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Iowa Plan: Dental Public Health in Iowa. Bob Russell, DDS, MPH Iowa Department of Public Health. Title V MCH Service Areas. Partners. Within each county are multiple agencies (local public and private/non-private a gencies) that serve families: County health departments

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Iowa plan dental public health in iowa

Iowa Plan: Dental Public Health in Iowa

Bob Russell, DDS, MPH

Iowa Department of Public Health


Within each county are multiple agencies (local public and private/non-private agencies) that serve families:

  • County health departments

  • Public health nursing services

  • Home health care agencies

  • Visiting nurse services

  • Community action programs

Assessment examples
Assessment Examples

  • Open Mouth Surveys

  • Medicaid Services

  • Title V Databases & Reports

  • Public Health Supervision Reports

National trends in caries free schoolchildren permanent teeth
National Trends in Caries-Free Schoolchildren – Permanent Teeth

Ages 5-17 years

Ages 6-19 years

Iowa untreated decay is decreasing
Iowa: Untreated decay is decreasing

Iowa adults
Iowa: Adults

Penetration of public health sealant programs in iowa
Penetration of Public Health Sealant Programs in Iowa

  • 79 elementary schools

    • Total: 990 elementary schools

  • 21 Junior High Schools

    • Total: 299 Junior High Schools

  • 9,941 Sealant placed on 1st molars in 2009-10

  • 2,381 sealants placed on second molar teeth


Decay Negative

Decay Positive

  • 37.8% from East Central Iowa

  • 22.2% Rural (Not adjacent to urban)

  • 70.5% white, 16% unknown race/ethnicity

  • 85.2% spoke English

  • 95.5% had a Medical Home

  • 61.2% had a Dental Home

  • 49.9% Males

  • 73.5% were younger than 5

  • 29.9% from East Central Iowa

  • 29.1% Rural (Not adjacent to urban)

  • 66.7% white, 16% unknown race/ethnicity

  • 80.5% spoke English

  • 92.2% had a Medical Home

  • 69.3% had a Dental Home

  • 52.7% Males

  • 56.8% were younger than 5

Iowa a state in transition

Iowa: a State in Transition

Demographic Trends

Rapid Ethnic Diversification

Aging white population

Low fertility rates among whites

Exodus of graduates to other states

Higher birth rates among native minorities

Large influx of immigrants, primarily

Latinos, to work in labor shortage

Iowa implications of changing demographics
IowaImplications of Changing Demographics

  • Need for increased outreach services

  • Need for new service hours

  • Child Care barriers

  • Geographic and transportation barriers

  • Different health care utilization patterns

The iowa picture
The Iowa Picture

  • We have stated that 92% of Iowans are receiving optimally fluoridated water. What does this % really mean?

  •  92% of Iowans who receive their water from a Community Water Supply are receiving optimally fluoridated water.

  •  Overall, approximately 83% of Iowa’s total population is receiving optimally fluoridated water. 

  • This percentage may actually be higher depending on if the population who receives their water by a private well has naturally fluoridated water or is adding fluoride to their water.

  • We have no system for tracking private wells or monitoring leaving over 248,205 estimated Iowans potentially lacking fluoridated water!

I smile an overview of iowa s dental home initiative for children
I-SmileAn Overview of Iowa’s Dental Home Initiative for Children

Bob Russell, DDS, MPH

State Public Health Dental Director

Iowa Department of Public Health

2005 legislative mandate
2005 Legislative Mandate

By July 1, 2008, every recipient of medical assistance who is a child 12 years of age or younger shall have a designated dental homeand shall be provided with the dental screenings and preventive care identified in the oral health standards under the EPSDT program.

Iowa legislative mandate modified
Iowa Legislative Mandate Modified

By December 31, 2010, every recipient of medical assistance who is a child 12 years of age or younger shall have a designated dental home and shall be provided with thedental screenings and preventive services, diagnostic services, treatment services, and emergency services as defined under the EPSDT program.

* Language modified in 2008, HF2539

Conceptual dental home
Conceptual Dental Home

The dental home is a systemthat allows all children, even those often excluded from receiving dental care, to have early and regular care to ensure optimal oral health.

The i smile dental home
The I-Smile Dental Home






I smile objectives

  • Improve the dental support system for families.

  • Improve the dental Medicaid program.

  • Implement recruitment and retention strategies for underserved areas.

  • Integrate dental services into rural and critical access hospitals.

I smile strategies
I-Smile Strategies

  • Partnerships and planning

  • Link with local board of health

  • Provide training for child health agency staff

  • Develop agency oral health protocols

  • Provide education and training for health care professionals

  • Ensure completion of screenings and risk assessment

  • Ensure care coordination services

  • Ensure provision of gap-filling preventive services

Improve d ental support system for families
Improve Dental Support System for Families

Strengthen Iowa’s Title V MCH System

  • Establish a dental hygienist within each Title V Child Health agency as the local I-Smile Oral Health Coordinator

  • Currently, Iowa has 24 dental hygienists working as regional I-Smile™ Coordinators

  • They create a system to assure optimal oral health for children.

