Princess Health and Dr. Nikki Stone and mobile dental team in Hazard have helped cut tooth decay in the region 20 percent in a decade of operation. Princessiccia

Princess Health and Dr. Nikki Stone and mobile dental team in Hazard have helped cut tooth decay in the region 20 percent in a decade of operation. Princessiccia

children children's health dental care dental health oral health tooth decay

Gusty 14:03 Add Comment

By Ann Blackford
University of Kentucky

When Dr. Daria "Nikki" Stone, associate professor at the University of Kentucky College of Dentistry, became the director of the Ronald McDonald Care Mobile program in Hazard, she realized she was finally in the right place at the right time, where her piece of the puzzle fit in the big picture.

Growing up in Blackey, in Letcher County about 30 minutes from Hazard, she didn't know she wanted to be a dentist. She was always a good student and loved science classes in school but her passion had always been art. At her father's coaxing, she entered college as a pre-med major, and discovered through the UK Health Careers Opportunities Program that dentistry was a profession that merged her love of art and science.

Dr. Daria "Nikki" Stone (University of Kentucky photos)

"Now, I have a passion and love for what I do, preventing tooth decay in children in elementary schools, preschools and Head Start centers in Eastern Kentucky and advocating for underserved children," Stone said.

Stone married her high school sweetheart, Mark, and they have two children; Ana and Ian, 16 and 13. Her early career included part-time teaching and covering clinics in Prestonsburg and Hazard as a stay-at-home mom and working in New Mexico for the National Health Service Corps to retire a school loan. She got a transfer to be closer to family, and her last year with NHSC was just across the Kentucky border in Virginia.

She had been practicing dentistry for 10 years when UK hired her to head the Mobile Care program, coming full circle to the place she holds most dear.

"I love that I've been able to come home to Appalachia, there is no more beautiful place or more wonderful culture," she said. "I love the way my people talk and hug and laugh, and I love that we are a deeply spiritual people who are deeply connected to one another. My children are 10th generation Appalachians and I wouldn't want to raise them anywhere else."

UK's North Fork Valley Community Health Center's mobile dental outreach program celebrated 10 years of serving children in 2015. Stone has directed the program since its inception. She and several dental hygienists and assistants provide preventive dental care twice a year to 2,400 Head Start children in Perry, Knott, Letcher and Leslie counties and once a year to all public elementary schools in Perry and Knott counties. Children receive dental exams, cleanings, fluoride treatments, sealants and both classroom-based and individualized educational sessions. Dental education is also available to parents and teachers at various community events.

"Teaching is actually one of my favorite parts of my job," Stone said. "I also love the practical, day-to-day side of being with children, and I also love the philosophical aspect of why we're doing what we're doing. . . . Children are truly a blessing to work with; they are so very honest and keep us laughing all day. I love that we are preventing tooth decay before it starts and lowering the tooth decay rates in Eastern Kentucky, which has some of the highest rates of tooth decay in the nation."

Stone and patient Wyatt "Bebo" Goins at
Roy G. Eversole Preschool in Hazard

Tooth-decay rates in the center's service area have decreased nearly 20 percentage points, urgent dental needs have been cut in half, and treatment-completion rates for Head Start children with urgent dental needs have increased dramatically, from 8 percent to more than 60 percent.

"When the UK dental outreach team started seeing children in local schools and Head Start centers in 2006, over half the children in Perry County had untreated cavities and 20 percent had painful abscessed teeth," Stone recalled.

Stone said she has found her place in the world. "I once had a very spunky little girl come on the mobile unit and she was very excited to be there," she recalled. "She couldn�t stop talking and she spoke really fast, going from one topic to another without transition. She jumped up in the dental chair and asked me this question, 'Did you wish upon a star to be a dentist?' It really caught me off guard and I had to stop and think about it for a couple of seconds. I realized I probably had not ever wished upon a star to be a dentist, but for some reason God chose to bless me with the opportunity to be a dentist to this beautiful little girl anyway, and to provide preventive dental care services to over 10,000 children just like her who have come on the mobile unit in the past 10 years. And maybe some of them will wish upon a star to become dentists someday."

Princess Health and Health-care law addresses the most common chronic health problem in children, tooth decay, by requiring coverage for kids.Princessiccia

Princess Health and Health-care law addresses the most common chronic health problem in children, tooth decay, by requiring coverage for kids.Princessiccia

Affordable Care Act Cabinet for Health and Family Services Centers for Disease Control dental care dental health health insurance insurance insurance exchange teeth tooth decay

Gusty 11:34 Add Comment

Tooth decay is children's most common chronic health problem, and the 2010 federal health-care law addresses this problem by requiring insurers to cover pediatric dental services. But some advocates are concerned that the new benefits may not be sufficiently comprehensive or affordable, Michelle Andrews writes for The Washington Post.

She notes that by the time children enter kindergarten, more than a quarter of them have decay in their baby teeth. As they age, the problem gets worse and nearly 68 percent of those age 16 to 19 have decay in their permanent teeth, according the the Centers for Disease Control and Prevention. 
   
Beginning next year, the Affordable Care Act requires individual and small-group health plans cover pediatric dental services, unless a plan has a specific exemption under the law. Those services are already part of the Medicaid benefit package, but most Kentucky dentists don't accept Medicaid.
For the expansion to private insurance, "Coverage requirements will be determined by each state within guidelines set by the federal Department of Health and Human Services," Andrews writes.

