Jared D. Evans, DMD and Brian L. Simmerman: Spokane’s legacy of oral health care innovation needs to be expanded

Spokane County has a legacy of innovation in oral health care that extends over a quarter of a century. This legacy has benefited all of Washington and has been an influence for good across the country. We have a story that needs to be expanded until preventable dental disease is completely eradicated.

In 1995, local dentists and physicians decided to work together with the University of Washington to address the high rate of dental decay in young children, especially among low-income families in which the problem was most prevalent and access to care most limited.

They created Access to Baby & Child Dentistry (ABCD), which provides dental care to children under age 6 covered by Medicaid (Apple Health). ABCD provided training and improved reimbursements to encourage dentists to care for Medicaid-eligible children, while emphasizing preventive services and education for families. The program greatly expanded the number of children receiving care.

Spokane’s ABCD program proved so promising that in 1999 Arcora Foundation (formerly Washington Dental Service Foundation) began providing grants to other counties to replicate ABCD.

Twenty years later, ABCD serves all 39 Washington counties. The percentage of young children receiving dental care has increased from less than 20 percent, when ABCD started, to 54 percent today. Untreated decay among low-income preschoolers has been cut by 35 percent.

Oral health is critical for young children. The pain and health impacts of severe cavities can harm a child’s ability to eat, sleep and learn, and can lead to lifelong problems.

Later in life, uncontrolled dental disease and infection can be a chronic source of inflammation. Oral disease is linked to heart disease, stroke, diabetes and pregnancy complications, including premature and low-birth-weight babies. Oral health is essential to overall health.

ABCD has helped push greater collaboration and integration of services between dental and medical providers statewide. More than 2,200 dentists have received specialized training in clinical and behavioral aspects of dentistry for young children through the University of Washington. Nearly half of all physicians who see young children have been trained to pay attention to oral health, provide oral health education, apply fluoride varnish during well-child checkups, and refer children to dentists. This is critical because infants and toddlers usually see a physician up to 11 times before age 3 for well-child care.

It’s no wonder that Connecticut, Georgia, Virginia, California and many other states have started similar programs.

Other innovations with roots in Spokane include Oral Health Connections, modeled after ABCD, which expands oral health care services for pregnant women and those with diabetes insured through Apple Health. The focus is on these patients because they are at increased risk from oral disease.

Spokane also developed the state’s first Local Impact Network (LIN), Smile Spokane, which links more than 20 community organizations and providers dedicated to reducing oral health disparities. Funded with a grant from Arcora Foundation, LIN partners focus on preventing disease and increasing access to care.

With the 20th anniversary of ABCD’s statewide expansion from Spokane, we have much to celebrate. But we can’t rest on our laurels; there is still more to be done.

Many ABCD-eligible children still can’t access care. Many people of all ages don’t get the essential dental care they need, and there is more we can do to prevent oral disease. Having water with a good balance of fluoride, a naturally occurring mineral, prevents cavities for everyone, young and old. Spokane is the largest city in Washington that does not provide residents the health benefits of community water fluoridation. Fluoridation is proven to reduce dental disease rates by more than 25%.

Cavities are nearly 100 percent preventable. Given our legacy of health innovation, if any community can get close to achieving that level of success, it should be Spokane.