In-School and On-Site Dental Program

1. In-School and On-SiteDental Program April, 2013 “Enhancing the qualityof life for children.”

2. Did you know? • Dental decay is the most common chronic and infectious disease in children. • 4 out of 5 low-income children do not see a dentist during the course of a year. • Children miss about 52 million hours of school due to oral health problems. • Poor access to dental care remains a barrier to maintaining good oral health. • The U.S. Surgeon General & American Dental Association recommend in-school dental outreach programs as an effective means of reaching low-income children. 2

3. Logistical Support Services • Smile Programs provides logistical support services to locally licensed dentists to enable the dentists to provide dental care in schools. • Smile Programs are contracted by dentists to manage the following logistical services. • Scheduling of schools • Contacting staff to be at the school • Arranging appointments • Arranging transportation of dental equipment and supplies • Supply ordering • Permission slip distribution and collection • Demographic information management • Billing services • Assist doctors with creating referral sites who will accept patients requiring care outside of what can be provided at school • Assist dentists with coordination of dental services to referral location • Assist dentists with coordination record storage, retention and sending out records when needed 3

4. Logistical Support Services • Why do local dentists need them? • Many dentists are interested in providing outreach services • Dentists view the logistics necessary providing school-based services onerous and complex • Smile Programs assist these dentists in providing the care they wish to deliver • There is a very high job satisfaction among these dentists who do outreach services for children in need in schools. 4

5. Logistical Support Services • Smile Programs helps to coordinate these services with: • Schools • Head Start and Pre-school programs • WIC centers • Group Homes • Juvenile Centers • Community Health Centers • Public Health Programs • MCO's • Health Fairs • and others 5

6. Smile Program’s Mission? ...to coordinate dental services for economically disadvantaged children in the school setting. • Of the 30MM+ Children on Medicaid, 2/3 won’t see a dentist this year • January, 2014, additional 4MM Children will gain dental coverage through the Affordable Care Act • Mostly inner-city, minorities and poor rural areas • Smile Programs distributes flyers and information • Prevention program including cleaning, fluoride, sealants , fillings and extractions • Each state has a PC who employs teams of dentist and hygienists 6

7. Smile Program’s History • Brief History: • Founded in 1997 in the Detroit area by Drs. Marcy Borofsky and Margo Woll - friends, busy mothers and career dentists. • Identified the need of the 30+ MM under-privileged children who were not getting basic preventive care, often because they were not taken to a dentist. • Innovated the concept of bringing dental care to these children directly at their schools. • Developed special portable equipment and a program to bring dental professionals to schools, who would provide preventive services including cleaning, fluoride treatment and sealants to children. • By 2007, serviced 14 states and started offering comprehensive care (prevention and restorative) in select markets. • In 2008, joined forces with an Arizona based company, and in 2010 with a GA based company.  • Now offer services in 23 states 7

8. Our Goals and Objectives • Deliverquality dental services and oral health education to children at their schools while providing a secure and familiar environment. • Establish a positive dental experience, including oral hygiene instruction, to instill healthy hygiene practices that will influence the child’s overall health throughout their life. • Safeguard quality dental care by having dentists and dental professionals who are respectful, knowledgeable, competent, gentle, compassionate, meet state and federal guidelines for the practice of clinical dentistry, and dedicated to helping and safeguarding children. • Encourage and assist families who don’t have insurance and are eligible for Public Aid or CHIP, to apply for assistance. • Refer patients requiring additional care to private and public health dentists. 8

9. School-Based Dental Program • Program created as recommended by the CDC and U.S. Surgeon General Guidelines. • Program is offered at NO COST TO SCHOOLS or facilities. • All dental services covered by Medicaid and/or state CHIP programs. • Dental services are provided by or under the direct on-site supervision of a state licensed dentist. 9

10. How We Operate Step: 1 Dental staff sets up a mobile dental clinic at the school Step: 8 Step: 2 The school is scheduled for its next 6 month visit and often for its next one year visit as well Exam is conducted Step: 7 Step: 3 Patients needing additional care are either rescheduled or referred to a fixed site dental office X-rays are taken, appropriate treatment is determined and provided Step: 6 Step: 4 Case files are returned to administrative centers for processing Oral health instruction is given and a dental report card is provided along with a toothbrush for each student to take home Step: 5 The school nurse or point of contact receives a copy of the dental report and is asked to fill out a satisfaction survey 10

11. In-School Dental Services Provided • Dental examinations and screenings • Dental cleaning/prophylaxis • Fluoride – tray application • Fluoride varnish • X-rays, when necessary • Sealants when indicated • Fillings • Pulpotomies • Simple Extractions 11

12. Program Description • Permission forms for each child are sent to the school for distribution to the students – completed and signed permission forms are collected and returned to us in a self-addressed postage paid envelope.   • On the scheduled date, dental teams comprised of a licensed dentist and staff arrive at the school in a mobile mini-van equipped with specially designed, portable dental equipment including a dental chair, sterilizer, compressor, x-ray unit, sterile instruments etc. 12

13. Program Description • The dental team converts a classroom or predetermined area in the school, into a fully functional makeshift “dental office” for the day. • Children receive quality preventive and restorative dental care in a comforting and familiar environment. 13

14. Program Description • Students are shown a video on proper brushing/flossing techniques. • Students who receive services are given an “oral health report card” to take home. A copy is also left with the school nurse. • If parents have not given permission for restorative care or if children are not insurance eligible, our Patient Care Coordinators will contact the parents to let them know that they need additional care. If we cannot reach parents with two phone calls, a letter is sent. • X-rays that are taken at our "Dental Day” are made available to patients & referral dentist(s) with completed release forms. 14

