Sharing Our Outcomes
In 2005, oral health care for young children was a subtly explored topic for many in public health. Unless you were a dentist, dental hygienist, or other dental specialist, community-centered messages were few and far between concerning brushing, flossing, and having fluoride varnish applications (FVA).
Fluoride Varnish Training Program for Clinics
Childhood Caries Prevention Program Training
This training is a foundation for a clinic establishing a Childhood Caries Prevention Program and includes training on the application of fluoride varnish.
There are three parts to the Childhood Caries Prevention Training.
Step 1: Watch the 16 minute video.
Step 2: Read the designated articles.
Step 3: Complete the online quiz.
The training provides 1 Minnesota Nursing CEU.
By Anna Pence, MNOHP PHN Consultant
Illustrated by Trudy Barsness
It is often a struggle to find interesting ways to help young children learn the importance of taking care of their teeth. The new book, Bye, Bye Germs, is an engaging tool designed to teach children this lesson.
The story features Emma, a little girl who faces off with Jerry the Germ. She is joined by Timmy the Toothbrush and together they win the battle to save her beautiful teeth. This book is a starting point for adults to discuss the importance of oral care in kid-friendly terms and will help children learn the importance of brushing their teeth twice daily for a minimum of 2 minutes.
Copies of Bye, Bye Germs are available for purchase. Contact Cris Gilb at email@example.com for more information. Individual books can be purchased for $5.00, and there are significant discounts if purchasing in bulk. As of April 1, the Minnesota Oral Health Project plans to sell individual printed copies of Bye, Bye Germs on Amazon.com via their print on demand service.
Now available in the Karen language! The book is printable on 8.5 by 11 printers. For best results, use two-sided printing. Some of the pages in the book are designed to be displayed back to back. Download Bye, Bye Germs in Karen.
Fluoride Varnish Application (FVA) preventive training is a foundation for a clinic establishing a Childhood Caries Prevention Program and includes training on the application of fluoride varnish.
The training takes approximately 1 hour, including the portion on fluoride varnish training. There are three parts to the Childhood Caries Prevention Training.
Keep a copy of our CEU document and the email you receive on the quiz. The email shows your name, the date you participated in our program, and the required elements to save for your records.
Step 1: Watch the 16 minute video.
Step 2: Read the designated articles.
Step 3: Complete the online quiz.
In addition, medical/dental professionals can also take the MNOHP on-line Childhood Caries Prevention Training. Objectives include:
- Health care provider’s role in preventive dental care for children
- Epidemiology of dental caries and high risk populations
- Cost of untreated dental infections to the healthcare system
- Components of Childhood Caries Prevention
- Basic clinic process for Childhood Caries Prevention
- Anticipatory Guidance for EPSDT (Child and Teen Checkups)
- Fluoride Varnish Training
- Application technique
Nursing CEUs: This program was designed for nurses licensed by the Minnesota Board of Nursing for 1 CEU. When you complete the quiz in Part 3, you will receive access to the forms you will need to keep for your records.Read More
Sharing Our Outcomes
INTRODUCTION: Child Oral Health in Minnesota
In 2005, oral health care for young children was a subtly explored topic for many in public health. Unless you were a dentist, dental hygienist, or other dental specialist, community-centered messages were few and far between concerning brushing, flossing, and having fluoride varnish applications (FVA).
This is no longer true. Today, Minnesota has a strong, preventive care initiative in children’s oral health. Thanks to the Minnesota Oral Health Project (MNOHP), founded by Amos Deinard, MD in 2005, oral health for children is a topic of education in Minnesota elementary schools, Head Start programs, and even library systems. A new children’s book, Bye, Bye Germs, is now read to preschool children in rural Minnesota areas as an introduction to how to care for developing teeth. New puzzles, games, and matching cards for children are now used to reinforce prevention messages.
This document describes the development and successes of MNOHP. Created as an outcome evaluation, this “The Story of MNOHP: Sharing our Outcomes” highlights how 15-years of oral health efforts by educators, coalitions, medical/dental professionals, and others changed the landscape in our state’s oral health policies and education.
Our Outcomes: What Has Changed
In 2005, Amos Deinard, MD was a practicing community health pediatrician in Minneapolis. Dr. Deinard began to notice the frequent neglect and lack of prevention in tooth and gum care of Minnesota children. In this year, Dr. Deinard was asked if he would lead the charge on prevention and early intervention for children’s oral health in our state.
He did not realize at this time that he was about to lead an evolving and powerful movement, the Minnesota Oral Health Project (MNOHP), in reaching children with marginalized care, especially in rural areas where patients travelled long distances to access dentists and hygienists.
MN Oral Health Project’s Mission
Since its founding in 2005, the mission of MNOHP has been to:
- Increase public awareness of the caries crisis affecting high-risk children
- Improve access to early caries preventative services through training and support for medical and dental providers, and
- Educate caregivers about healthy dental practices
MNOHP’s primary focus of action has consistently focused on children from birth to six years of age in Greater (rural) Minnesota, their parents, early education educators, public health professionals, and pre-school education organizations. MNOHP has made substantial prevention and early intervention progress with these targeted audiences. The following seven outcomes summarize important oral health progress noted in Minnesota.
