The School of Dentistry and three other organizations across the state will join forces in an effort to develop a comprehensive interprofessional program to reduce the burden of childhood dental disease in Michigan.

The effort is made possible by the U.S. government’s Center for Medicare and Medicaid Innovation, which has awarded a $9.4 million grant to the Altarum Institute in Ann Arbor and collaborators including the School of Dentistry, Delta Dental of Michigan and the Michigan Department of Community Health.

The project will test a service delivery model with four important components:

Dr. Margherita Fontana will provide her expertise in clinical research and childhood caries management and oversee U-M staff and faculty involved in the project. (Photo by Jerry Mastey)

• Direct work with primary care providers and dentists to identify children at risk.

• Promoting evidence-based preventive care in medical settings.

• Developing and enhancing health information technologies for referrals between dentists and pediatricians.

• Implementing a statewide quality monitoring system.

Dr. Margherita Fontana, a professor of dentistry with an extensive clinical research background in childhood caries management, including risk assessment, will provide her expertise and oversee U-M staff and faculty involved in the project.

A professor in the Department of Cariology, Restorative Sciences and Endodontics, Fontana will help evaluate and select the oral health screening approach to use as well as support the development of training materials for pediatricians. She will also help develop information and education materials for patients and their families.

Fontana will oversee a pilot clinical program that involves patients, their families and oral health care providers at Mott Children’s Health Center in Flint. The center provides oral health care services to Genesee County residents, from birth through age 18, whose families fall within 200 percent of the federal government’s poverty guidelines (annual income of less than $47,700 for a family of four).

She also will serve as a consultant in developing the statewide monitoring system that will provide feedback to individual providers on their performance relative to their peers.

Fontana said research shows that in some parts of the country, as few as 25 percent of children saw a dentist during the past year. In 22 states, including Michigan, less than half of children covered by Medicaid received any dental care in 2011.

“For example, on average, 25 percent of Michigan Head Start children had unmet dental treatment needs, 30 percent had caries and 23 percent had untreated caries lesions,” she said.

“Dental caries is an infectious, progressive but yet preventable disease,” Fontana said.  “Left untreated, the disease often has broad dental, medical and quality of life consequences, especially for very young children.”

Fontana said the four organizations involved “represent a unique coalition of interested groups whose focus will be on interprofessional prevention of this disease, because prevention is always less costly, in the long run.”  

While childhood dental caries is relatively inexpensive to prevent, dental decay is the most prevalent chronic condition among children in the U.S. and the most common unmet health care need of poor children across the country and the state.

Fontana noted that as much as 80 percent of caries is experienced by only 20 percent to 25 perent of the population, and that children from the lowest socio-economic groups experience caries at significantly higher rates and at younger ages than their peers.

The National Health and Nutrition Examination Survey showed that rates of early dental caries of children ages 2-5 increased from 24 percent (1988-1994) to 27 percent (1999-2004).