Our team hoped to improve coordination of care between a child’s primary care pediatric health center and dental home through the integration of a Community Dental Health Coordinator (CDHC) into the existing system. My goal was to address barriers to oral health care for Medicaid-enrolled children in Wards 7 and 8.

The Community Dental Health Coordinator is a new and important role within the health care team, based on the American Dental Association model. In addition to oral health promotion and disease prevention, interactions consisted of talking directly with children and families who are at risk for dental disease but are unsure of how to access a dental clinic. My role was to function as the CDHC at two Children’s National Facilities THE ARC and Anacostia. In my two years of conversation with families I was able to learn more about the local issues and challenges to getting preventative dental care appointments.

What are some of the challenges?

Limited access to specialty services

Some young kids in have a limited ability cooperate in the dental clinic for treatment. Because of their limited ability to cooperate, the treatment can be difficult to start or complete. When a child is not able to cooperate during dental treatment in an office that offers basic behavior guidance, they are then referred to an office which is able to provide advanced options such as minimal to moderate sedation or general anesthesia.

There are five dental clinics that provide dental services to children in the Ward 7 and 8 communities. Only two of the five offices provide sedation and general anesthesia services, the other three do not. It was challenging to help some families when the resources within the communities were not able to meet the patient’s needs and the parent was not willing or able to travel to a dental office that would be able to meet their needs.

Dental Office Administration and Location

Some families were inconvenienced when dental offices would cancel appointments due to shortage of staff, ill or injured providers, or even permanent closure of a dental office. There were instances where the patient’s insurance was accepted by a dental provider but at the second dental visit the parent would be told the insurance was not in-network. These system errors caused the patient to have to find a dental provider and start the new patient process over again, after already taking the time to establish a dental home and treatment plan.

Parents were cautious of the areas they chose to make dental appointments. Most areas in the Ward 7 and 8 communities were high crime areas. Parents were concerned about theft, robberies, and violence. To give an example, at one of the dental offices I refer patient to a dental dentist was assaulted by an adult patient. This violent assault made parents feel uncomfortable to go back to that dental office because of safety reasons.

Work

Parents also had to choose between work and their child’s oral health. A parent could have started a new position that did not allow time off because of a probation period, or the parent did not have enough paid time off to be absent from work with pay. Single parents often had an additional challenge being able to get time off to ensure a guardian was present for the dental visit. Parents would often try to have a family member bring their child to the dentist in their absence, but some dental clinics policies prohibited anyone other than the parent or legal guardian from bringing the child to the appointment. Most parents asked about weekend appointments or after school hours, but each office I referred patients to was only opened on weekdays during typical business hours.

What are my lessons learned?

Parents want:

• Appointments to be available within 3-4 weeks of scheduling.
• A dental office that offers weekend and afterschool appointments.
• More options of dental offices in their communities
• Dental offices to be co located with their medical home.
• Dental offices that are close to home or near their child’s or children’s school.
• Dental offices in safe neighborhoods
• To have more dental providers that specialize in working with children with special needs and advanced procedures like sedation and general anesthesia