15. Oral Health Educators • Trained staff (aka “The Tooth Fairy”) visit a school. • A fun and educational presentation is made to the children in their classrooms. • The 5 – 8 minute presentation: • uses a puppet to show the children how to brush their teeth • talks about the importance of taking care of their teeth • talks about eating healthy foods • stresses the importance of seeing the dentist twice per year 15

16. Providing and Ensuring Quality Care • We comply with all HIPAA and OSHA rules and regulations including Universal Precautions and sterilization policies. • Background checks performed on all dentists, hygienists and assistants. • All professional licenses reviewed for current status and eligibility. • The team doctor completes the examination, monitors and signs all documentation and oversees delivery of care. 16

17. Providing and Ensuring Quality Care • Daily communication is required between home office & field teams • Dentists and team leaders report to home office regarding quality issues • Performance issues are addressed immediately and monitored • Extensive network of dental partners – Locally licensed dentists willing to accept all patients (Medicaid and local CHIP) • Local, public health and private dentists • List of dental partners is made available to parents in writing and accessible on our website 17

18. Providing and Ensuring Quality Care • Oral health report card/patient record are completed for each child receiving dental services • A program satisfaction survey is given to schools after each visit • Quality Control Program monitors sealant retention (sealants are replaced at no cost, when missing) 18

19. Services Offered Mirror that of a typical General Dentistry Office Diagnosis and Preventive Services • Comprehensive exam • Digital x-rays • Cleanings • Fluoride treatments • Sealants (when indicated) Restorative Services • Fillings • For primary teeth: • Pulpotomies • Stainless steel crowns • Extractions • Space maintainers 19

20. Basic Set-up and Operating Model • Smile Programs brings state-of-the-art portable dental equipment • Self-contained dental units that require no modification to electrical or plumbing. • Smile Programs’ Call Center provides assistance in signing up & scheduling patients. • Smile Programs accepts most dental plans • Certain administrative functions are done off-site (i.e., claims administration, IT) • Additional cost savings can be discussed when company holds ongoing dental clinics. 20

21. Facility Requirements are Minimal Typical room set-up and portable equipment at Employer Site. Equipment can be set-up or dismantled in approximately 40 minutes. • 180 sq. ft. needed • No sink required in room • Smile Programs ensures HIPAA and OSHA compliance • Privacy curtains set-up as necessary Digital X-ray area Privacy barrier 12’ Portable dental chair & Equipment Door 14’ 21

22. Electronic Records System Tablet PC provides all past treatment data as well as treatment plan. No internet connectivity need be provided by Site. • Track patient treatment • Automate billing procedures • Provide records quickly to specialty referral offices 22

23. Case Specialists Our Case Specialists ensure ease and effectiveness. • Handle all inquiries from patients so the employer doesn’t have to • Proactively notify and schedule patients/schoolswhen they are due for treatment • 24x7x365 clinical availability in case of emergency • Bilingual Smile Programs Business Center Staffing level: 70 agents 23

24. Grants Awarded(Partial listing) • Robert Wood Johnson Foundation Award Grantee • Oral Health America • Community Foundations • Annenberg Schools for the 21st Century • Blue Cross Blue Shield • HRSA Sealant Grant • The Lovelight Foundation • Michigan Department of Community Health 24

25. Program Satisfaction Survey A program satisfaction survey is given to sites after each visit. 25

26. Program Satisfaction What Our Clients Say About Us… “I didn’t want the year to end without taking this opportunity to let you know what a pleasure it was working with your amazing staff at our recent Boston Musicians’ Dental Clinic last month. The Boston Musicians’ Association officers and the clients who received services all commented on the high quality of care the clients received during the clinic event…a tribute to the success of our on-going and collaborative efforts! I look forward to our continued cooperation and again, I thank you. Dee Dee Acquisto, M.S., Senior Director, Health & Human Services, MusiCares “Your staff has always been extremely courteous and prompt.” Tamika McCombs, secretary, Center for Literacy and Creativity, Detroit “This is an excellent outreach to the community. The staff was very professional. It was just like being in a dental office.” Jeni Stuart, HCA, Kenneth Co. Culbert Elementary, Hamilton, VA 26

27. Program Satisfaction What Our Clients Say About Us… “We are so grateful for your recent visit to St. Margaret’s House. The work you do reaches a very specific population in need. We are touched and overwhelmed by your generosity. Your work helps our guests to live more comfortable and dignified lives. Because of your thoughtfulness and dedication to serving the community, we are able to offer the women and children who come to us seeking help additional services. We are honored by your support and we want you to know that your work is making areal difference in the lives of the women and children of St. Margaret’s House.” Angelica Healy, Guest Services Coordinator, St. Margaret’s House, South Bend, IN “Excellent services – very professional. The children were very comfortable with staff.” Diane Marshburn, RN, Garfield Jackson Academy, East Orange, NJ “Polite, efficient, and able to work with children well.” Patti Zehall, RN, Church Street School – Hamden, CT “It was amazing how you transformed a classroom into a dental clinic. The staff were very professional and reassured those children who were anxious.” Anita Carstens, Special Events Coordinator, Liberty Elementary, Baltimore, MD 27

28. QuestionsFor Program InformationContact: 888-833-8441 28