Funding for the project is provided in part by the Oregon Community Foundation,

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A program

of the

Eastern

Oregon

Healthy

Living

Alliance

Funding for the project is provided in part by the Oregon Community Foundation, Eastern Oregon Healthy Living Alliance, PO Box 1230 Lakeview, OR 97630

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Preventative Dental Services in Eastern Oregon Schools

Background

The 2018-2019 school year saw the third year of the Healthy, Happy Smiles (HHS) program in Eastern Oregon schools. The program received funding support from the Oregon Children’s Dental Health Initiative (OCDHI) and was provided in partnership with Advantage Dental from DentaQuest. The program served 30 schools in four counties,

including Baker, Grant, Harney, and Malheur. All four counties are considered frontier counties where 68% of children aged 6-9 have already experienced a cavity, compared to the state average of 52% [1]. Together they cover 27,773 square miles of Eastern Oregon, where there are limited services. For example, Fields Elementary in Harney County is 112 miles from the nearest dental office.

Services

Healthy, Happy Smiles provides free dental screenings, fluoride application, sealants, follow-up care for children with urgent dental care needs, and free toothbrush kits

to every student in grades Kindergarten through 12th regardless of insurance status. Participating schools have at least a 40% Free and Reduced Lunch Rate (FRL), and many of the schools did not previously have a school-based oral health program in place. Schools also had the opportunity to participate in a hands-on dental health learning lab. The lab features age appropriate educational materials on brushing, flossing, fluoride, orthodontics, tooth anatomy, oral safety, tobacco’s effect on the mouth, sugary foods and drinks, and dental careers.

HHS also utilizes Silver Diamine Fluoride, which is Fluoride with silver that looks like water but is very powerful and stops cavities that are hard to see. It is painted on the teeth and can heal early tooth decay. Fillings may not be needed for cavities that are treated with Silver Fluoride.

Goals

In 2016 EOHLA set an organizational goal to reduce the cavity rate of children in participating counties by 3% by the year 2019. According to the 2012 Oregon Health Authority Smile Survey, 72% of children aged 6-9 in the HHS service area had already experience a cavity. Preliminary data from the 2017-2018 Oregon Health Authority Smile Survey shows that that number dropped by 5%, to 68% of children aged 6-9 have had a cavity. Preventative services and early intervention provided through HHS helped contribute to the 5% drop in the children’s cavity rate in this region.

The cavity rate of children aged 6-9 has decreased by 5% in the Healthy, Happy Smiles service area.

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Process measure goals for the program include 60% of eligible children to return parent consent forms; 55% of eligible children to receive a dental screening or assessment, at least 40% of students to receive the fluoride application, and 20% of eligible children to receive dental sealants over the course of the 2018-2019 school year.

Partnership with Advantage Dental from DentaQuest

The continued partnership with Advantage Dental from DentaQuest utilizes an already existing dental delivery service model that assists in connecting the local community of dentists to provide care to the members of the county. Each county is assigned an expanded practice dental hygienist (EPDH) that provides the services to students. EOHLA Program Coordinator, Alanna Chamulak, has been working in coordination with each hygienist to work with schools, schedule service days and provide care to students, and community outreach.

All students that are seen by the EPDH are sent home with a printed report card of the screenings findings and of any services that were provided. If a student is identified to have urgent dental care needs it is indicated on the report card and the Advantage Dental from DentaQuest Case Management team contacts the parents by phone. Case Management encourages the parents to schedule an appointment with the families’ preferred dentist or can assist in scheduling an appointment with an Advantage Dental from DentaQuest provider in their area. Secondary dates are also set with schools so that the EPDH can follow-up with the students that were identified as having urgent dental care needs.

Steering Committee

The steering committee consists of members from core partners in each community. The committee includes, Advantage Dental from DentaQuest Manager, Community Care Mary Ann Wren, Carolyn Bauer with Burns Dental Group, Lake Health District CHIP Coordinator Arvinder Singh, Baker School District 5J Special Education Director Barry Nemec, Frontier Early Leaning Hub Coordinator Patti Wright with Grant and Harney Counties, Malheur ESD Director of Community Based Services Kelly Poe, and EOHLA Executive Director John Adams facilitates the meetings. Together, this diverse group provides the expertise needed to guide a successful program.

Impact

Overall, 51% of students returned parent consent forms; 40% of students received dental screenings; at least 36% of students received fluoride application or silver diamine fluoride application; and 724 students received 2162 individual dental sealants. 36% of students received oral health education through the learning lab; 100% of students received free toothbrush kits; and 56 students were referred to their provider for urgent dental care needs.

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Baker County:

While the Baker County program continues to be a strong program, schools saw a drop in the parent consent form return rate by 5%, in comparison to the last school year, which impacted the other services provided. Percentage of students screened dropped from 53% to 48%; the percentage of students that received a fluoride application dropped from 85% to 56%; and the percentage of students that received sealants dropped from 23% to 17%.

Baker County Schools

School # of students Consent Form Return Rate # Students Screened # Students Fluoride Applied # Students Silver Diamine Fluoride # Students Sealants Applied Learning Lab

Baker Middle School 275 57% 103 77 39 50 No

South Baker Intermediate 360 79% 186 128 63 54 No

Brooklyn Elementary School 504 63% 267 227 104 92 No

Haines Elementary School 170 46% 63 62 24 24 No

Keating Elementary School 34 76% 24 23 11 7 No

Total 1343 64% 643 517 241 227

Grant County:

Grant County schools saw a significant increase student participation over the prior year, with an overall consent form return rate of 67% compared to last year’s 48%. The higher student participation rate can be attributed to schools growing more familiar with the program and a strong relationship with the Advantage Dental from DentaQuest’s Expanded Practice Dental Hygienist.