Seven Important Outcomes
- FVAs given by Primary Care Medical Providers (PCMP) exceeded those provided by dental providers in 2018 for the first time:
Non-dental providers now provide more fluoride varnish applications (FVA) to high-risk children than dental providers.
- FVAs by all providers have increased by 143% since 2015:
-In 2015, the number of PCMP organizations that offered FVAs was 240.
-In 2019, 538 provider organizations offered FVAs.
-In 2015, FVAs completed were 50,314.
-In 2018, FVAs increased to 241,599.
- FVAs given by PCMP have more than doubled since the Minnesota Department of Human Services (MDHS) required the service for Child and Teen Checkups (C&TC) eligible children ages 0–5 years in 2017.
- More than 99% of PCMP clinics report they are providing childhood caries prevention.
- More than 150 community-centered education sessions in Greater Minnesota helped to raise child oral health awareness in early childhood education programs, public schools, libraries, and other civic organizations.
- An updated, user-friendly FVA online training video and guide for oral health educators and providers was developed and is available on the Crush Cavities website.
- Minnesota’s diversity has been celebrated and recognized with new, culturally-rich oral health education materials developed by MNOHP.
These include parent brochures, education sheets, videos, multicultural handouts, books, and games developed for Minnesota’s Somali, Hmong, Latino, Karen, Lao, Portuguese, Vietnamese, and Russian speaking communities. The materials are free and downloadable on the Crush Cavities website. Printable education flyers can be found in the top bar at the top of the website home page.
MNOHP’s Strong Community-Centered Presence is Evident Through It’s Partnerships
Several oral health leaders have included their experiences on the impact of this project within their Greater Minnesota communities.
“Dental caries in youth are the most common chronic childhood disease. Oral health awareness and education can be linked to cavity prevention and an overall improvement in health. Public health has the opportunity to build capacity at the local community and school levels to improve access and promote preventative education for children and families. Southwest Health and Human Services (SWHHS) and the Minnesota Oral Health Project have partnered on several occasions to create opportunities for sustainable changes that promote oral health. SWHHS implemented a fluoride varnish program with support from MNOHP and the two agencies have worked together to bring education and information to families in Southwest Minnesota at health fairs, county fairs, schools, and similar community events.”
–Shannon Gossen, Public Health Nurse, Southwest Health and Human Services
“I was lucky enough to be a part of the team that worked with MNOHP in partnership with the Westbrook/Walnut Grove School (Walnut Grove, MN/Redwood County). Educating children about oral health is much needed in our rural communities. Working as a team, we were able to make oral health education fun for the children using music, games, demonstrations, and hands-on activities. These provided a way to reach the children on their own level, making an impact on the importance of caring for their own teeth. It was fun to see the excitement on their faces and their desire to learn about oral health.”
–Mavis Salfer, Health Services Program Aide, Southwest Health and Human Services
“The Westbrook/Walnut Grove School System was very fortunate to have the help and expertise of MNOHP when several community agencies partnered to provide oral health education to our elementary students. As a School Board member and clinical nurse specialist, I know how important health is for a child in order to be successful at school. I have three grandchildren at the school who are fourth generation school district enrollees. I was involved in planning and implementing the program at the school. It was a wonderful experience for the students and has put a strong focus on oral health for our school.”
–Maydra Maas, RN, CNS, Westbrook/Walnut Grove School Board Member
“The Early Childhood Dental Network has been active in west central Minnesota and across Minnesota since 2008. Over the course of these years, we collaborated and as part of our respective collaborative efforts, our paths have crossed frequently with MNOHP. With their focus on improving the lives of children through prevention and early intervention of dental disease, our missions aligned perfectly. MNOHP was essential in advancing medical/dental integration through their tireless promotion of the importance of incorporating FVAs and oral health education in well child exams. This concept and the advances made in bringing it to fruition will positively impact children’s lives for generations to come.”
–Jane Neubauer, Early Childhood Dental Network Coordinator
Timelines & Benchmarks
2000: Dr. Amos Deinard attended the Surgeon General’s Conference on Oral Health and met Dr. Olson Huff of South Carolina who had implemented a program challenging Primary Care Medical Providers (PCMPs) to provide preventive oral health care for vulnerable children.
2001 – 2014: Dr. Deinard worked to ensure payment for PCMP preventive oral health visits, trained PCMP providers in FVAs throughout Minnesota, and developed materials to educate caregivers. He named this project the Minnesota Oral Health Project (MNOHP) and used grant funds to further these preventive education efforts.
2014: Dr. Deinard chose Southwest Minnesota in Greater Minnesota to begin a community project. This targeted area initiated a concentrated education focus on preventive oral health care with partnerships including state and local government services, PCMP clinics, local service organizations and other community members with the support of a UCare grant. Southwest Health and Human Services was a key partner.
2015: MNOHP was expanded to include counties in Central Minnesota with a Blue Plus grant in partnership with the Minnesota Chapter of the American Academy of Pediatrics.
2015 – 2016: Two American Dental Association grants furthered work in Greater Minnesota, focusing on education with mothers-to-be and mothers of 0-5-year olds in partnership with the Association of State and Territorial Dental Directors (ASTDD).
