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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Preventive Dental Visit: Child.

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Strategy. Teledentistry. (13.2)

Approach. Develop and provide training. (for professional development) for oral health professionals at the state and/for local level about teledentistry. (including state practice acts and reimbursement policies), and provide teledentistry services for children and adolescents

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Overview. Teledentistry has been utilized in the pediatric population for the purpose of oral health education and promotion, remote diagnosis and monitoring, and behavior guidance.[1] Studies have shown that teledentistry is beneficial to provide dental treatment in remote locations with little access to pediatric dental specialists, monitor patients between appointments, conduct remote diagnosis and screening programs, promote oral health of children through dental education, and in pre-appointment behavior guidance, and was particularly useful during the COVID-19 pandemic.[2] Provider education is an evidence-based strategy that has shown utility in increasing use of professional services other than oral health by MCH population groups. While limited research has been conducted to verify results with populations in need of oral health services, this research can serve as a proxy to gauge effect.[3,4] As an incentive for oral health professionals to complete training, offer continuing education credits. Examples of preventive oral health care include risk assessment, education and anticipatory guidance. (eating practices, oral hygiene practices, smoking prevention/cessation), and fluoride varnish applications. See Holt K, Louie R. 2019. Strengthening State and Jurisdiction Efforts Related to Title V Maternal and Child Health National Performance Measure 13. (Oral Health). Washington, DC: National Maternal and Child Oral Health Resource Center and additional resources.5 https://www.mchevidence.org/documents/NPM13_StateEfforts.pdf

Evidence. Scientifically Rigorous Evidence. Strategies with this rating are most likely to be effective. These strategies have been tested in multiple robust studies in a variety of populations and settings with consistently positive results, both on their own and in combination with other strategies. (Clarifying Note: The WWFH database calls this "scientifically supported evidence").

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source. (Read more about understanding evidence ratings).

Source. Peer-Reviewed Literature

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

  • Access to/Receipt of Care. This strategy increases the ability for individuals to obtain healthcare services when needed, including preventive, diagnostic, and treatment services.
  • Utilization. This strategy improves the extent to which individuals and communities use available healthcare services.
  • Patient Experience of Care. This study improves individuals' perceptions, feelings, and satisfaction with the healthcare services they receive.

Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.

Intervention Type. Health Teaching (Education and Promotion) (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Community-Focused

Examples from the Field. Access descriptions of ESMs that use this strategy directly or intervention components that align with this strategy. You can use these ESMs to see how other Title V agencies are addressing the NPM.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the Results-Based Accountability framework (for suggestions on how to develop programs to support this strategy, see The Role of Title V in Adapting Strategies).

Quadrant 1:
Measuring Quantity of Effort ("What/how much did we do?")

PROCESS MEASURES:

  • Number of oral health professionals who complete training on teledentistry best practices, policies, and reimbursement. (Measures workforce development reach)
  • Number of children and adolescents provided with information on accessing oral health care via teledentistry. (Assesses promotion to focus population)

Quadrant 2:
Measuring Quality of Effort ("How well did we do it?")

PROCESS MEASURES:

  • Percent of teledentistry training for professionals that includes interactive skill-building and simulation exercises. (Measures quality of training approach)
  • Percent of teledentistry services for children and adolescents that adhere to clinical guidelines and quality standards. (Evaluates fidelity to evidence-based care)

Quadrant 3:
Measuring Quantity of Effect ("Is anyone better off?")

PROCESS MEASURES:

  • Number of partnerships established between pediatric care providers and dental professionals to facilitate teledentistry referrals and coordination. (Measures collaboration)
  • Number of school-based oral health programs that integrate teledentistry services into their screening and care delivery models. (Assesses penetration into community settings)

OUTCOME MEASURES:

  • Number of children and adolescents receiving preventive oral health services via teledentistry who adhere to recommended visit schedules. (Evaluates continuity of care)
  • Number of oral health providers and payers that adopt and sustain teledentistry for pediatric populations. (Assesses long-term systems change)

Quadrant 4:
Measuring Quality of Effect ("How are they better off?")

