About four out of 10 Maine children didn't have consistent dental coverage in 2020, and about half the children who do have coverage are not using their dental benefits. Disparities for children covered under Medicaid often leave this population with disproportionately less access to care. Additionally, many traditional dental practices do not accept children until age 3 or later, leaving children in the most vulnerable state in dental development without access to preventive care.

Because of this, integrating oral health into children's primary care as early as possible is vital to ensuring a healthier life into adulthood.

At MCD, we implement different initiatives to improve oral health and overall health. Our teams provide routine screenings and sealants to children in Maine schools and beyond, coordinating with health partners in exploring innovative approaches to increase access to care.

One such initiative that launched this year is called the Virtual Dental Home Program. In collaboration with the Children's Oral Health Network of Maine, our team is developing a prototype for a fully integrated medical-dental health care model utilizing virtual dental home technology.

Virtual dental home technology has been used in other parts of the country for many years and has, to date, been successfully piloted in Maine HeadStarts.

I spoke with the initiative’s program manager at MCD Global Health, Courtney Vannah, about this innovative and important program and what residents in Maine can expect from this virtual dental care initiative.

Thank you for joining me, Courtney Vannah, to discuss this new children's oral health program starting up in Maine. What is your background of oral health? How did you get involved with this program, and how do you feel about this program that starting to take off?

Yeah, thank you for having me, Katie, I'm glad to talk with you. I have been in dentistry for just under 24 years now, but, about 13 years ago, I had the opportunity to work with medical practices, specifically federally qualified health centers, to co-locate dental services in their facility. So, essentially, bringing dental services into the medical practice.

It was through that experience that I saw the benefits of this interdisciplinary team for both the patients and the communities, and I truly developed an appreciation for alternative access to care models as a means of improving access to care for, especially means rural communities. I took a bit of a hiatus from that strong focus on medical-dental integration when I took a faculty appointment and dental hygiene program for about a decade. However, my passion remained for medical-dental integration because I truly am, I view it as a key component of solving the access to care crisis.

So, about a year ago, in partnership with the Children's Oral Health Network of Maine, I was able to return my focus to this passion when I joined MCD Global Health to begin making strides towards reducing dental disease. The Children's Oral Health Network of Maine has been leading integration of this virtual dental home idea in Maine with pilots in HeadStarts, which are early childhood education programs, and I'm absolutely thrilled that MCD has supported bringing this concept to medical practices.

And we're thrilled to have you at MCD. Can you describe what the virtual dental home entails? What is the goal of this program, who can use it, and how can they use it?

A virtual dental home, or a VDH, which we call it for short, is actually a concept that's been in practice in other parts of the country for some time now. It utilizes telehealth, or in this case teledentistry technology, to connect practitioners and community locations to a dentist in a more traditional dental clinic setting.

The goal of the VDH is to increase access to a full range of dental care for patients who do not have readily access available to a dental office, whether that be due to geographic regions, lack of providers, or the many other reasons that prevent folks from accessing care in a dental practice. And, actually, anybody can use a VDH in a location that is providing this service. Right now, in Maine, that includes multiple HeadStarts locations and soon-to-be many pediatrician offices. And, in the future, hopefully many other community locations.

Can you explain why offering a virtual program like this is significant, specifically for Maine children? Can you describe the impacts you expect to see from it, as well?

Sure. There are a startling number of Mainers who have no access to dental care. This can be for many reasons that the virtual dental home can help overcome. Specific to children, the Children's Oral Health Network of Maine is targeting locations where children are already located, such as HeadStarts and their pediatrician office.

In the HeadStarts, we see that 99% of children have a medical doctor, but yet less than half of them have a dentist. This tells us that the greatest access to the population who needs preventive care the most is actually in their pediatrician's office. By bringing that access to care to their doctor's office, we can greatly increase access to dental care for children.

Creating greater access to care for very young children, specifically, will set them up for a lifetime of success as opposed to the current status quo, which is that a third of them arrive in kindergarten with active dental disease. With our School Oral Health Program, we've seen that one in four children in the schools have an urgent need for dental care, and, unfortunately, that trend shows a trend upward with that number increasing since the beginning of the COVID-19 pandemic.

Are there other individuals or outside organizations that you're working with? Can you describe how such collaborations assist in making such a program successful?

Yes, there definitely are. The Children's Oral Health Network of Maine is a robustly diverse group of stakeholders with a shared interest of all children in Maine having access to oral health. A full list of the stakeholders involved in the network can be found on their website, but, in summary, the list includes members from multiple community organizations, dental practices, philanthropic organizations, health systems, insurers, practitioners, advocacy organizations, and educational institutions.

