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Navigating the Dental Safety Net in San Francisco

Navigating the Dental Safety Net in San Francisco. Irene V. Hilton, DDS, MPH SFDPH Dental Services UCSF Department of Family & Community Medicine. Objectives. To understand the the Dental Safety Net in San Francisco

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Navigating the Dental Safety Net in San Francisco

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  1. Navigating the Dental Safety Net in San Francisco Irene V. Hilton, DDS, MPH SFDPH Dental Services UCSF Department of Family & Community Medicine

  2. Objectives • To understand the the Dental Safety Net in San Francisco • To identify appropriate dental referrals for routine dental care and for dental emergencies for DPH patients. • To learn what constitutes a dental emergency and how primary care staff can initiate management

  3. Course • Describe SF Dental safety net • Children • Emergency & Routine & Specialty • Adults • Pregnant & Non-pregnant • Routine & Specialty & Emergency • Dental Emergencies • Assessment & Management

  4. SF Dental Safety Net • FQHCs • SFDPH • NEMS • NAHC • SMHC • Dental Schools- UCSF & UOP • VA- Emergency only unless 100% service related disability • Clinic by the Bay • Dentists accepting DentiCal (≈ 40 offices)

  5. 2014 Changes • Prior to Jan. 1, 2014- estimate 200,000 adults w/o dental insurance in SF • Jan. 1, 2014- ACA adds all US born adults to MediCal- 15,000 new SFDPH enrollees will have dental benefits • May 1, 2014- California restores basic dental benefits for adult MediCal beneficiaries (cut July 2009)

  6. SFDPH Dental Services • Surveillance • K screening dental caries prevalence • Population based • CHDP case management • CCS handicapping malocclusion/orthodontics • School based sealant program • Clinical Services • 5 sites + YGC • Policy/Partnerships/Collaboration

  7. SFDPH Dental Clinics • 5 FTE dentists @ 5 sites + YGC • SAFHC & CPHC- children & perinatal • SEHC & PHHC- children & perinatal & adult • TW- Homeless & HIV, adult • SFGH Oral Surgery • UCSF managed collaboration • Extractions only, GA • Children & perinatal & adult

  8. SFDPH Basic Dental Care Provided Not Provided Dentures, partials, crowns, bridges, implants Surgical extractions Root Canal - Posterior teeth Specialist care Sedation • Diagnostic • Preventive • Hygiene/cleaning • Fillings • Uncomplicated extractions • Emergency- open & drain infected teeth • Anterior root canal – SEHC & PHHC

  9. Chinatown Public Health Center (CPHC) Medical Respite and Sobering Center (Polk St) CHPY Larkin Street Clinic Maxine Hall Health Center (MHHC) Housing & Urban Health Clinic (HUHC) Medical Respite and Sobering Center (Fell St) Curry Senior Center Tom Waddell Health Center (TWHC) CHPY Cole Street Clinic Ocean Park Health Center (OPHC) San Francisco General Hospital Oral Surgery Clinic (SFGH OS) Castro Mission Health Center (CMHC) Potrero Hill Health Center (PHHC) Special Programs for Youth (SPY) Silver Avenue Family Health Center (SAFHC) Southeast Health Center (SEHC) CHPY Hip Hop to Health Clinic CHPY Balboa Teen Health Center CHPY Hawkins Clinic

  10. Interprofesssional Oral Health Competencies for Primary Care • Assess & evaluation oral health status • Preventive interventions • Educate & address concerns • Refer

  11. Training Curriculums • Smiles for Life www.smilesforlifeoralhealth.org • Oral Health Nursing Education and Practice (OHNEP) http://www.ohnep.org/ • A+merican Academy of Pediatrics http://www.ohnep.org/ • http://www.paeaonline.org/index.php?ht=d/ContentDetails/i/144233

  12. Accessing Care

  13. Children • SF has universal care- MediCal + Healthy Kids program • Any child 0-18 has access to health care coverage including dental • MediCal covers to age 21- HK does not

  14. Children- Routine & Emergency Dental Care • Public & private providers • Population desired since has payer source • Case management sometimes needed • CHDP list every 6 months- website

  15. Role of Primary Care • Discuss beliefs & attitudes that can be barriers to optimal oral health for kids • Tap water • “Just baby teeth” • Parent dental experience

  16. Children- Specialty Care Issues • Pediatric Dentistry- management issues • Age, amount of treatment, special needs • Only UCSF does GA • Orthodontics (age 11-19) • CCS provider panel • Refer to general dentist first • Oral surgery- SFGH wisdom teeth

