Tuesday, February 2, 2016

MI SmilesToo many of Michigan’s children experience a highly preventable dental disease known as early childhood caries (ECC) – tooth decay among children younger than 6 years of age. Shockingly, more than 40% of children entering kindergarten have at least one cavity,1 and caries are most severe among low-income, minority preschool-aged children, compounded by limited access to dental care.2

The American Academy of Pediatrics Bright Futures guidelines recommend that children see a physician 11 times by age 2.3 Since many children have not seen a dentist by this age, the timing and frequency of medical checkups means that primary care providers are often the first line of defense in preventing tooth decay. Indeed, these providers can have a significant impact on children’s oral health by supporting access to early preventive oral health services (e.g., fluoride varnish applications, oral health screenings, oral health risk assessments, dental home referrals).4

The Michigan Caries Prevention Program (MCPP), a collaborative effort among Altarum, Delta Dental of Michigan, the University of Michigan School of Dentistry, and the Michigan Department of Health and Human Services, is leading a transformative change in the current oral health landscape in Michigan by working towards comprehensive oral health and primary care integration. Funded by the Center for Medicare & Medicaid Innovation, the MCPP seeks to improve the oral health of more than 1 million publicly insured children. To reduce the burden of childhood dental disease and address access-related barriers, the MCPP is developing an innovative care delivery system, promoting systems-based change through primary care education and technology development and integration.

Primary Care Training and Education

A key strategy in improving children’s oral health access is to provide primary care providers with the training and support tools necessary to implement preventive oral health services during well-child visits. To best serve the primary care provider community and entice interested providers, Altarum is collaborating with the University of Michigan Medical School and the University of Michigan Health System to joint-sponsor Continuing Medical Education (CME) and Maintenance of Certification (MOC) Part IV performance and quality improvement activities as part of the training efforts. Among other strategic recruitment methods, these incentives have played a significant role in encouraging primary care providers to participate in the technical assistance program and to implement oral health services in their practice.

MCPP MapTo maximize outreach and accelerate recruitment for the technical assistance program, the MCPP launched an extensive communication campaign. Consisting of strategic messaging, social media, and outreach materials, the communication campaign increases interest and awareness for the training program, provides resources for primary care providers interested in implementing preventative oral health services in their practices, and provides details on how to register for technical assistance. Strategic messaging encouraging Michigan primary care providers to enroll in our program through the program’s website and Twitter account has garnered increased interest and inquiries.

Since launching statewide in July 2015, the MCPP has made great strides in increasing the provision of preventive oral health services in the medical setting. More than 297 primary care providers and 295 clinical support staff have participated in this quality improvement effort, leading to access to preventive oral health care services for more than 17,000 children in Michigan, thereby reducing their overall risk of experiencing adverse outcomes associated with dental caries.

Technology Development and Integration

To further strengthen the medical-dental provider collaborative, the creation of a first-of-its-kind statewide dental quality monitoring system is underway. Deemed the Michigan’s Dental Registry (MiDR), this information architecture serves the primary purpose of facilitating an electronic referral and patient tracking tool for both medical and dental providers in Michigan. Through the MiDR system,

  • Physicians will be able to manage preventive oral health services provided in the medical setting and facilitate the referral to a dentist,
  • Dentists will be able to access information on referred patients and communicate with referring medical providers, and
  • Public health professionals will be able to monitor population oral health trends.

The MiDR introduces an opportunity to effectively close the gap in preventive oral health access and significantly advance oral health coordination between the medical, dental, and public health stakeholders in the state, with the potential capacity for national expansion.

Community Engagement

While primary care training and technological infrastructure development are large components of the multifaceted model to improve care delivery in Michigan, access-related disparities still exist. To foster access to care beyond the clinical setting, the MCPP is also pioneering a social network solution to bring care to those who need it most in an effort called SmileConnect℠. This infrastructure was developed as an online portal that works to better connect available oral health resources with early childhood education groups and schools. Churches, schools, and Head Start programs often look to find resources to fulfill oral health services for their students but are usually unsure where to begin. Similarly, practicing dental providers, dental hygiene students, and dental students are interested in providing services to these unique settings but do not have the connections to facilitate the provision of care. SmileConnect℠ serves as a platform to foster these connections in three simple steps: post, browse, and connect. Launching in Michigan in spring 2016, SmileConnectsm will ultimately leverage existing dental resources and workforce capacity to help fulfill the need for oral health education and caries prevention among children nationwide.

The Impact

Ultimately, the MCPP aims to produce a systemwide transformation, resulting in lasting effects for years to come. Because tooth decay experienced in the primary dentition (baby teeth) is a significant predictor for decay in the permanent dentition (adult teeth), this innovative care delivery model will improve chronic childhood disease management and prevention, as well as quality of care, while lowering health care costs. Accelerating implementation of these early preventive measures in both the care delivery and community settings will help shield Michigan’s children from future dental caries risk into adulthood.5

If you are interested in getting involved or would like to learn ways to help support the sustainability of the MCPP efforts, please email info@miteeth.org or visit our website here. Join us in celebrating National Children’s Dental Health Month by following the conversation on Twitter: @MI_Teeth and @SmileConnected.

CMS Disclaimer: The project described was supported by Grant Number 1C1CMS331321 from the Department of Health and Human Services, Centers for Medicare & Medicaid Services. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the U.S. Department of Health and Human Services or any of its agencies.


  1. American Academy of Pediatric Dentistry. (2014). Guideline on infant oral health care. Clinical Practice Guidelines, 37(6), 146–150. Retrieved from http://www.aapd.org/media/policies_guidelines/g_infantoralhealthcare.pdf.
  2. Grembowski, D., Spiekerman, C., & Milgrom, P. (2007, November). Disparities in regular source of dental care among mothers of Medicaid-enrolled preschool children. Journal of Health Care for the Poor and Underserved, 18(4), 789–813. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2266968/.
  3. American Academy of Pediatrics. (2015). Recommendations for preventive pediatric health care. Retrieved from https://www.aap.org/en-us/professional-resources/practicesupport/Periodicity/Periodicity%20Schedule_FINAL.pdf.
  4. National Academy of State Health Policy. (2008, December). The role of physicians in children’s oral health. Retrieved from http://nashp.org/sites/default/files/Fluoride%20Varnish%20Monitor.pdf.
  5. Skeie, M. S., Raadal, M., Strand, G. V., & Espelid, I. (2006, May). The relationship between caries in the primary dentition at 5 years of age and permanent dentition at 10 years of age—A longitudinal study. International Journal of Pediatric Dentistry, 16(3), 152–160. Retrieved from http://onlinelibrary.wiley.com/doi/10.1111/j.1365-263X.2006.00720.x/full.

All postings to the Health Policy Forum (whether from employees or those outside the Institute) represent the views of the individual authors and/or organizations and do not necessarily represent the position, interests, strategy, or opinions of Altarum Institute. Altarum is a nonprofit, nonpartisan organization. No posting should be considered an endorsement by Altarum of individual candidates, political parties, opinions or policy positions.