The Story of the Minnesota Health Care Project

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.

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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

1. 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.
2. 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.
3. 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.
4. More than 99% of PCMP clinics report they are providing childhood caries prevention.
5. 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.
6. 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.
7. 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.

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Celebrating Successes

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

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“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

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“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

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“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

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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.

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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).

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Success Stories

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 .

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Speaker’s Bureau Sampling

National Conferences

• American Public Health Association (2018, 2019)
• American Academy of Pediatrics (2018)
• National Oral Health Conference (2019)

Minnesota Conferences/Webinars

• 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

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Lessons Learned

• 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, 2020