  17. Adult Dental Care • Adults have huge pre-existing existing dental needs, especially if have not accessed care for several years • Most common dental diseases- cavities & gum disease- are chronic progressive conditions • Dental treatment $$$ because equivalent to ambulatory same-day surgery

  18. Return of Adult Denti-Cal! May 2014 • Returning • Exam/x-rays • 1 visit cleaning • Fillings • Front root canals • Prefab crowns • Full dentures • Staying- emergency Tx

  19. ACA & Adult Dental Coverage?

  20. Perinatal May 1, 2014 Full Scope MediCal Pregnancy Only MediCal Exam/x-rays Hygiene/cleaning Emergency • Exam/x-rays • Hygiene/cleaning • Emergency • Fillings • Front root canals • Prefab crowns • Full dentures

  21. Perinatal • SFDPH has been providing full DPH dental scope to perinatal clients, regardless of payer status • Only safety net provider offering this • Tremendous demand from out of network clients

  22. Perinatal- Routine & Emergency Dental Care • For in-network default is SFDPH clinics • Complete referral form & fax to clinic • https://www.sfdph.org/dph/files/MCHdocs/PerinatalOralHlthRefForm022009.pdf

  23. Role of Primary Care • Discuss concerns that may be barriers to optimal oral health for perinatal clients • Dental anesthesia • X-rays • Getting dental treatment

  24. Adults- Routine & Emergency Dental Care Full Scope MediCal No Dental Coverage SFDPH SFHN member- Discounted fees SFHN non-member- Emergency only VA- Emergency only Other SF safety net providers-sliding scale/discount • FQHCs • SFDPH- 5 sites • NEMS • NAHC • SMHC • UCSF & UOP • Dentists accepting DentiCal (≈ 40 offices)

  25. Oral Surgery Clinic @ SFGH • Monday-Wednesday-Friday • 9AM-11AM • 1PM-3:30PM • 206-8104

  26. What They Do • Extractions • Biopsies On call from ER • Reduction of fractures • Trauma • Acute infection management

  27. Who & How to Refer • Children • Emergent- trauma, swelling, pain • Routine- 0-5 with obvious need for extraction- broken teeth • General anesthesia • Routine- late teens with third molar/wisdom teeth

  28. Who & How to Refer • Perinatal • Emergent- trauma, swelling, pain • Routine- obvious need for extraction- broken teeth • MUST HAVE MEDICAL CLEARENCE/PERINATAL ORAL HEALTH REFERRAL FORM • May need follow-up to insure care

  29. Who & How to Refer- Adults Full Scope MediCal No Dental Coverage Self pay- same as MediCal Provider of last resort- medically indicated • Emergent- trauma, swelling, pain • Routine- obvious need for extraction- broken teeth • Wisdom teeth

  30. Acute Dental Emergencies • Trauma • Pain • Infection

  31. Soft Tissue Trauma • Intra-oral highly vascularized • Only suture if extensive • Antibiotic or tetanus if indicated • Soft diet • Analgesic

  32. Hard Tissue Trauma • Jaw fractures • Limited opening • Bite “off” • Refer to SFGH OS for reduction

  33. Tooth Displacement- Avulsion • Permanent tooth- hold the tooth by the crown (part of tooth which is above the gumline). • IF there is dirt on it rinse it under tap water (NEVER SCRUB), and immediately place it back in the socket • If this is impossible, the tooth should be placed in cold milk, special solution or wet gauze. To dentist ASAP

  34. Tooth Displacement- Avulsion • Studies indicate if tooth is re-implanted within one-half hour after the accident, 95% success rate for normal re-attachment and growth • Due to viability of periodontal ligaments which attach root of tooth to jawbone

  35. Other Tooth Trauma • Fractured crown • Intrusion • Extrusion • Refer to dentist

  36. Pain  Infection

  37. Occasional Pain • Occasional pain from decayed teeth or lost fillings is not a true dental emergency • However, if left untreated these could over time progress to the acute phase • Dental referral indicated

  38. Severe Constant Pain • Most frequently caused by trauma or infection in the tooth or gums • Analgesic- Rx’d or OTC • Dental referral indicated • Extraction most frequent treatment

  39. Localized Swelling • Limited to bone around infected tooth or • Draining fistula • If left untreated may progress to acute phase • Analgesic & antibiotic if appropriate • All swellings have to be definitively treated by removing the source of infection (extraction or root canal) • Dental referral indicated

  40. Acute Swelling • New or increasing facial swelling affecting the eyes or distention of the mandible • If other signs of infection are present i.e. fever, nausea, disorientation, malaise, blurring of vision or inability to swallow • Immediate referral to OS or ER

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