2016: Another expansion was accomplished through a DentaQuest grant to include Northern Minnesota counties working with ASTDD. MNOHP staff was enlarged to include an Executive Director, four consultants, and a web designer. Volunteer professionals were also engaged in a Leadership Team and developed a mission, vision, and strategic plan for the project.
2017 – 2018: Bentson Foundation grant helped improve caregiver education with new, dynamic website materials including updated on-line resources. It funded the development of a widely used oral health book for children, Bye, Bye Germs, and new oral health education for school-centered programs.
2019 – 2020: Through a partnership with the Minnesota Departments of Health and Human Services, MNOHP staff were able to contact most PCMP clinics in Minnesota to offer training for Childhood Caries Preventive Services or problem-solve issues related to offering the service. We can report that Minnesota clinics are prepared and offering more oral health preventive services for young children.
2019 – 2020: MNOHP expanded to serve all Greater Minnesota counties, employing 10 consultants to bring community partners together in reaching out to caregivers in preventive oral care. Today, nearly all PCMP clinics offer preventive oral health services as a result of community efforts to enhance oral health care for children.
Thank You to Our Partners
Southwest Health and Human Services was an early partner in the project and collaborated with school-based oral health education in the Westbrook/ Walnut Grove School system, Walnut Grove, MN and the Luverne Elementary School in Luverne, MN (2013-2019).
Early Childhood Dental Network collaborated and shared oral health educational resources (2013-2020).
Association of State and Territorial Dental Directors (ASTDD) enabled research and partnerships with Early Childhood Education providers (2015-2016).
Minnesota Oral Health Coalition helped to access dental providers throughout Minnesota using findadentist.com resources and providing updated medical provider training (2013-2020).
Minnesota Department of Health/Oral Health Division provided training and shared oral health resources (2018-2020).
Minnesota Department of Human Services/Oral Health Department provided training, consultation, and state data resources (2018-2020).
1. White Earth Indian Reservation: After a meeting with Dr. Deinard and staff, the public health department at White Earth implemented a school-based fluoride varnish program in all reservation schools to complement FVAs provided in Indian Health Services and Maternal Child Health home visits.
2. School-based Education: Thanks to a United Way grant, MNOHP partnered with local community services, initiated an elementary school educational program, and provided consultation to Walnut Grove schools for a school-wide, year-long focus on oral health. The program was replicated at the Luverne Elementary School and can be used statewide.
3. Provider Training & Implementation of Preventive Services: Dr. Deinard’s oral health provider training was updated to video format – providing real-time, user-friendly provider training and narration for Minnesota PCMP clinics.
4. Children’s Book – Bye, Bye Germs: The book was written and offered in print, as a Kindle book and online. The book was translated into the Karen language, thanks to a volunteer from Worthington, MN. We would like to translate it into more languages and have created a translation tool to facilitate the translation work. Check our website to access either book.
5. Free resources available on www.crushcavitites.com:
- Slideshow training program for children (ages 3-7). Includes activity worksheets, coloring pages, puzzles and more.
- Slideshow training program and video for parents and caregivers. Includes activity worksheets such as a Caregiver Checklist and Brushing Chart.
- Children’s playground with video games and puzzles.
- Crush Cavities blog and Brush Strokes quarterly e-newsletter .
Speaker’s Bureau Sampling
- American Public Health Association (2018, 2019)
- American Academy of Pediatrics (2018)
- National Oral Health Conference (2019)
- Minnesota Department of Health Community Health Conference (2017, 2018, 2019)
- Minnesota Association of Family and Early Education (2017, 2018, 2019)
- Minnesota Department of Health Rural Health Conference (2015)
- Minnesota Public Health Association (2019)
- Minnesota Community Health Workers Alliance (2020)
Greater Minnesota Community Education Sessions
- Head Start and Early Child and Family Education (ECFE) sessions in rural Minnesota
- Public library child, parent, and caregiver education sessions using the newly developed Bye, Bye, Germs children’s book as a learning resource
- Elementary school education sessions
- Southwest Minnesota State University (SMSU) community market-based research that explored key components affecting child oral health care and barriers to care
- Southwest and South Central School Nurse Education
- Despite important progress, many Minnesota children continue to fall through the gaps in accessing childhood caries prevention services. While more than 600,000 MN children qualify annually for C&TC exams, less than 500,000 FVAs were completed annually for qualifying children. Additional education and compliance in providing FVAs by medical providers still remains.
- Early childhood education is an excellent place to begin educating families and helping them adopt best practices in caring for the teeth and gums of young children.
- Upstream actions such as incorporating baby and childhood tooth/gum care and education in baby showers, Head Start programs, Minnesota libraries, and other venues are important preventive measures in reaching Minnesota parents.
- Improving care for children’s teeth is the shared responsibility of dental and medical providers. A win/win partnership results when both disciplines work closely together to share parent and community-centered messaging, education materials, statewide data, and best practices to reach children and families of all races, ethnicities, income, education levels, and backgrounds.
- Using local, respected educators throughout the state that can reach into their own communities in a culturally-thoughtful manner is an enduring way to integrate oral health into the broader health of Minnesota communities.
