摘要：Dental caries is a potentially preventable infectious disease that, untreated, can cause significant morbidity requiring costly treatment. The Access to Baby and Child Dentistry (ABCD) program increases access to prevention and early treatment for Medicaid-eligible children aged younger than 6 years in Washington State. The program is a partnership of Washington Dental Service Foundation, the University of Washington School of Pediatric Dentistry, the state Medical Assistance Administration, and local stakeholders. Through training in pediatric dental techniques and enhanced reimbursement, ABCD equips and encourages dentists to serve young Medicaid patients. Family counseling increases oral care compliance and reduces no-show rates. Program evaluation demonstrates changing attitudes and behavior among participating families and dentists, with more young, low-income Washington children receiving oral health care. DENTAL CARIES IS THE SINGLE most common chronic childhood disease—5 times more common than asthma and 7 times more common than hay fever. 1 In Washington State, dental decay rates for 1- and 2-year-olds are substantially higher than national rates. 2 (p5) Children from low-income families are at higher risk for oral disease and often have difficulty accessing dental care. 2 (p6) More than 230000 Washington State children younger than 6 years old were enrolled in Medicaid during 1997, but fewer than 1 in 4 actually saw a dentist. 3 The Access to Baby and Child Dentistry (ABCD) program was initiated to address the high incidence of oral disease and limited access to dental services among young, Medicaid-eligible children in Washington State. The goals are to increase access to prevention and early treatment for these children and thereby improve their lifelong oral health. ABCD, which began in Spokane County in 1995, is a statewide partnership of health districts, local dental societies, community health advocates, the University of Washington School of Pediatric Dentistry, the state Medicaid program, and the Washington Dental Service Foundation (WDSF). Private dental practices provide services to Medicaid-enrolled children younger than age 6; local health jurisdictions identify and enroll families. Dentists are trained in early childhood dental techniques and paid enhanced reimbursement rates by the state Medicaid administration, respectively mitigating providers’ hesitance to treat young children and the financial disincentive to participation. Dental offices receive sensitivity training and often have multilingual staff and materials available to reduce cultural barriers. Services provided in a typical ABCD visit include a periodic oral examination and family oral health education, along with fluoride varnish application and restorative procedures if warranted. Client families are provided counseling aimed at reducing the number of no-shows, increasing home care compliance, and promoting prevention (e.g., by encouraging children’s first dental visit before their first birthday or with the eruption of their first tooth). Highly conducive to replication, ABCD now operates in 20 Washington counties. Programs in each county differ as they are adapted to local communities, but key implementation elements and stakeholder roles are common to all and include the following: A state Medicaid program willing to (1) support this cost-effective program, including establishment of an enhanced Medicaid fee schedule to attract participating dentists, and (2) contract with a local government agency to collect federal administrative matching funds for program operation. Pediatric dentists (usually from a dental school) willing to develop and deliver training in nontraumatic, early pediatric techniques, as well as to offer certification and peer consultation. A local health district or nonprofit organization for administering the program on a daily basis, including client outreach, case management, and program promotion (government agencies are eligible for federal matching funds). A local dental society to encourage its members to become ABCD providers. An oversight task force, composed of key stakeholders, for strategic planning and general guidance. KEY FINDINGS Working together, public and private stakeholders can improve access to oral health care for low-income children. Multiple interventions (pediatric training, enhanced reimbursement, client coaching) for health care providers encourage greater involvement in oral health promotion and decay prevention, and expand the number of providers willing to treat young children and low-income patients. Multiple interventions for patients/clients (greater access, case management, oral health instruction) can diminish economic and cultural barriers to care while empowering parents to care for their children’s oral health. Multifaceted program assessment has shown that more economically disadvantaged children are seeing oral health care providers at an earlier age, and parents understand that good oral health is essential to good overall health.
