‘Points of Light’

1. ‘Points of Light’ Presented to the Michigan Oral Health Coalition January 30, 2008

2. Enduring Goals of the Organized Dental Community: • Improve the Oral Health of the Citizenry. • Improve Access to Oral Health Care. • Improve the effectiveness of Oral Health Care delivery systems. • Improve the Oral Health of Children, (MAPD).

3. Defining the Issue: Michigan • ~ 130,000 live births/year • Nationally, 15 to 17 million children without access to oral health care (increasing). • ~900K of Michigan’s 2.5 million kids are Medicaid eligible, (increasing). • Decay rates are on the rise in pre-school children (4% in last 10 years; CDC, 07) • 58% of Michigan 3rd Graders have caries.

4. Dentistry in Michigan: By the Numbers • 82 pediatric dentists of which an estimated 84% (~70) see 1 year olds. • 4630 general dentists, (MDA, 08) • Evidence suggests that Pediatric Dentist migrate to upper income communities. • There will never be enough Pediatric Dentists and most general dentists are not comfortable treating very young children.

5. Good doctors treat disease.Great doctors prevent disease.

6. Justifying IOH: General Overview • Demographics of the Professional Communities, (Medical and Dental). • Cariology that defines: Primary Prevention vs. Secondary Prevention that create timing dependant opportunities. • Economic Implications that define the impact on dental practices and lower the cost of managing low SES populations. • Culminating in a new ‘Best Practice’.

7. Addressing the Needs of Michigan’s Infants • Currently: 130,000 live births =>1800 new patients/pediatric dentist/year. • If all Pediatric Dentists accepted infants = ~1500 infants/year. • If all Dentists accepted infants = ~27 infants/year. (If only half see infants = ~ 60 infants/year) • Conclusion: This is possible!

9. Advocacy: • Improving the Oral Health of the entire community. (Not just low SES, because low SES will benefit along with the community) • Enacting the ‘Atlas Concept’: Taking responsibility for all patients within a community regardless of the fact that they will never walk into your practice.

10. Advocacy Goals: • To improve the Health and Oral Health of the Citizenry, (Pan SES). • To Create behavioral transitions in arenas of impact: Dentistry, Medicine, Legislative, General Public. • To have infants presented to a ‘Dental Home’ for primary prevention rather than surgical intervention.

11. The Challenge of providing care to Low SES: • Medicaid covers 25% of children and 33% of infants • Nationally, 27 million children are covered by Medicaid. (Michigan: 1:1.5) • Economic distress is increasing , impacting middle income families. These are NOT ‘Welfare Deadbeats’!

12. Relationships are not about obligation. Relationships are about opportunity. • This tenant pertains to all relationships. • If you not looking at relationships from this perspective, you are really missing the point of relationships altogether. • What opportunities can you create for your patients and your community?

13. Caring for our poorest and most vulnerable: • Consider that children seen early are less costly to care for over time. • Consider that, with very young patients, preventing decay is far easier than restoring teeth. • Consider that children with less complex restorative needs are less likely to require referral to a pediatric dentist.

14. Involvement vs. Commitment: The difference between involvement and commitment is like an eggs & ham breakfast. The chicken was ‘involved’, the pig was ‘committed’!

15. Ongoing Efforts: • Varnish! Michigan • Adopt-a-Head Start program • Early Head Start & Head Start Programs • PA 161 • Community Dental Health Coordinator

20. Ideal Dental Care: ‘Dental Home’ • Ongoing relationship between the dental office and the family. • Care that is Comprehensive • Care that is Accessible • Care that is family-centered • Care that is Culturally-effective • Care that you would want for your child

21. Meta-Questions: • How do we improve the oral health of very young children? • How do we lower the cost of providing oral health care to low SES populations? • How do improve the oral health of the community at large? • How do we best utilize our workforce?

22. What is ‘Points of Light’?

23. Organizational Transition:Changing Behaviors on a large scale # of Adopters Tipping Point Mavens Brokers Pragmatists Conservatives (early adopters) (late adopters)

24. ‘Social Proof’ A behavior that has reached a ‘tipping point’ within a given population group resulting in mass adoption and participation, (Herd Behavior). i.e., stock runs, fads, voting tends, drug use, suicides, movie attendance, etc….

25. Organizations of Interest: • The General Public: Parents & children. • Dentistry: General Dentists, Pediatric Dentists, Dental Hygienists, etc… • Medicine: Pediatricians, Family Practice, Nurse Practitioners, Physician Assistants, etc… • Legislative Bodies: Federal, State & local. • Educational Institutions: Pre & Post Doctoral Programs in Medicine and Dentistry.

26. Organizations of Impact Legislators Dentistry Medicine General Public Education

27. “Points of Light” • Identify a ‘Point Dentist’ within a community. • Establish a dental provider network, ‘EPII’. • Provide the EPII list to Pediatric Medical Providers. • Interact with medical providers, ‘ECTAMR’. • Educate medical providers, AAP policy. • Operationalize ‘Points of Light’ locally. • Operationalize ‘Points of Light’ state wide. • Infant Dental Exams become a ‘Social Proof’.

28. Three Levels of Advocacy: • Bronze Level: Initiating an Infant Oral Health program in your practice. • Silver Level: Instigating ‘Infant Oral Health’ Programs in your community, (EPII). • Gold Level: Developing a multi-community project that impacts the entire state over time, (Points of Light).

29. -Antonio de Saint-Exupéry “Life has taught us that love does not consist in gazing at each other but in looking outward together in the same direction”

30. Question/Comments

31. MOHC, Thank You!!