Why focus on preventive oral health?
According to the 1998 Ohio Family Health Survey, dental care was the number one unmet health need of all adults and children. For these medically underserved populations, lack of providers, transportation and oral health literacy also present significant barriers to care. Left untreated, oral diseases impact productivity, increase oral health care costs, reduce employability, decrease overall health and can result in pain, malnutrition, disfigurement, and even death.

And while dental care still remains the top unmet health need for Ohio’s children and low-income adults of Hispanic and Latino descent, HPF-Ohio's oral health initiatives have helped lay the groundwork — both in its service area and statewide — for enhancing access to dental care and improved oral health status.

About the oral health initiative
HPF-Ohio began its preventive oral health initiative in 2000. To date, more than $7 million has been awarded to organizations and programs serving 26 Ohio counties. From that funding, more than half has been awarded for the start-up, expansion, renovation and operating support of safety net dental clinics (SNDCs). Specifically, eight new SNDCs have been established and five existing clinics have been expanded/restored to serve low-income and medically underserved populations.

“HPF-Ohio has put forth a tremendous amount of time and effort to increase access to dental care in Ohio,” said Mark Siegal, DDS, chief, Ohio Department of Health’s Bureau of Oral Health Services. “The number of SNDCs has grown substantially since HPF-Ohio has formed, largely due to the increased visibility HPF-Ohio has brought to the issue of oral health. In the late ‘90’s, there were roughly 75 SNDCs — today that number has grown to more than 100. HPF-Ohio’s leadership role has definitely fertilized the ground for collaboration and created a statewide momentum in advancement of preventive oral health efforts.”

The importance of collaborations truly cannot be overlooked. Partnerships with various community and state organizations have allowed HPF-Ohio grantees, and the foundation itself, to leverage significant additional funding for ongoing preventive oral health initiatives. In fact, HPF-Ohio grantees report that they have secured nearly $5.7 million to help support HPF-Ohio funded projects.
 
Oral Health Capacity Building (OHCB)
In 2006, HPF-Ohio, in collaboration with the Ohio Department of Health (ODH), Osteopathic Heritage Foundation, and the Sisters of Charity Foundations of Canton, launched the OHCB project. The foundations wanted to approach the issue of SNDC sustainability in a more comprehensive manner by looking at various processes, organization structure, and use of resources. HPF-Ohio’s investment of more than $1.1 million has focused on technical assistance, capacity building and operational improvements. In 2010, HPF-Ohio will provide funding for up to an additional four sites to participate in the OHCB project.

Additional components of the OHCB program include $112,000 in funding awarded to the National Maternal and Child Oral Health Resource Center at Georgetown University to design and maintain a Web-based Ohio Dental Safety Net Information Center (ODSNIC) site. A comprehensive Web site used by dental safety net professionals, ODSNIC provides mutual support, technical assistance, information and linkage to resources, as well as long distance learning opportunities. HPF-Ohio also sponsored the 2007 Ohio Dental Safety Net Summit. The summit provided another opportunity to share information on best/promising practices and to develop a shared agenda for moving the issue of oral health forward in the future. 

Early Childhood Oral Health Initiative (ECOH)
According to a report released in March 2007 by the Ohio Department of Health (ODH), 23 percent or 670,000 Ohio children are uninsured for dental care. And compounding this matter, three out of four Ohio dentists do not participate in Medicaid. This sad reality inspired the start-up of HPF-Ohio’s Early Childhood Oral Health (ECOH) Initiative. This multi-year grant of more than $1 million was awarded to the Ohio Association of Community Health Centers (OACHC) and focuses on the provision of early childhood preventive oral health services in a primary care setting as part of well-child visits. It includes an emphasis on oral health screenings and fluoride varnish applications for young children, as well as oral health education for their primary caregivers.

“There is a tremendous problem in accessing dental care,” explained Shawn Frick, president and CEO of the OACHC. “The ECOH Initiative addresses this problem by teaching appropriate medical professionals to apply fluoride varnishes, thus expanding the oral health workforce. The impact of this initiative has been far reaching. To date, eight networks covering about 25 sites are participating in the ECOH Initiative, which will continue through 2013.”

Have our preventive oral health efforts been successful?
HPF-Ohio is proud to report that its preventive oral health efforts have provided funding for initiatives that have led to both organizational and system-level change. Some examples include:

• The release of HPF-Ohio’s “Oral Health” white paper served as a catalyst for Hamilton County, as well as other parts of Ohio, to make oral health a top priority. 
• HPF-Ohio’s sponsorship of the first statewide Summit on Oral Health led to the creation of the Ohio Coalition for Oral Health (OCOH) which provides statewide oral health advocacy, leadership and education.
• OCOH's advocacy advocacy and education efforts have played a critical role in minimizing cuts to Medicaid reimbursement for adult dental services.
• HPF-Ohio’s pioneering work in “funded fluoride varnishes” provided a roadmap for other primary caregivers to implement similar programs in Ohio. It also contributed to Ohio Medicaid’s decision to allow primary caregivers to receive payment for providing fluoride varnish applications. Finally, the ODH has developed the “Smiles for Ohio” fluoride varnish training program.
• Case-management and referral programs have resulted in an increased number of private- practice dentists that will accept Medicaid patients and offer pro bono services.
• The Health Policy Institute of Ohio (an HPF-Ohio grantee), in collaboration with the ODH, convened the Ohio Dental Workforce Roundtable. The roundtable was a statewide effort that explored dental workforce issues and developed recommendations for how to increase access to dental care.
• Through HPF-Ohio’s funding to the OACHC for the ECOH Project, 3,455 children have received fluoride varnish applications as part of their well-child check-ups.