Minnesota Oral Health Project
Cris Gilb, Executive Director and Barbara Greene, Education Consultant
August 5, 2020Read More
We would like to express our sincere appreciation for all those who have made MNOHP a successful oral health care initiative over the last 15 years.
- To our Leadership Team for their generous volunteer time to promote the project; our consultants for taking our message into the community with children and families; and White Buffalo Websites for the wonderful work on our website, education materials, and social media campaigns.
- To the Primary Care Medical Clinics who took our message to heart and implemented Childhood Caries Prevention so many more children could get preventive oral care.
- To the Early Childhood Educators, schools, and public libraries for allowing us to bring our important message about preventing cavities in young children and young families.
- To the Public Health agencies, Minnesota Departments of Health and Human Services, and other oral health programs that work every day to help families with oral health education and resources.
- To our partners, too numerous to list, for the collaboration and the common goal of improving oral health in the lives of children in Greater Minnesota.
Dr. Amos Deinard, Founder and Cris Gilb, Executive Director, MNOHPRead More
An interview with Linda Maytan, DDS, MPH
Author and Interviewer: Barbara Greene, MPH
Linda Maytan, DDS, MPH is the MN Department of Human Services Dental Policy Director for Minnesota Health Care Programs (Medicaid). She has observed oral health care outcomes among Minnesota’s children and has a broad perspective as a policy maker and a former dental practitioner. Dr. Maytan believes, “We need to create a new norm for oral health prevention among Minnesota’s children.”
Dr. Maytan was recently interviewed by MNOHP to gather her current perspectives. Several key questions were posed concerning Minnesota’s greatest child oral health successes in recent years, next steps for increasing Minnesota’s oral health care for children, and our statewide impact on children’s oral health.
MNOHP: Please give us a brief foundation about our nation’s status with oral health concerns.
“Although dental caries are largely preventable, they remain the most common chronic disease of children aged 6 to 11 years and adolescents aged 12 to 19 years. Tooth decay is four times more common than asthma among adolescents aged 14 to 17 years. Dental caries also affects adults, with 9 out of 10 over the age of 20 having some degree of tooth-root decay.”
MNOHP: What are the greatest child oral health successes that you have seen in the past five years in Minnesota?
“Both fluoride varnish and sodium diamine fluoride are important public health interventions used in Minnesota.
Minnesota Health Care Programs (MHCP) includes Medicaid and CHIP programs. MHCP calls medical well child visits “Child and Teen Check Up” (C & TC). C & TC uses the American Academy of Pediatrics Bright Futures guidelines as the starting point for the C & TC recommendations. In March of 2018, the Schedule of Age Related Screening Standards was updated. The update requires the application of fluoride varnish for children 0 – 5 years old at C & TC appointments. Fluoride varnish application continues to be recommendedfor children ages 6-20. An oral assessment is required for all C & TC visits ages 0-20.
MNOHP plays a key role in provider messaging and training about fluoride varnish. Children will see a medical provider, even if they don’t see a dental provider. Medical providers have a crucial role in the oral health of children, especially the very young.
The US has expanded the use of SDF (silver diamine fluoride). Minnesota is no exception. SDF is a caries arresting agent that stops decay (cavities) from progressing. Application of SDF to a cavity extends the timeframe to provide clinical intervention (SDF “buys time”) by stopping the disease progression. Young children, patients with complex medical and behavioral issues, and others with treatment constraints benefit from the use of SDF. This is helpful to families with challenging work schedules, transportation needs, and other daily living considerations.”
Are there particular noteworthy child oral health successes impacting Greater Minnesota?
“The ability of community health workers (CHWs) who have been trained in fluoride varnish application (Smiles for Life – Course 6) to educate individuals and their families, then apply FVs under a provider’s supervision, is a win in Minnesota. CHW’s are members of the communities they serve. They are trusted advocates for groups which may not feel empowered to speak up on their own.”
What have we learned about narrowing the gap in Minnesota’s child oral health disparities?
“A local dental organization recently celebrated their 100th year of operation. The organization was founded as a result of the consequences of the Spanish flu in 1918. What was striking to me at the celebration event was the realization that little has changed with respect to the question “who gets dental care?” Health disparities have existed in oral health before and since this organization was first formed. Social determinants strongly influence oral health. This organization is working every day to change the narrative. They cannot do it alone. Fluoride varnish application is one part of addressing oral health disparities.”
What are our next steps for improving oral health care for children in MN?
“In Minnesota and across America, a health care culture shift is needed. Mid-level dental providers should be included in the health care team. Ideally, these providers should be embedded in the pediatric health care team. It becomes a ‘one stop shopping’ model for children and their families, and is a real-time referral source for the medical team.
Referring families to another office at another location and another time and date creates obstacles for parents. Ideally, oral health should be a standard part of medical well child checks.”
What impact has MNOHP had in increasing oral health prevention for Minnesota children?
“MNOHP has created a tangible community-based way to reach parents and children throughout our state. MNOHP has been particularly active in getting the message about good oral health practices out to Minnesota parents. Their education in Head Start programs, library systems, and other venues has helped embed the oral health message.
