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The “Into the Mouths of Babes” (IMB) program trains medical providers to deliver preventive oral health services to high-risk children who receive N.C. Medicaid. Services are provided from the time of tooth eruption until age 3-1/2 (42 months), including oral evaluation, parent/caregiver education, and fluoride varnish application. The goal is to reduce the incidence of early childhood tooth decay in North Carolina. The provider is reimbursed through N.C. Medicaid.
Our data show that Medicaid-covered children receiving the procedure have fewer caries-related treatments in dental offices than enrolled children not having IMB preventive services. Children having 4, 5, or 6 IMB visits before their 3rd birthday have the most benefit.
1. ORAL EVALUATION
2. COUNSELING WITH PRIMARY CAREGIVERS
3. APPLICATION OF TOPICAL FLUORIDE VARNISH
Application of fluoride varnish can be compared to having a fluoride treatment at the dental office. Fluoride varnish is safe because such a small amount is used and it adheres to the teeth until it is brushed off.
Medicaid-covered children can have the procedure a maximum of six times from tooth eruption until the age of 3 ½. The procedure is recommended every 3 to 6 months and is most successfully incorporated as part of a well child visit. Medicaid requires a 60-day time interval between procedures.
Training consists of a standard 1-1/4 hour American Medical Association (AMA) approved continuing medical education (CME) session. In addition to providing training on oral evaluation, parent counseling, and fluoride varnish application, the training includes information on Medicaid billing, an “oral health toolkit” containing helpful resources, and a starter kit with supplies for 10 procedures. Information for ordering subsequent supplies is included as well.
The medical provider conducting the oral evaluation portion of the procedure must be a physician, physician assistant, or nurse practitioner. In public health clinics a registered or licensed nurse can perform the procedure with standing orders. Oral and written parent/caregiver counseling is also a required part of the preventive procedure and includes information about the importance of parents brushing their child’s teeth with fluoride toothpaste and starting dental visits early. Post-operative instructions tell parents to wait and brush their child’s teeth the next day after the varnish is applied. This gives the fluoride varnish more contact time with the tooth surface, strengthening the tooth enamel.
The procedure may be documented on a provided encounter form or directly in the patient chart. Documentation should include the three parts of the procedure, any noted disease or abnormalities, and if the provider referred the child to a dentist.
As a partner in the Project, N.C. Medicaid reimburses medical providers for the three-part procedure. A child can have the procedure a total of six times from tooth eruption until the age of 3 1/2 (42 months).
Medicaid reimbursement is approximately $52 for each of the six visits.
Time involved providing the three-part service depends on the child’s age and tooth eruption patterns, but the average is five minutes.
Toolkit for Into the Mouths of Babes Participants
For more information about IMB contact Kelly Close, 919-707-5485.
The Into the Mouths of Babes N.C. Dental Screening and Varnish Project is the collaborative effort of six partners: The N.C. Academy of Family Physicians, the N.C. Pediatric Society, the N.C. Division of Medical Assistance, the N.C. Oral Health Section, the UNC-CH School of Dentistry, and the UNC-CH Gillings School of Global Public Health.
Initial and continued grant funding has been provided by the Centers for Disease Control, the Center for Medicare and Medicaid Services, the Health Resources and Services Administration (HRSA), HRSA State Oral Health Collaborative Systems, and most recently, HRSA Targeted State MCH Oral Health Service Systems Grant Program. The IMB program is now part of the N.C. Department of Health and Human Services, Oral Health Section, and continues to collaborate with the partner agencies.
