Good habits start young, making pediatric dentistry the foundation of a lifetime of oral health. Yet many children lack education about and access to dental care. Thanks to a $2.4 million federal grant, the Virginia Commonwealth University (VCU) School of Dentistry hopes to improve its efforts in treating at-risk pediatric patients.
The 5-year grant from the US Department of Health and Human Services Health Resources and Services Administration will fund the development of a new interprofessional curriculum, provide funds for teledentistry equipment, and expand the pediatric dental residency program at two clinical care sites. Approved by the Commission on Dental Accreditation for 6 slots a year, the 2-year program accepts 4 to 6 students each year.
“The grant will help initiate a curriculum that integrates interprofessional education and collaborative care into the pediatric dentistry residency training program, with an emphasis on treating low-income populations and children with complex healthcare needs,” said Tegwyn H. Brickhouse, DDS, PhD, department chair, research director, and associate professor of the department of pediatric dentistry at the VCU School of Dentistry.
The new curriculum will let pediatric dentistry residents participate in the VCU Center for Interprofessional Education and Collaborative Care’s educational programs at the Children’s Hospital of Richmond at VCU and the Piedmont Regional Dental Center in Orange, Va.
“The Richmond site was chosen because at the Children’s Hospital of Richmond at VCU Brook Road Campus, there is a large population of children with complex health needs,” said Brickhouse. “That campus runs many programs such as a feeding program, a craniofacial team, physical therapy, and occupational therapy where the residents can collaborate easily with the other disciplines beyond what is in a dental school setting.”
The Piedmont Regional Dental Center was selected because it serves a rural population of low-income children. It is a safety-net practice, which means it is a nonprofit practice that has a sliding fee schedule or a lower fee schedule than private practices.
These residents will participate in the treatment planning of virtual cases with other medical residency programs including nursing, social work, and pharmacy. Then, they will have clinical experience of this type of collaborative care in a children’s hospital setting, Brickhouse explained.
“Residents feel they find out so much more about how to approach a patient once they have partnered with other providers who interact with those same children,” she said. “They have a better understanding of the family’s expectations, medical conditions, and drug effects that interact with their oral health.”
The grant also will cover the cost of equipment such as a digital x-ray, digital sensors, and intraoral video cameras. The new technology will enable pediatric dentistry residents to provide consultation services for children at rural sites without necessitating a trip to a dental office—particularly the Custom iCart 200, which VCU based on teledentistry units now used at Eastern Carolina University’s satellite practices.
The Custom iCart 200 boasts a mounted InVisionCam with an integrated video teleconference system. It also features a motorized lift, a 24-inch LCD monitor, an integrated VTC HD codec, a microphone, a speaker, and a universal HDMI input. VCU plans on working with the vendor that has the best fit for the school’s needs to develop the cart.
Noting that tooth decay is the most common chronic disease of children, the Centers for Disease Control and Prevention (CDC) have found that the number of children with tooth decay in baby teeth is increasing. The reasons behind this increase are complex, Brickhouse noted. For example, she said, many caregivers aren’t aware of when they should start to brush their children’s teeth with toothpaste, nor do they know when they should schedule their first dental visit.
“Drinking bottled water and using filtration systems that remove fluoride from the community water systems also contribute,” she said. “Food is also becoming more packaged and processed for convenience, so there are high-sugar drinks and snacks such as gummies that are consumed multiple times a day by the average child.”
The percentage of children and adolescents aged 5 to 9 with untreated tooth decay is twice as high for those from low-income families compared to children from higher-income households, according to the CDC. Through interprofessional education, collaborative clinical training, and innovative use of dental technology, the residents and pediatric dentists at the VCU School of Dentistry will work to bridge that gap during the next 5 years.
“The hope is that we will be able to reach the approximately 50% of low-income children in Virginia who are not yet seeing a dentist,” Brickhouse said.
While tooth decay is the most common problem, conditions with dental complications such as ectodermal dysplasia and amelogenesis imperfecta are seen among the program’s patients as well. The program does not include orthodontics, but it does refer patients to the VCU orthodontic residency program, which also treats children at lower fees or who have Medicaid.
In February, the VCU School of Dentistry provided free dental services for more than 200 children in need of dental care who did not have dental insurance at the school’s annual Give Kids a Smile Day. The VCU Dental Care pediatric dental practice provides year-round specialty dental care for children from birth to the age of 18.
“The parents we reach through collaborating with pediatricians are so thankful to hear tips to help take care of their children’s teeth and that there is a pediatric dentist that they can see,” Brickhouse said. “They often are thinking so much about immunizations and their child’s growth chart that they have not thought too much about their oral health.”
