Creating a New Norm: Lessons Learned in Child Oral Health Care
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.
The Interview
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[1].”
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[2].
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[3] guidelines as the starting point for the C & TC recommendations. In March of 2018, the Schedule of Age Related Screening Standards[4] was updated. The update requires the application of fluoride varnish for children 0 – 5 years old at C & TC appointments[5]. 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[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[7] 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[8].”
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?
- https://www.cdc.gov/oralhealth/basics/childrens-oral-health/index.html
- https://www.hopkinsmedicine.org/health/conditions-and-diseases/tooth-decay-caries-or-cavities-in-children
[1] https://www.cdc.gov/healthywater/hygiene/etiquette/index.html
[2] https://www.mchoralhealth.org/PDFs/ResGuide-fv-sdf.pdf
[3] https://brightfutures.aap.org/Pages/default.aspx
[4] http://edocs.dhs.state.mn.us/lfserver/Public/DHS-3379-ENG
[5] At parent and provider discretion
[6] https://www.smilesforlifeoralhealth.org/buildcontent.aspx?tut=584&pagekey=64563&cbreceipt=0
[7] In Minnesota, mid-level dental providers are dental hygienists, dental therapists, and advanced dental therapists