Jill Midkiff, chief spokesperson for the Cabinet for Health and Family Services, said Kentucky is awaiting the publication of the final rule from HHS, which will define essential health benefits for each state and provide further guidance relating to coverage of benefits. Although no specific publication date for this rule has been announced, she said its release is expected within the next several weeks to allow insurers to modify existing health plans to be made available to individuals and small businesses for purchase through health exchanges by Oct. 1. (Read more)

Princess Health and New oral health coalition expected to spur changes in state.Princessiccia

Princess Health and New oral health coalition expected to spur changes in state.Princessiccia

dentistry dentists health policy oral health state law tooth decay

Gusty 06:10 Add Comment

By Tara Kaprowy
Kentucky Health News

For the past 30 years, Dr. Fred Howard of Harlan has been seating patients in his blue dental chair and telling them to open up. When they do, he's seen all kinds of scenarios, from toddlers whose teeth are already rotten from sucking on bottle filled with soft drinks to 20-year-old adults with no teeth at all. On some occasions, children walk in with such a severe abscess in their mouth their eyes are swollen shut.

Though the view can be grim, Howard said he has seen some improvements in his decades of practice, but with new changes in Medicaid managed care, the overwhelming prevalence of children and teens drinking soda pop and an embedded cultural belief in some areas that "teeth are just something to get rid of," Howard concedes that making headway can feel like one step forward and two steps back.

Enter the newly re-established Kentucky Oral Health Coalition, a statewide force whose goal is to ensure Kentuckians have happy, healthy smiles.

Dozens of organizers and stakeholders met in March to discuss the coalition's aims, and a membership drive is underway to build financial momentum. The coalition will promote oral health education, statewide partnerships statewide and advocate oral-health legislation. "I think they will turn into the advocacy group for dental change," said Dr. Julie McKee, dental director for the state Department of Public Health. "They're working hard to come up with a plan. They've got their heads on straight."

One of the major issues facing the dental profession is possible expansion of the scope of practice for mid-level providers, such as dental therapists who can assess, clean teeth, replace sealants, provide fluoride as well as fill cavities and extract teeth. As nurse practitioners do in the medical field, having such providers could help address shortages in rural areas, said Dr. Jim Cecil, former state dental director and coalition steering committee chair. The concept is in practice in 54 other countries, but the only U.S. states with it are Minnesota and Alaska, mainly because of opposition form dentists.

Andrea Plummer, coalition member and senior policy analyst for Kentucky Youth Advocates, acknowledged that scope-of-practice issues "can be a very tense subject" and "there would have to be buy-in" from members of the committee, who include dentists, but discussion is ongoing. Cecil said the issue is "something we'll need to look at and take a stand on eventually."

Howard (pictured with Gov. Steve Beshear at signing of the bill that requires dental exams for students starting school) favors the expansion, but doesn't feel Kentucky's oral-health problems can be solved just by putting more boots on the ground.

"The bottom line is: We can have twice as many dentists, have more dental hygienists, but if we don't change the mindset, if we don't provide the education, I don't think we're going to solve the problem," he said.

To that end, the coalition is also investigating ways to expand school-based health and dental education, either by finding funding, collaborating with groups that are already in place or advocating legislation changes, Plummer said.

A recently enacted state law requires children to get a dental screening before entering kindergarten, but there is little else in the way of legislation that requires schools to offer services to help students with dental problems, Plummer said. "Kentucky law says that students' health does affect their learning and schools should take steps to affect their learning but it's fairly broad," she said.

An analysis by KYA last year showed school districts spend less than 1 percent of their budgets on school health services.

Examining how to get more dentists to accept Medicaid patients is another hot-button issue. Of about 2,200 dentists statewide, only about 600 are enrolled in Medicaid, Cecil said, and "They feel like they're working for free" because of the program's low reimbursements. "In many cases, they're really not meeting overhead."

The administrative burden that comes with these patients has also gotten worse since Medicaid transitioned to managed care, Cecil said. "Everything they do has to be pre-authorized," he said. "That delays approval, delays treatment, delays payment."

Under managed care, Howard said, patients now need to come in twice to get a full complement of X-rays and radiographs done, which can not only make it hard on dental practices, but for patients as well. "The more times they have to come, that gives them more opportunities to miss appointments," Howard said.

The Oral Health Coalition also sees a need for "quality, updated data," Plummer said. Getting data was one of the successes of the first coalition, formed in 1990. Run by volunteers and funded by the dental schools at the University of Kentucky and University of Louisville, it was formed after the General Assembly told the schools that they either needed to work together or one could "risk being shut down," Plummer said. The group had several successes, including working with the state to conduct an oral health survey, lobbying legislators for oral-health measures and holding an annual symposium. But after more than 15 years, "It kind of just fizzled out a little bit," Plummer said. The group went inactive in 2006 but had some assets that the new group will take over.

The group's rebirth began in 2009, when Kentucky Youth Advocates was approached by the DentaQuest Foundation, which is connected to DentaQuest, one of the largest managed-care organizations in the country that administers dental benefits. DentaQuest officials were interested in seeing the coalition resurrected and offered $80,000 to KYA so it could provide the manpower to run it, Plummer said. It was the first time the coalition had funding to back it up. The KYA talked to state stakeholders and discovered "there really did seem to be an interest in putting a coalition back together," Plummer said. Planning began in earnest and in January the steering committee drafted by-laws. In March, 70 people showed up to the first meeting.

That gathering was not just made up of dentists, oral-health advocates and experts, Howard said. Members of the media were present, along with parents, health department officials, school nurses, students and educators. That made all the difference to Howard, who said he is inspired by what changes might occur and what education can take place. "When we have people from all these different venues, we have more of an opportunity to make a difference," he said.

The coalition's next meeting will be July 25. Those interested in attending or becoming members of the coalition can contact Andrea Plummer at aplummer@kyyouth.org or 502-895-8167. Dues for individual members are $25. Government organizations pay $100, nonprofit organizations pay $250 and for-profit organizations pay $500.

Kentucky Health News is a service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.