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Into the Mouths of Babes/Connecting the Docs

Medical Providers: Partner with us to improve your child patients’ oral health

The Into the Mouths of Babes (IMB)/Connecting the Docs program trains medical providers to deliver preventive oral health services to high-risk children insured by NC Medicaid. Services are provided from the time of tooth eruption until age 3½ (42 months), including oral evaluation and risk assessment, parent/caregiver education, fluoride varnish application, and referral to a dental home as needed. The goals are to prevent and reduce early childhood tooth decay in North Carolina and refer children to a dental home. The medical provider is reimbursed through N.C. Medicaid.

Evaluation of the IMB/Connecting the Docs program is conducted by the UNC Gillings School of Global Public Health.

Highlights include:

  • high adoption rates by medical providers
  • 49% reduction in dental treatment needs before 18 months
  • 21% reduction in hospital episodes
  • at least  four IMB visits before the 3rd birthday have the most benefit

References:
Rozier et al. J Dent Educ. 2003;67:876-85.
Sterns et al. JAMA Pediatrics. 2012;27:1-7.
Pahel et al. Pediatrics. 2011:e682-9.

 

THE ORAL PREVENTIVE PROCEDURE

THE ORAL PREVENTIVE PROCEDURE CONSISTS OF THREE EQUALLY IMPORTANT PARTS:

1. ORAL EVALUATION and RISK ASSESSMENT

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 a small amount is used which adheres to the teeth until it is brushed off.

Medicaid-insured children can have the procedure a maximum of six times from tooth eruption until the age of 3½ (42 months). The procedure is recommended every three to six months and is most successfully incorporated as part of a well-child visit. Medicaid requires a 60-day time interval between procedures.

 

TRAINING

Training consists of a standard one-hour American Medical Association (AMA) approved continuing medical education (CME) session. The training provides information on oral evaluation, priority risk assessment and referral, parent counseling, and fluoride varnish application. Additionally, 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 and risk assessment 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. Counseling should include 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 the provided priority oral health risk assessment and referral tool (PORRT) or directly in the patient chart. Documentation should include the parts of the procedure, any noted disease or abnormalities, and if the provider referred the child to a dentist.

 

REIMBURSMENT

As a partner in the IMB/Connecting the Docs program, N.C. Medicaid reimburses medical providers for the procedure. A child can have the procedure a total of six times from tooth eruption until the age of 3½ (42 months).

Medicaid reimbursement is approximately $50 for each of the six visits.

Time involved providing the procedure depends on the child’s age and tooth eruption patterns.

 

N.C. TOOLKIT

Toolkit for Into the Mouths of Babes/Connecting the Docs Participants


IMB / Connecting the Docs: CONTACT INFORMATION

For more information about IMB/Connecting the Docs, contact Kelly Close at 919-707-5485 or Kelly.Close@dhhs.nc.gov

If your medical practice is part of a Community Care of NC network, you may contact your CHIPRA Quality Improvement Specialist for information about IMB/Connecting the Docs.

 

PARTNERSHIPS

The Into the Mouths of Babes (IMB) program began as 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.

Today the IMB/Connecting the Docs Program is guided by the N.C. Early Childhood Oral Health Collaborative, which includes the original six partners and additional partners N.C. Head Start and Early Head Start, East Coast Migrant Head Start Program, N.C. Partnership for Children, N.C. Dental Society, the ECU School of Dental Medicine and Community Care of N.C. 

Initial and past grant funding was 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.