Remembering Amos Deinard, MD, MPH
Champion of Oral Health for Low-Income Children
He dedicated his life to caring for low-income children
Amos Deinard, MD, MPH, was an associate professor in the Department of Pediatrics, University of Minnesota Medical School and School of Public Health. He dedicated the last 20 years of his life to improving the oral health of high-risk children by promoting the application of fluoride varnish in medical clinics. He founded the Minnesota Oral Health Project and served as its Medical Director.
Read his Obituary at the Star Tribune Website
For most of his career, Dr. Deinard was the director of the Community-University Health Care Center (CUHCC), an inner-city community clinic serving low-income patients. While serving at the clinic, he was concerned that many of his young patients were suffering from tooth decay. He knew the pain of tooth decay would keep children out of school and prevent them from sleeping, exacerbating the effects of poverty on their young lives. Too many of his youngest patients had to have all of their baby teeth removed due to baby bottle tooth decay.
When he stopped treating patients in 1999, he did not retire. Instead, he made it his life's mission to find solutions to the problem of dental caries in low-income children. Research on fluoride varnish treatments from other countries demonstrated that applying fluoride varnish to children's teeth dramatically reduced dental caries. He undertook a campaign to require that every medical clinic in Minnesota apply fluoride varnish the teeth of their low-income patients.
"The Mouth is Part of the Body"
He focused his fluoride varnish campaign on medical clinics rather than dental clinics. He did not accept that medical practitioners should limit their care to every part of the body except for the teeth.
When he started his campaign, very few medical clinics were applying fluoride varnish. Two decades later, virtually all medical clinics apply fluoride varnish. Minnesota rules now require the application of fluoride varnish as a part of its Early and Periodic Screening, Diagnostic and Treatment (EPSDT) program, known as Child and Teen Checkups in Minnesota.
I met Dr. Amos Deinard, Amos as he preferred to be called, when I worked in Public Health and I later joined him in the Minnesota Oral Health Project. We traveled the state together to talk to people about oral health and the suffering many children endured with cavities. He had such a passion for his important mission; people listened and wanted to help him make a difference. We had quite some conversations, a Minneapolis pediatrician and a rural nurse.
Cris Gilb, RN, PHN, MHA
Executive Director, Minnesota Oral Health Project
Persistent and Relentless: Working Through the Barriers to Success
Anyone blessed to know Dr. Deinard knew that he was persistent and relentless. He would not accept "no" for an answer. He contacted public health administrators and medical directors throughtout the state of Minnesota, insisting that fluoride varnish be applied by medical clinics.
He worked through several barriers to adoption of fluoride varnish.
Reimbursement for Fluoride Varnish. One of Dr. Deinard's first barriers was reimbursement for fluoride varnish. If clinics were going to apply fluoride varnish, they needed to be paid for the treatments. He worked with the Minnesota Department of Human Services to set up a procedure code for reimbursement for medical clinics. Once he had the procedure code in place, then he worked with clinics and health plans to make sure that all of their systems would accept the procedure code. Since it was a dental service, there were administrative barriers to paying for fluoride varnish as a medical service, because the payment systems for medical and dental systems are separate.
Training. Medical staff needed training to apply fluoride varnish to children's teeth. Even after fluoride varnish was a covered procedure, clinic staff did not know how to apply it. Amos created a training program and trained thousands of clinic employees in Minnesota clinics.
Clinic Adoption and State Requirement. Now that clinics had a way to be reimbursed and a training, the next barrier was that clinics were reluctant to add the fluoride varnish service to their standard practice of care. Individual clinic staff stepped up to the plate, but overall clinics were very slow to adopt fluoride varnish. At this stage of his campaign, Amos called leaders of the Departments of Health and Human Services, health plans, and clinic medical directors, demanding that they make the fluoride varnish a required part of Child and Teen Checkups. Slowly but surely more and more clinics started to integrate fluoride varnish into their care of young patients.
In the end, the Minnesota Department of Health made fluoride varnish a required part of every Child and Teen Checkups screening, and, as Dr. Deinard predicted, that was the last barrier to universal adoption fluoride varnish.
Recognition
Susan Metoxen, MBA
Technology and Communications, Minnesota Oral Health Project
The Minnesota Oral Health Project
To support his efforts, Dr. Deinard created the Minnesota Oral Health Project in 2005, assembling a team of part-time staff to support the mission. Under his leadership, the Minnesota Oral Health Project has created training for clinics and dental health education for children, caregivers and parents, educators, and clinic staff.
After fluoride varnish became a requirement in Minnesota, the Minnesota Oral Health Project team increased the scope of their work to include health fairs attended by Public Health Consultants and educational efforts like the ones described below.
1 CEU Training Program for Clinic Staff
The online training program was written by Dr. Amos Deinard, with extensive additions by Cris Gilb, Executive Director of the Minnesota Oral Health Project. It was professionally read by broadcaster Jim DuBois.
The training program has been completed by more than 100 clinic staff.
Multilingual Training Materials for Patients
The Minnesota Oral Health Project crafted 20 "Public Service Announcements" for parents and caregivers, and translated them into Hmong, Karen, Lao, Portuguese, Russian, Somali, Spanish, Vietnamese. These are available for free on the CrushCavities.com website.
Education and Activities for Children
The Minnesota Oral Health Project created a tool kit for teaching children about oral health care targeting preschoolers and kindergartners. In addition to training, there are fun worksheets and even video games for the children to play.
As part of their efforts, the Minnesota Oral Health Project created a children's book, Bye Bye Germs, to teach children to brush their teeth thoroughly. Over 11,000 books have been distributed. The book is available for purchase on Amazon.com.
Training for Parents and Caregivers
The Minnesota Oral Health Project created a training tool kit for educators to use in training parents. The tool kit includes a Caregiver Checklist as well as fun activities for adult education.