MNOHP helps to bring prevention messages to many different community audiences through a variety of actions. This includes talking to parents about drinking tap water, providing daily oral cares for themselves and their children, and receiving fluoride varnish on a regular basis.”
If you could suggest one thing to all Minnesota parents/caregivers about protecting their child’s oral health, what would it be?
“My number 1 message to parents and caregivers is: “If your child has a tooth, it needs to be brushed! Secondly, don’t put your child to bed with a bottle. Thirdly, do not put anything into your child’s bottle except milk, formula, or water – no juice or soda. Infants and children drinking sweetened juices and sodas from a bottle or sippy cup results in decay. This decay is commonly known as Baby Bottle Caries (cavities). It can be quite severe and cause pain, infection, and trauma for a child suffering from it.
Children with Baby Bottle Caries (also called Early Childhood Caries) are more likely to have decay in their permanent teeth. Baby teeth (also called primary teeth) are important. They lay the groundwork for the future adult mouth.”
Do you have any closing remarks for Minnesota parents?
“Dental decay is the most preventable disease of childhood.
I recently saw a young child drinking from an 8 oz. baby bottle filled with Mountain Dew.” This is an example of parents’ need for oral health information. There is no “magic bullet” for sound oral health care. Drinking tap water, eating nutritious foods, brushing and flossing every day are important at-home activities for everyone in the family. Daily consistency is the best of all practices.”
What additional resources can you share on the importance of having good daily oral health habits for our children?
 At parent and provider discretion
 In Minnesota, mid-level dental providers are dental hygienists, dental therapists, and advanced dental therapistsRead More
An Interview with Dr. Prasida Khanal, BDS, MPH (Honors)
Prasida Khanal, BDS, MPH (Honors) is the State Oral Health Director at the Minnesota Department of Health. She is foreign-trained dentist with a public health background and holds a certificate in project management.
Interviewer and Author: Barbara Greene, MPH, Senior Health Consultant
Serving Children From Nepal to Minnesota
Dr. Khanal practiced as a community dentist in Nepal for underserved communities. She has witnessed the socio-cultural and economic impact of dental disease among Nepali children. Despite of advances in dentistry, access to education and preventive dental care remain an uphill task in Nepal. Nepal’s political and policy landscape add hurdles to promoting optimal oral health.
Dr. Khanal was astounded when she found children missing appointments for free dental care in Minnesota. Not all families had cars to drive to the appointment, some of them could not speak in English and many of them had competing priorities that forced them to underutilize the dental service for their children. Dr. Khanal handed bus passes to parents and navigated resources which made her think about the impact of social determinants for improving the oral health of children.
As State Oral Health Director at the Minnesota Department of Health, Dr. Khanal serves as a Principal Investigator for federal and state grants promoting oral health in Minnesota, including evidenced based interventions for prevention of oral disease and innovative workforce models to increase access to care in Dental Health Professional Shortage Areas.
The Center for Health Care Strategies awarded Dr. Khanal fellowship to achieve broad improvements in oral health policy and delivery. Dr. Khanal serves as the ex-officio member of the Dental Services Advisory Committee (DSAC), a legislative subcommittee of the Health Services Advisory Council and Minnesota Oral Health Coalition. She has worked as a volunteer with the United Nations and a number of Minnesota nonprofits. Dr. Khanal has received both public health and humanitarian awards.
The Triple Aim of Health Equity
Dr. Khanal envisions a statewide coordinated and systematic approach to improve the oral health of Minnesotans. She has the necessary leadership skills and policy knowledge to improve oral health outcomes especially for low-income children and adults through an upstream approach.
Dr. Khanal firmly believes in the MDH triple aim of health equity. She has been collaborating with ethnic and underserved communities to understand and address the social determinants and partnering with stakeholders to strengthen the dental public health system of Minnesota.
What are the greatest child oral health successes that you have seen in the past five years in MN?
“There are so many! The first is the Healthy Teeth. Health Baby. initiative. This community-centered initiative focuses on prevention of early dental disease, starting during pregnancy and through the first three years of life.
The initiative provides resources and education to pregnant women, expecting/new parents and caregivers of children up to the age of three. The campaign is geared toward communities of color and recent immigrants. It is part of the larger statewide Early Dental Disease Prevention Initiative (EDDPI) which legislators called for in 2015.
MDH Oral Health Program has also provided mini-grants to diverse community partners, developed culturally appropriate communication tools for families and distributed over 15,000 oral hygiene kits for pregnant women, mothers and infants at WIC sites and other community settings.
The second great children’s oral health success is making fluoride varnish application is a requirement for Minnesota’s Child and Teen Checkups. Data shows this is increasing access to fluoride varnish across the state.
SEAL Minnesota, MDH Oral Health Program’s statewide coordinated approach to school sealant programs, provides mini-grants to prevent decay among children. We also provide technical assistance, education and outreach.
Our clinical partners are also doing phenomenal work in providing dental care to children in both traditional clinics as well as in schools.”
Are there particular child oral health successes that we have witnessed in Greater Minnesota?
