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We Are Public Health - July 2016

We Are Public Health, July 2016

We Are Public Health

This story features the work of the Montana State University Nurse Practitioner Program and Sealants for Smiles!. Photos courtesy of Sealants for Smiles! and Michelle Trost.

We are public health.
We increase access to oral health care for underserved children.

Tooth decay is the most common chronic disease among children—leading to pain and problems with eating, socializing, school attendance, and academic performance. Left untreated, it can lead to systemic infection and even death. While tooth decay is preventable through early preventive care, large disparities exist for minority and low-income populations, many of whom face difficulty accessing dental care and chronic dental problems as adults.

In Montana, 88 percent of third grade students attending the lowest income schools experience decay. Challenges in access to dental care is compounded by the fact that many cities in Montana do not fluoridate their drinking water—a highly recommended, evidence-based community intervention—making other prevention methods more crucial than ever. Sealants for Smiles!, a Montana school-based oral health improvement program, helps fill this need by providing no-cost exams and tooth decay preventing interventions such as dental sealants and fluoride varnish treatments. The program has been operating for five years throughout Montana, including one elementary school in Yellowstone County, where 70 percent of the students participate in the federal Free and/or Reduced Lunch Program.

To enhance the success of Sealants for Smiles! at the Yellowstone County elementary school, Michelle Trost, DNP, FNP-BC, RN, designed a project for her Nurse Practitioner Program at Montana State University (MSU), which focused on improving the efficacy of the program through incorporating additional fluoride varnish treatments and increasing access to dental treatment. Trost used the National Association of School Nurses’ Framework for the 21st Century School Nursing Practice as the guiding principle for her work. Her project is part of a larger integration of oral health care and nursing at MSU. The Nursing Department has incorporated oral health care into the curriculum and research of its undergraduate and the nurse practitioner programs.

“Somewhere along the line, medical practitioners and dentists started treating oral health as a separate entity, so it is wonderful to see programs like MSU’s, which understand the implications and interconnection of oral health with the health of the rest of the body,” said Dr. Jane Gillette, DDS, one of Trost’s project advisors and Director of the Sealants for Smiles! Program.

For her project, Trost leveraged the data collected during a Sealants for Smiles! oral health screening event at the Yellowstone County elementary school to identify students at risk for tooth decay. Students who had previously been treated but were still at high risk for disease were offered additional tooth decay preventing fluoride varnish treatments. Additionally, for students with untreated tooth decay, Trost partnered with the Ronald McDonald Care Mobile who provided onsite restorative dental care. Trost and her fellow school nurses applied a second application of fluoride varnish to 39 students and nine students received professional restorative dental treatment onsite at the school via the Ronald McDonald Care Mobile.

“Coordinating care for unmet dental needs with partners was the key to extending our reach to these students and further improving access to oral health care services,” said Trost.

School nurses employed by the Yellowstone County school district played a vital role in increasing access to preventive oral health care services by providing fluoride varnish treatments to children. Participating school nurses received training in pediatric oral health by completing the Smiles for Life Oral Health Curriculum. Trost also led an in-service learning day where the nurses received hands-on training in applying fluoride varnish.

“The great thing about this model is that you don’t have to be an oral health care provider to help these students in need—you can be a school nurse,” said Trost. “Time away from class for a school nurse to apply fluoride varnish is less than five minutes per child, and students with unmet dental needs can be case managed.”

Trost and Gillette presented their findings to the Montana School Nurse Association at the fall 2015 Montana Education Association meeting, and many schools expressed interest in implementing the practice model.

“Because of Michelle’s project, we were able to secure a $50,000 Montana Health Care Foundation grant in May, 2016 which will help spread the practice model she developed to other schools in the state,” said Gillette.

The Butte school district, as well as school nurses in Park County will be among the first to adopt the model with others to follow suit. In the future because of the grant award, a School Nurse Fluoride Varnish Program Manual and Reimbursement Toolkit will also be produced to assist school nurses in the implementation and sustainability of school nurse led fluoride varnish programs throughout Montana.