Waukesha Smiles: Dental Outreach to Low-income Waukesha Children

A. HYPOTHESIS / SPECIFIC AIMS: The purpose of Waukesha Smiles: Dental Outreach to Low-income Children will be to improve oral health habits and increase access to primary and preventive dental care for low-income children in the city of Waukesha.

The typical forms of dental decay seen in children, also called dental "caries," are the result of a transmissible infectious disease process that is enabled by poor oral hygiene and dietary choices.1-5 When unchecked, this process leads to pain and tooth loss, which can in turn lead to disfigurement, self-esteem problems, impaired nutrition, and even systemic disease.3, 6 Access to basic dental care and good oral health habits can reduce preventable dental disease and these associated outcomes.7 However, poor oral health habits are more prevalent among children from lower socioeconomic strata.7-9 And limited access to primary/preventive dental care is common for low income and/or minority children, and represents a major health risk for these specific populations.9, 10 Self-pay for care is a major barrier for low-income families.9, 10 Children with Title 19-related dental insurance (Medicaid) also face similar barriers from limited provider acceptance of this program: due to low levels of reimbursement many dentists in the Waukesha area limit the number of Title-19 patients in their practices, and some do not accept this insurance at all.10, 11 Furthermore, adequate access to dental care alone is not sufficient to assure oral health: regular dental visits cannot compensate for poor oral health habits.

The Waukesha County Dental Clinic (WCDC) will open in January 2008 with a mission to serve low-income uninsured and underinsured county residents. This new clinic will serve a critical function in our community. However, despite the increased access to care that the Waukesha County Dental Clinic will provide, we expect that many eligible low-income Waukesha children will still not receive needed dental care for a variety of reasons. These include: lack of awareness of the clinic; persistent concern about financial burdens; lack of understanding about the benefits of routine dental care; logistical barriers; and language and cultural barriers. Moreover, we expect that if basic oral health habits could be improved in Waukesha children, the need for anything but preventive dental care would diminish.

We hypothesize that an Educational Intervention, consisting of brief monthly classroom presentations on oral health plus monthly distribution of a new toothbrush and tooth paste, will lead to improved oral health outcomes among low-income 3rd grade students when compared to a Referral Intervention wherein children will receive a detailed referral and assistance finding a dentist after an oral health screening exam. Our primary outcomes are rates of untreated dental caries, and the proportion of children needing early or urgent dental care.

B. DESIGN/ METHODS: Aim/Objective 1: Assemble a cohesive study team, including parent advisory board and bilingual study staff for oral health outreach interventions.