“The MDH Oral Health Program is equitable in administering grants especially to partners in Greater Minnesota. Our SEAL Minnesota (school sealant program), community water fluoridation and Healthy Teeth. Healthy Baby. mini-grants have benefitted children across the state. Licensed dental hygienists in collaborative practice agreements are serving schools and bringing children into the pipeline for dental care. The Child and Teen Check Ups providers, WIC sites, Community Health Workers and Early/Head Start programs are also promoting children’s oral health in different capacities. These programs in rural Minnesota have made a major impact in increasing access to care.”
What have we learned about narrowing the gap in child oral health disparities?
“The MDH Oral Health Program assesses the oral health of Minnesota’s third graders every five years. Our data shows there is a significant disparity between oral health outcomes of children especially from different racial-socio-economic backgrounds.
These disparities are not only the result of poor access to dental care. Rather, they’re driven by the socioeconomic circumstances in which people live. Language, transportation, flexi-time and geographic location are some of the key barriers that might hinder our communities from even accessing free care. The most important strategies to narrow this gap are to engage families to understand their needs and then to design culturally appropriate educational intervention to move upstream instead of directing our resources to fix cavities.”
What are next steps for improving oral health care for Minnesota’s children?
“Prevention is best accomplished by timely identification of risk factors and appropriate intervention. Fixing cavities is critical but upstream education and prevention are important strategies in reducing oral health disparities.
Professionals, both dental and non-dental, need to begin to understand the importance of achieving and maintaining good oral health as an integral part of total health in order to address the oral health crisis. As a state, we are thinking about how to best serve our communities and what resources or tools are need to help educate and inform them.
To prepare for these changes, dentists and the health providers with whom they collaborate will need to know how to best serve their multi-ethnic patients using low literacy educational tools and practice applying their knowledge in the community.
Through early detection, proper counselling and the involvement of health professionals and caregivers, the consequences of early dental disease can be minimized and hopefully, in the future, completely eliminated.
One area we’re currently exploring is the potential for engaging community health workers to help provide that culturally-competent education and connect community members to resources.”
What impact has MNOHP had in increasing FVA and other preventive efforts?
“Dr. Amos and I co-presented on the importance of the fluoride varnish application to the Minnesota Maternal Child Health Taskforce. He has been pioneer in providing training to non-dental professionals such as pediatricians, medical doctors, nurses, etc. This workforce training aligns well with the mission of the Early Dental Disease Prevention Initiative.”
If you could suggest key preventive actions for all Minnesota parents/caregivers to take, what would they be?
“For caregivers, prevention of early dental disease starts during pregnancy and is most effective in the first three years of life.
Prenatal visits should include oral health education for both mother and baby. Pregnant women should visit a dentist and take good care of their teeth and gums.
Parents and caregivers are the drivers of child’s oral health. Home oral care needs to include such actions as brushing, using fluoridated toothpaste, flossing, drinking tap water, limiting sugar-sweetened beverages and visiting a dentist at least twice a year help prevent decay and cavities.”
By Melissa Walden, MNONP Consultant and Educator
“1-2-3…Come read, brush, sing and play with me!” Preschool and family story hours are powerful, interactive ways to reach families with young children on good oral health practices and early caries prevention!
Throughout 2019, we read and shared the Minnesota Oral Health Project’s (MNOHP) new book, “Bye, Bye Germs”, at city and county libraries. This book uses kid-friendly language and images to help children learn the importance of daily brushing. “Bye, Bye Germs” gets kids excited to brush twice a day for two minutes. When Emma, a little girl, faces off against Jerry the Germ, Timmy the Toothbrush swoops in to teach her why she should brush. Together, they save her beautiful teeth.
There are many easy ways to incorporate new, fun learning moments as you read this story! When Timmy the Toothbrush enters the storyline, it’s a prime time to see whose toothbrush is blue just like Timmy’s. Kids love to share the color and description of their toothbrushes. Timmy and Emma also discuss how sugary foods “feed” Jerry on Emma’s teeth. This is a key cue to ask our little listeners what healthy foods Emma (and they) can eat for healthy teeth and bodies.
Kids love to volunteer and share their favorite stories, too. The song, “Brush, Brush, Brush” (sung to the tune of “Twinkle, Twinkle Little Star”) is published in the back of “Bye, Bye Germs”. Everyone can join in for a sing-a-long prior to the end of their library session. This song demonstrates how kids can now implement this important ritual in their daily life.
During our story times together, we ask who has been to a dentist. We invite kids to share their experiences. This is an easy segue to remind parents that appointments should be made at the eruption of the first tooth. We can also offer resources for families with questions about finding a dental home.
MNOHP has developed games, cavities puzzles, and origami paper-folding activities. Depending on age ranges of children, we have many tools for active play times. And all activities reinforce best oral health care practices! While children are engaged in coloring workbooks or puzzles, we have a prime window to talk with parents about the importance of fluoride and fluoride varnishes. Each family also leaves with the gift of a new “Bye, Bye Germs” book to read.
Library story telling times give us an opportunity to share success stories. Who can resist a picture of a smiling child who is now pain-free because her/his teeth have been restored and sealed to prevent further decay? Library oral health activities change the lives of participants for the better. Parents, caregivers, and children can engage in easy activities together and learn how to incorporate brushing, flossing, and care as daily family rituals.