Iowa plan dental public health in iowa

I-Smile Referral System

Iowa plan dental public health in iowa

I-Smile Dental Home Care Plan Diagram


Oral Health Coordinator

Oral Screening and Risk Assessment

Preventive Care


Medicaid, uninsured, and underinsured children from birth-12 years

Level 1Level 2Level 3

Low Risk

No observable disease

Moderate Risk

No observable disease

High Risk

Observable disease

High Risk







I smile challenges
I-Smile--Challenges Human Services

  • Still too many children under the age of 3 who do not receive dental services.

  • Lack in dentists willing to see the very young child.

  • Low participation by dentists willing to see Medicaid children.

  • Low Medicaid reimbursement.

  • Decreasing and aging dental workforce

  • Mal-distribution of available dental providers

I smile sustainability
I-Smile--Sustainability Human Services

  • Promote children’s oral health to parent’s and caregivers.

  • Support gap-filling preventive services within public health and Title V agencies.

  • Maintain partnerships with early childhood programs.

  • Share information with stakeholders in anticipation of a changing health care system within Iowa.

  • Continue to support “health homes” by collaborating with medical providers to include oral health as part of well-child care.

  • Explore funding and collaborative opportunities with private organizations so that oral health becomes a priority statewide.

I smile future
I-Smile™ Future Human Services

Good oral health for all children beginning at birth

Long-term savings in dental care costs

Improved overall health of Iowa children and adults

Dental screening requirement
Dental Screening Requirement Human Services

(became effective July 1, 2008)

A critical step in “closing the gap” in access to care for underserved children

Dental screening requirements
Dental Screening Requirements Human Services

  • Elementary school

    • Prior to age 6, but no earlier than age 3

    • Licensed physician, physician assistant, nurse, dental hygienist, dentist

  • High School:

    • Within one year of enrollment

    • Licensed dental hygienist or

    • dentist

Integration with i smile
Integration with I-Smile™ Human Services

What if a child has a problem getting a screening?

What if a problem is detected and a child doesn’t have a dentist?

Contact local I-Smile Coordinator

S upervision
S Human Services upervision

Dental hygienist providing direct care services in Iowa must work under the supervision of a dentist. In public health settings, this would be either public health or general supervision.

Public health s upervision
Public Health Human Services Supervision

  • Recommended by IDPH, this allows hygienists working in a public health setting to provide services without the patient first being examined by a dentist.

    *Dentists providing public health supervision arenot required to provide future dental treatment to patients served by the hygienist.

Iowa plan dental public health in iowa

Requirements for Practice as a Public Health Supervision Hygienist (PHSH)




Some services required to maintain Public Health Status:

Iowa plan dental public health in iowa

Practice as Public Health Supervision Hygienist– Hygienist (PHSH)

What Else Do I Need to Know?

General supervision
General Supervision Hygienist (PHSH)

  • A dentist is required to see a patient prior to a dental hygienist providing certain services under general supervision

    • Sealants

    • Prophylaxis

    • Radiographs

Public health s upervision1
Public Health Hygienist (PHSH)Supervision

Currently, a hygienist must have an Iowa license and a minimum of threeyearsof clinical experience to work under public health supervision.

Loan repayment
Loan Repayment Hygienist (PHSH)

Two options:

  • National Health Service Corps – federal program

  • State Loan Repayment Program (called PRIMECARRE)

    Site criteria:

  • For PRIMECARRE, must be public or non-profit; NHSC also allows for-profit

  • Federal Health Professional Shortage Area (found at

  • Sliding fee scale, accept Medicaid and Medicare

Applicant eligibility
Applicant Eligibility Hygienist (PHSH)

Full-time or half-time (meet definition)

U.S. citizen

Education-related debts

No unfulfilled practice obligation to federal, state, local government or other entity (such as employer)

Certification or license to practice in Iowa

Serve all patients regardless of ability to pay

Eligible professions
Eligible Professions Hygienist (PHSH)

  • Primary care physician

  • Dentist

  • Dental Hygienist

  • Physician Assistant

  • Nurse Practitioner

  • Certified nurse Midwife

  • Clinical Psychologist

  • Clinical Social Worker (LISW only)

  • Psychiatric nurse specialist

  • Mental Health Counselor

  • Marriage and Family Therapist

Iowa plan dental public health in iowa

Thank you! Hygienist (PHSH)

Dr. Bob Russell, DDS, MPH

Public Health Dental Director

(515) 281-4916

Iowa Department of Public Health

Oral Health Center

Lucas State Office Building

321 East 12th Street

Des Moines, Iowa 50319


References Hygienist (PHSH)

Institute of Medicine, National Academy of Sciences. The Future of Public Health. Washington DC; National Academy Press; 1988.

Public Health Functions Steering Committee. Public Health in America. Washington, DC: PHS; 1995.

CDC. Ten Great Public Health Achievements - United States, 1900-1999. MMWR. 1999;48(12); 241- 243.