PROCESS MEASURES:

  • Percent of teledentistry training and education materials that are tailored for professionals serving a variety of pediatric populations. (Measures relevance)
  • Percent of teledentistry services and technologies that accommodate literacy levels and developmental stages of children and families. (Assesses access in design)

OUTCOME MEASURES:

  • Percent of children and adolescents who rate their teledentistry experience as positive and developmentally appropriate. (Measures patient satisfaction)
  • Percent of parents who report improved oral health knowledge and behaviors after their child's teledentistry visit. (Assesses impact on family engagement)

Note. When looking at your ESMs, SPMs, or other strategies:

  1. Move from measuring quantity to quality.
  2. Move from measuring effort to effect.
  3. Quadrant 1 strategies should be used sparingly, when no other data exists.
  4. The most effective measurement combines strategies in all levels, with most in Quadrants 2 and 4.

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.

References

[1] Sharma H, Suprabha BS, Rao A. Teledentistry and its applications in paediatric dentistry: A literature review. Pediatric Dental Journal. 2021 Dec 1;31(3):203-15.

[2] Ibid

[3] Lipper J. Advancing Oral Health through the Women, Infants, and Children Program: A New Hampshire Pilot Project. (2016). Center for Health Care Strategies.

[4] Perkins, R. B., Zisblatt, L., Legler, A., Trucks, E., Hanchate, A., & Gorin, S. S. (2015). Effectiveness of a provider-focused intervention to improve HPV vaccination rates in boys and girls. Vaccine, 33(9), 1223-1229.

[5] Additional Resources:

Association of State and Territorial Dental Directors, Best Practice Committee. 2019. Best Practice Approach: Perinatal Oral Health. Reno, NV: Association of State and Territorial Dental Directors. http://www.astdd.org/bestpractices/BPAPernatalOralHhealth.pdf

Casamassimo P, Holt K, eds. 2016. Bright Futures in Practice: Oral Health—Pocket Guide(3rd ed.).Washington, DC: National Maternal and Child Oral Health Resource Center. https://www.mchoralhealth.org/pocket/index.php

Clark MB, Douglass AB, Maier R, Deutchman M, Gonsalves W, Silk H, Wrightson AS, Quinonez R, Dolce M, Dalal M, Rizzolo D. 2010. Smiles for Life: A National Oral Health Curriculum(3rd ed.).Leawood, KS: Society of Teachers of Family Medicine. http://www.smilesforlifeoralhealth.org/

Holt K, Louie R. 2019. Strengthening State and Jurisdiction Efforts Related to Title V Maternal and Child Health National Performance Measure 13 (Oral Health). Washington, DC: National Maternal and Child Oral Health Resource Center. https://www.mchevidence.org/documents/NPM13_StateEfforts.pdf.

Lorenzo S, Goodman H, Stemmler P, Holt K, Barzel R, eds. 2019.The Maternal and Child Health Bureau–Funded Perinatal and Infant Oral Health Quality Improvement (PIOHQI) Initiative 2013–2019: Final Report. Washington, DC: National Maternal and Child Oral Health Resource Center. https://www.mchoralhealth.org/PDFs/piohqi-final-report-2019.pdf.

Oral Health Care During Pregnancy Expert Workgroup. 2012. Oral Health Care During Pregnancy: A National Consensus Statement. Washington, DC: National Maternal and Child Oral Health Resource Center.

Maternal and Child Oral Health Resource Center. 2010. Open Wide: Oral Health Training for Health Professionals. Washington, DC: National Maternal and Child Oral Health Resource Center. file:///Users/skolo/Downloads/Link%20to%20https:/www.mchoralhealth.org/OpenWide/.

Wells J. 2019. Improving Oral Health Outcomes for Pregnant Women and Infants by Educating Home Visitors. Washington, DC: Association of Maternal and Child Health Programs. http://www.amchp.org/programsandtopics/BestPractices/InnovationStation/ISDocs/Oral%20Health%20Home%20Visiting.pdf

[6] Systematic reviews of teledentistry:

Alabdullah JH, Daniel SJ. A Systematic Review on the Validity of Teledentistry. Telemed J E Health. 2018;24(8):639‐648. doi:10.1089/tmj.2017.0132 https://www.liebertpub.com/doi/abs/10.1089/tmj.2017.0132.

Estai M, Kanagasingam Y, Tennant M, Bunt S. A systematic review of the research evidence for the benefits of teledentistry. J Telemed Telecare. 2018;24(3):147‐156.
https://www.researchgate.net/profile/Mohamed_Estai/publication/312836443_A_systematic_review_of_the_research_evidence_for_the_benefits_of_teledentistry/links/59e06af8a6fdcca9842ec1a0/A-systematic-review-of-the-research-evidence-for-the-benefits-of-teledentistry.pdf

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.