If you have any questions about implementing library story times in your community or about free MNOHP childhood resources, reach us at firstname.lastname@example.org. Our Kids Playground has many creative ways to share information about resources and how to get kids engaged in daily oral health habits. For bulk copies of “Bye, Bye Germs” contact Cris Gilb at email@example.comRead More
By Barbara Greene, MPH, Consultant & Educator
The Fluoride Guy
Amos S. Deinard, Jr., MD, MPH is well-known in health care circles as an Associate Professor in the Department of Pediatrics, University of Minnesota Medical School and School of Public Health. While this is his official title, he is most frequently known as “The Fluoride Guy”. Dr. Deinard, or Amos, as he prefers to be called, has spent his career helping under-served children’s health needs in Minneapolis, MN communities. So it’s not surprising he was challenged by a colleague in 2005 to initiate a Childhood Caries Prevention project that focused on oral health care anticipatory guidance and fluoride varnish treatments Minnesota’s Primary Care Medical Clinics.
The goal of this prevention project was to improve access to dental services for children insured through public health plans. While this was an ambitious goal, Amos was up to the challenge and readily accepted it.
Advocating for fluoride varnish treatments
The project began with one staff member in Southwest Minnesota. Today a team of 15 Minnesota Oral Health Project (MNOHP) professionals, representing diverse public health and clinical backgrounds, work with oral health providers, public health educators, and community advocates throughout the state to provide essential oral health clinic care (see www.crushcavities.com).
Amos’ passion for children impacted by dental disease is evident for all who’ve heard him speak. He carefully describes how dental disease causes pain, speech problems, chewing difficulty, and poor school performance, affecting children for a lifetime. He addresses oral health disparities as “the silent epidemic” because it is the most common chronic disease of childhood.
Many years ago, Amos wrote, “If community leaders in Greater Minnesota knew what the children in their cities and towns endure without dental care, they will take measures to correct the problem”. After 15 years of his leadership and expanded influence, oral health for Minnesota’s children is looking different. His initial goal of implementing Childhood Caries Prevention in medical clinics is nearly complete, with more than 99% of clinics providing this service through well-child and CT&C checks. MNOHP staff and team members bring Amos’ earliest messages to parents, schools and communities across Minnesota via community presentations, social media opportunities, website education and materials, and stakeholder meetings. The work he started in helping under-served children and their caregivers access preventive care and fluoride varnish treatments has reached communities in all quadrants of Minnesota.
Amos’ legacy in improving oral health for all Minnesota children continues today through the work of the current Minnesota Oral Health Project (MNOHP). In 2016 he was recognized in a National Lifetime Achievement Award for Public Health Dentistry – the first time a pediatrician was given this national recognition. His timely message, “Go forth and varnish” continues to be heard in every county throughout Minnesota, as well as nationally among oral health leaders. This April 2020 MNOHP edition honors Amos for his tireless work in inspiring a new generation of oral health providers and public health leaders!
Learn more about Dr. Deinard’s contribution to oral health in this video: Meet Dr. Deinard. Our provider training program (for 1 CEU) is inspired by the countless clinic training sessions he has done over the years.Read More
By Barbara Greene, MPH, Consultant & Educator
Establishing new family rituals for brushing teeth is an excellent way to make brushing and bedtime oral health preparation easier! Parents often tell us, “I let my daughter brush my teeth sometimes, so she will let me brush hers without argument.” Still others create nightly rituals by suggesting, “You brush for a while, then I’ll brush for a while!’”
To help establish new brushing rituals, MNOHP has created and identified several lively music videos that children can watch to make brushing a more stress-free part of daily living. Simply click on any of these links and share them with children and families. By using these new tools, we can all create bigger smiles and learn new tunes to sing together at bedtime!
- Sesame Street “Healthy Teeth, Healthy Me” video
- Sesame Street “Kids Just Love to Brush” video
- “Dudley the Dinosaur Brush & Floss” video
Find these videos and more at the Kids’ Playground at CrushCavities.com
Nasra Budul is an oral health educator and Community Health Worker in Minneapolis public and charter schools. As an educator of children age fourteen and younger, Nasra is keenly aware of oral health disparities within her Somali community. She educates school systems, helps get children to preventive dental visits twice each school year, and visits with parents at all school events and conferences. As a Community Health Worker for Ready Set Smile, a nonprofit in Minneapolis whose mission is to reduce oral health disparities and educate communities on best oral health practices, Nasra is a highly sought after advocate and groundbreaking champion with the Minneapolis Somali community.
Many children in public and charter school systems have never seen a dentist. They do not know what cavities are or how to prevent them. Most have loving, hard-working parents who do not know how to best care for their children’s teeth for life-long health. Since many parents have never learned sound oral health practices, their children are missing out on essential daily oral health preventive practices.