This broad network is a very unique model that allows for very thoughtfully crafted interventions with multiple opinions, cultures, backgrounds, populations, and geographic regions represented in the conversation. The depth and breadth of the network allows for the creation of comprehensive solutions designed to help the greatest number of people in the most efficient and effective way.

That sounds excellent. Can you describe the estimated timeline and strategies of this project? When can Maine residents expect it to become available to them?

Sure! The Children's Oral Health Network has recently received a congressional earmark funding to support the expansion of the virtual dental home activity in Maine over the next five years. Currently, virtual dental home activity is occurring in HeadStarts locations in nine counties with plans to begin offering this service in many primary care locations within the next year or two. Other community locations that are currently being explored include schools; they're actively involved in this work through the Maine School Oral Health Program.

You know, being able to receive virtual dental care sounds mind-blowing since traditionally you'd physically go into an office in order to receive care. What can Maine residents expect from this type of dental service? Can you describe a play-by-play of what a typical appointment will involve?

That's a really great question. Virtual dental home activity is typically offered in conjunction with regular preventive care. For example, in the pediatrician practices, the plan is for children to receive a full spectrum of preventive dental services, including education, screening, fluoride and sealant application, dental cleanings, and early intervention services that can stop or slow the progression of dental cavities. These activities will occur much like they would in a traditional dental practice, just in a different location.

The difference with the virtual dental home is that when it comes time in the appointment where the dentist would normally pop in and take a quick peek at the child's teeth, in the virtual dental home, technology will be used instead to transfer the patient's information to a dental practice for examination by a dentist.

We have technology now that includes things like intraoral cameras that can actually take photos of the teeth with such high resolution that in some cases the photo would actually be more telling of the patient's condition than an in-person exam of the tooth would itself.

In addition to intraoral photos, there are other digital items in the patient record, such as dental charting and dental radiographs or dental x-rays, that can be transmitted via teledentistry technology to allow the dentist a complete review of the patient's case.

Upon reviewing the data, the dentist can triage and make treatment recommendations that may include just continuing to manage the patient’s care in the community location, or the recommendation may be that, yes, additional care is needed by the dentist in-person, and that the patient actually needs to schedule an appointment with the dentist in the dental practice.

In the HeadStarts pilots, we've seen that the majority of children can have their needs met in the community location through virtual connection to a dentist without actually having to travel in-person to the dental practice.

So, practicing under this model allows a greater percentage of the population to have access to the preventive care that they need to maintain their health while still offering a connection to a restorative dentist, as needed. This is particularly useful in our rural areas where travel to a dental practice itself is a barrier as well as in areas where there are limited numbers of providers who just don't have the capacity to provide the full comprehensive preventive care to as many children as could be seen through a model like this in a community setting.

Based on collected data about children's oral health in Maine, it sounds like solutions are needed to improve children's health and well-being. Describe how this program may be a solution to this ongoing issue.

Yes, you are absolutely correct. Maine’s children, as well as children nationally, desperately need strategic innovations to alter their oral health trajectory. Even prior to the pandemic, far too many children were suffering from the ill effects associated with dental disease that can include everything from lost learning time in school to managing chronic pain, and even dealing with life-threatening infections.

Unfortunately, since the beginning of the pandemic, we've only seen that number increase with traditionally underserved populations, such as Medicaid recipients, being affected very disproportionately. As they say, “Desperate times call for desperate measures,” and this is just the type of systems-change thinking that is necessary to fill the gaps in the current model to provide increased equity and access to care for all.

It sounds like it. Do you have any additional comments you'd like to share about yourself, this program, or oral health in general?

Sure. I think it's important for people to realize that dental disease is a community issue. Even if you aren't suffering directly, there are many people in the community who are. Like any health condition, when people are suffering it taxes resources, and it negatively affects the entire community, not just the individual.

I also think it's important for people to know that dental disease is preventable. We have the tools and knowledge available to us that can greatly reduce the need for restorative intervention. There's no good reason for children to undergo unnecessary, risky, and costly procedures, such as needing to be sedated in an operating room, for a condition that was preventable in the first place.

The piece that's been missing for far too long are the interventions and strategies necessary to bring the care to the children where they are and supply them with these preventive tools.

I am incredibly proud of the work that the Children's Oral Health Network of Maine is doing and, with the support of organizations, like MCD Global Health and the community at large, I believe we can see a population of children with significantly less suffering from dental disease and who will ultimately grow into healthier adults thriving in an overall healthier community.

That sounds like it would be a great future indeed. Well, that's all the questions that I have for you. Thank you so much for your time and interest in speaking with me about the new Virtual Dental Home Program that you're leading at MCD Global Health. It sounds like a great option for improving the oral health of children in Maine.

Thank you for having me, Katie. I appreciate all that MCD Global Health does to advance the health of our communities.