Baker County – 5 schools

 64% consent form return rate  48% students screened  56% fluoride application  17% sealant application

Grant County – 4 schools

Harney County – 11 schools

Malheur County – 10 schools

 26% consent form return rate  22% students screened  21% fluoride application  8% sealant application

Grant County Schools

School # of students Consent Form Return Rate # Students Screened # Students Fluoride Applied # Students Silver Diamine Fluoride # Students Sealants Applied Learning Lab

Prairie City School 124 71% 132 7 43 33 Yes

Seneca Elementary School 25 100% 20 9 9 7 No

Humbolt School 311 80% 203 56 110 73 No

Grant Jr./Sr. High School 250 46% 62 10 40 33 No

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Harney County:

Harney County schools continue to have the highest student participation in the program, although they did see a drop in student participation this year. 71% of students returned parent consent forms compared to last year’s 86%. *All Rural Schools includes Diamond, Double O, Drewsey, Frenchglen, Pine Creek, Fields, and Suntex

Harney County Schools

School # of Students Consent Form Return Rate # Students Screened # Students Fluoride Applied # Students Silver Diamine Fluoride # Students Sealants Applied Learning Lab

Burns High School 231 56% 60 4 20 4 No

Diamond Elementary

Double O Elementary 4 100% 3 No

Drewsey Elementary 9 100% 7 No

Frenchglen Elementary

Hines Middle School 201 73% 116 14 49 51 Yes

Henry L Slater Elementary 424 93% 335 77 157 119 No

Pine Creek Elementary 8 100% 9 No

Fields Elementary 12

Suntex Elementary 12 No

Crane Elementary 146 35% 58 41 18 20 No

*All Rural Schools 31 7 15 10 Yes

Total 1048 71% 583 108 259 204

Malheur County:

While we saw some improvement with individual schools in Malheur County, the overall program within the county had the lowest student participation rates in the HHS program, seeing a drop in the consent form return rate by 7%. The Nyssa schools, in particular, continue to have low participation.

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Statewide Impact

The Oregon Community Foundation, in partnership with numerous funders throughout the state, launched a 5-year initiative called the Oregon Children’s Dental Health Initiative in 2014. This initiative recently published a report titled Learning What Works for School-Based Dental Health Programs. HHS was a featured case study within that report which can be found at oregoncf.org/childrensdentalhealth [2].

Challenges

For the second year in a row Malheur County is the lowest performing county within Healthy, Happy Smiles. Scheduling conflicts and staffing changes are two contributing factors to the low numbers. Developing a year-to-year relationship with administrative staff is a key strategy in the success of the program and staffing changes can make this difficult because new relationships need to be built. Consent form return rates for middle and high schools continue to be a challenge because often times consent forms don’t make it home to parents. For the 2018-2019 school year, there were also

scheduling issues with a number of the schools regarding the learning lab which resulted in only 35% of students participating in the learning lab.

Successes

Overall, the program saw a small decline in consent form return rate but fluoride and sealant application numbers held steady. Dental screenings remained at 40%, fluoride application remained at 35% and dental sealant application remained at 14%.

Malheur County Schools

School # of students Consent Form Return Rate # Students Screened # Students Fluoride Applied # Students Silver Diamine Fluoride # Students Sealants Applied Learning Lab

Harper Charter School 110 43% 33 8 9 No

Jordan Valley Elementary 17 53% 5 7 71 2 No

Jordan Valley High 38 11% 1 1 0 No

Rockville Elementary 5 100% 5 8 2 No

Ontario Middle 350 35% 78 34 42 33 No

Vale Elementary 460 45% 155 103 71 56 Yes

Vale Middle 110 65% 42 44 17 24 Yes

Willowcreek Elementary 100 70% 29 15 9 12 No

Nyssa Elementary 500 6% 25 12 12 10 Yes

Nyssa Middle 256 23% 46 20 12 Yes

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Harney County, the highest performing county, saw success due to a few key factors. Harney Education Service District and Carolyn Bauer with Burns Dental Group have been key partners contributing to the success of the program. Harney ESD helped to fully integrate the program into existing vision and hearing screenings. This allowed for continued trust in the program as well as limiting the amount of time required for students to miss class. Carolyn and Burns Dental Group volunteered to help collect parent consent forms with multiple schools in Harney County and helped with outreach and education with the dental learning lab. Additionally, the EPDH continues to build upon existing relationships with school staff and administrators.

Grant County saw the largest improvement over last year’s numbers. The improvement in Grant County is attributed to schools becoming more familiar with the programs process.

Moving Forward

Moving forward, we will continue to strengthen our relationships with schools and communities so that we can bring services to as many students across Eastern Oregon as possible. EOHLA has been awarded a $60,000 grant by the Oregon Children’s Dental Health Initiative to provide the program in the 2019-2020 school year. The Malheur County Community Advisory Council will also contribute to support the purchase and dissemination of tooth brush kits, incentives, and outreach efforts in the county through the Healthy, Happy Smiles program.

EOHLA is dedicated to continuing to contribute to the reduction in the cavity rate which in turn reduces student pain level, decreases missed school hours and increases quality of life. We hope to see rising participation numbers and to see the cavity rate continue to drop across Eastern Oregon.

32% _31% 20% 13% 54% 40% 35% 14% 51% 40% 35% 14% 0% 10% 20% 30% 40% 50% 60%

Consent Form Return Rate Dental Screening Fluoride Application Sealant Application

Overall Impact Comparison

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References

1.

Oregon Health Authority (OHA). Oregon Smile Survey. 2012.

https://public.health.oregon.gov/PreventionWellness/oralhealth/Documents/SmileSurvey2012. pdf

2.

Oregon Community Foundation (OCF). Learning What Works for School-Based Dental Health Programs. 2019.