Nasra focuses on teaching best practices for caring for children’s teeth and oral health every time she visits school classrooms. She also teaches parents these practices at school events and conferences. “I meet with children and parents in so many environments. These include conferences and after school activities as well as in larger community settings. I also create flyers, provide consent forms, and organize all needed materials between schools and parents. This helps children to more easily receive the care they need. I also make certain children enrolled in Ready Set Smile receive two preventive oral health visits through onsite dental clinics in our partnering schools. An advanced dental therapist and collaborative dental hygienists provide exams, give fluoride varnishes, and help children understand how to care for their teeth as a life-long practice. We see more than 1,600 school-age children a year during clinic visits. And we provide oral health education for all children in those schools regardless of enrollment in the Ready Set Smile dental clinic.”
Nasra listens each day to what children say about their oral health. “Many children – and their parents – have myths about oral care. One 12 year-old recently told me that his mother gives him orange soda every day to drink. He told me this is because it is made from oranges and therefore has lots of vitamin C. When I explained the sugar content in soda to him and how it causes cavities to form, he was astounded. Another child recently told me that he brushes his teeth every morning because he learned if you brush in the morning, you will not need to brush again until the next day. After I explain the realities of good oral care to children, they are often shocked.”
Nasra completed her Minnesota Community Health Worker certificate program two years ago. She was a Somali interpreter in health care settings before she received her certification. “I am always startled to learn how little many parents and children know about the importance of oral health care. This is a practice that shapes our future health in so many ways. Many parents simply don’t have a lot of information about cavities or how to prevent them. We work alongside parents and educators to help students have access to preventative oral health care and education. I love working with children, their families, and school systems as an advocate. I help them to learn actual realities and myths about oral health care.”
As a Community Health Educator for Ready Set Smile, Nasra lives the organization’s two-fold mission: educating and providing preventive oral health services and then empowering children to care for their oral health. “I love what I do. Being an advocate for children and parents is the best way to live each day.”
For more information, see https://www.readysetsmile.org/aboutusrev.Read More
Diverse patients and backgrounds
For the last nine years, Havva Zeynep Ertugrul, DMD, has brought oral care to the pediatric patients at Community University Health Care Center (CUHCC) in the urban, ethnically diverse Phillips Neighborhood of Minneapolis. Dr. Ertugrul provides restorative and preventive oral health care, including fluoride varnish, for multicultural children. Many of the children she treats are of Latino/Hispanic, Asian/Pacific Islander, East African, Native American, European American, and other backgrounds. The majority of her patients are on federal and state public programs. Others pay a percent of costs on a sliding fee scale. Still others have commercially insured payers or are uninsured. Forty-six percent of the children she sees prefer a language other than English, implying at least that many patients she sees live in families that speak a language other than English in their home.
Multicultural barriers toward oral health and fluoride varnish
Many of Dr. Ertugrul’s patients have never seen a dentist. As a pediatric practitioner, Dr. Ertugrul understands many children are extremely fearful of invasive, unknown preventive care. Dr. Ertugrul is intent on establishing trust with the children and their parents from the first visit onward.
“Being aware of their cultural and social differences, I approach my patients with utmost flexibility and sensitivity. I always use professional, bilingual interpreters when needed as an integral part of my team. I use properly chosen educational materials and communications, taking my time to inform and train what cavities are and how to prevent caries. Many of my patients and their parents initially have no knowledge of oral health and oral diseases, and their impact. The most common chronic childhood disease is caries, and I give information about the process of caries and the consequences of having caries. I teach how brushing, flossing, and ongoing fluoride varnishes prevent oral health disease. I also see the majority of my patients at least every three months.”
With carefully designed multicultural oral health and fluoride varnish education, parents and children begin to understand the importance of prevention and early oral care. Dr. Ertugrul explains:
“Families are anxious to learn. I talk about food and healthy diet because the food patients eat in their homes varies according to cultural considerations and preferences. I take this into consideration. From the beginning, I try to form a consistent oral health “team” with the children, parents, onsite interpreters, and our dental staff.”
Treating the individual’s oral health
Dr. Ertugrul shared a recent experience involving a patient we will call Erica, a young girl of Ecuadorian descent. Erica visited the dentist at age seven for the first time. Because Erica’s parents are recent immigrants, language and cultural changes are critical barriers they are currently experiencing. However, as recent arrivals, they are eligible for a sliding fee scale at CUHCC and they appreciate this adjustment in affordable care. When Erica arrived at CUHCC’s dental clinic with her parents, her mother and father explained the key reason for their visit was bad breath or halitosis.
Upon examination, Dr. Ertugrul discovered large, deep caries in all quadrants of Erica’s mouth. Her parents had no understanding of infection or what caused it. After ongoing team work with the patient, her parents, clinical staff including front desk and finance departments, and Spanish-language interpreters during all clinic visits, Erica gradually became familiarized and desensitized towards the dental procedures that she needed. Over time, her caries and abscess were eliminated with improving compliance to treatments. Throughout this whole process, Erica’s parents established new patterns for brushing and flossing that included changing after-meal practices. These successes were the result of a fully dedicated team working patiently in unison. Today, her parents continue to bring her to the dental clinic every three months for ongoing preventive care and maintenance.
“Erica’s parents are so grateful and appreciative of what they learned and the care provided. They put all the practiced preventive actions into their daily home care routine. This not only helped Erica and her parents but also became a great inspiration for our clinic. CUHCC learned what we can do and achieve as a team and how we can help our patients improve their lives for the better!”