Challenges to Dental Home Establishment for Kentucky Head Start Children

OBJECTIVE: Establish dental outreach program providing preventive care to 600+ Head Start children in rural Kentucky and explore factors contributing to poor oral health of rural Appalachian children.

METHOD: The University of Kentucky contracted with a four-county Head Start program to provide preventive care on-site at each of 18 centers in rural Kentucky (examination, cleaning, and fluoride varnish every three months). Demographic and oral health data were collected via a tablet-PC program linked with the Kentucky Children's Oral Health Surveillance Program. Parents received a report card, three follow-up phone calls, and a final letter encouraging establishment of a dental home to complete comprehensive care.

RESULTS: Two years preliminary data shows 86% have Medicaid dental benefits. 78% of Medicaid children had untreated decay, compared to 51% in the non-Medicaid group. Medicaid children also had more severe decay, 33% urgent needs versus 23% in the non-Medicaid group.

Challenges were identified in follow-up and case-management of this population. Three visits occurred about 3-6 months apart. Only 49% of the children seen at the initial visit were available at the second visit, and only 16% were still enrolled the following school year (frequent absences and withdrawals). Despite multiple attempts to encourage follow-up care, only 20% of those examined more than once had received care. Over 40% of the children had worse conditions: 84 newly decayed teeth were charted in only 37 children, with an average of about 4 new decay lesions per child.

CONCLUSIONS: The efforts of this program have resulted in newly implemented strategies: children with urgent care needs will receive home visits from Head Start staff to encourage establishment of dental homes. New strategies to reach and educate parents are being explored, with a goal of increased utilization of Medicaid dental benefits and improvement in the oral health status of this vulnerable population via the establishment of dental homes.