The Impact of Social Determinants on Children’s Oral Health in Minnesota
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.
Interview
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.”
Click here to access educational materials and posters for Minnesota’s legislative Early Dental Disease Prevention Initiative (EDDPI), Healthy Teeth. Healthy Baby.