us what the results
were in terms of participation. And I hope I have not misspoken
there because we certainly do want to know what will happen
as a result of all of our participants really
rolling up their sleeves, and I guess getting
their thumbs out to tweet and blog about this
important message. I think we have
just a few minutes left. I want to open things up
for any additional questions about materials,
questions for Dr. Cheng on the ACOG statement,
and also questions for Matt if you have questions
about how to proceed with the social media blitz. So Laurie, I don’t know
if you are in a position to read out questions that
are coming through the chat.>>Laurie Norris
Yes, we have questions, boy do we have questions.>>Donna Cohen-Ross
Okay. [ laughs ]>>Laurie Norris
So, a question for Dr. Cheng. Is xylitol and chlorhexidine
gluconate safe for pregnant women?>>Donna Cohen-Ross
I think we first need a translation.>>Dr. Diana Cheng
So, we looked at both chlorhexidine rinses
and the xylitol, and both of them
we haven’t found any adverse reactions at all
to those elements. So I think they’re fine to use.>>Laurie Norris
And also for you Dr. Cheng, is it still sort of evidence
based that the second trimester of pregnancy is the safest
time for dental care, or is that not the case?>>Dr. Diana Cheng
Well, generally in OBGYN we always say that the second
trimester is the best time to do any kind of procedures,
mainly because the first trimester,
especially for dental care, women have a lot of morning
sickness and they don’t feel as, it’s hard sometimes
for them to get dental work during that time. Also the first trimester,
if there is going to be any kind of harmful effect causing birth
defects in it’s going to happen very very early in pregnancy
during the first trimester. So as a general precaution,
some people do delay things into the second trimester. And then into the third
trimester you kind of run the risk of just early labor,
things like that, but you know,
we actually do feel that dental care is safe
during the entire pregnancy, and we really,
I don’t want to say that one trimester is better
or safer than the other, I really think
there is no problem as long as the woman feels
up to it to get dental work, routine dental cleanings,
during any trimester.>>Laurie Norris
So thank you Dr. Cheng. We’ve run out of time. I do want to quickly address
one other question that came in about materials. How many printed materials
may be ordered. We do have a limited supply,
so it is not unlimited. I actually don’t know
if the ordering box has been set up to self limit,
but I suggest that you go on and try it out. I would also request that
if you do order materials that you only order
what you think you can use, and then once you run out
you can always reorder. For those of you
who might be wondering, these flyers will be available
on InsureKidsNow if you want to go back and look at
any of the information. There are still questions
left for Dr. Lee, Dr. Chi and Dr. Cheng,
we will get to all of them and send you the answers. I’ll turn it over
to you Donna to close.>>Donna Cohen-Ross
Laurie, we can go for another couple of minutes
if folks want to, and I’m just wondering
if there are any questions in the queue for Matt,
I don’t want to close if people have questions
about how to participate in the media blitz. So I’m wondering
if you can take a quick look for any questions for Matt,
although it looks like we might not have Matt anymore.>>Laurie Norris
There are no questions for Matt. And no Matt.>>Donna Cohen-Ross
Are there one or two pressing questions
that you’d like to take, or shall we start
tweeting and blogging?>>Laurie Norris
Let’s start tweeting and blogging,
and we will answer the other questions
individually.>>Donna Cohen-Ross
Good. Thank you so much Laurie. I want to take this opportunity
to thank our panelists, each and every one of them. Dr. Lee from Connecticut,
Dr. Chi who is in the library up in Alaska, I think
the children were quiet during your presentation
so we’re grateful for that. But thank you for joining us. And also Dr. Cheng
for joining us to talk about the ACOG opinion,
we really are very grateful to be in sync with what
the best evidence is about making sure that
pregnant women have the oral health care
that they need. I want to thank
all of our participants, you stuck with us
throughout the hour. We had about
500 people with us, and that is really
quite a record for us. I want to also thank
the folks at GMMB, they are part of our Connecting
Kids to Coverage Team. Without them we would never
be able to manage the technology as well as they can,
and so we’re very grateful for that. I want to thank my partner
Laurie Norris for her great work and the work of her team
in helping to develop these materials and making sure
that we get the messages right and we get them
out to you. So I want to end just by saying
we hope that you will all, if you haven’t already
subscribed to our e-newsletter, because that’s how you’ll find
out about additional materials that are available,
future webinars, and all kinds of activities
that we are sponsoring and promoting through
Connecting Kids to Coverage. So with that we are just
three minutes over our time, but we really thank you
for your participation and we are just looking
forward to working with you as we go forward. Thank you everyone and
enjoy the rest of your day.

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