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Something new under the sun

May 1, 2006
Two hygienists use Extended Care Permits to extend access to oral preventive care for underserved Kansans in nursing homes and public schools.
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Two hygienists use Extended Care Permits to extend access to oral preventive care for underserved Kansans in nursing homes and public schools.

Each dental hygienist has a unique mission. If you haven’t found yours, look at what two hygienists in Kansas are doing to fulfill their career goals and provide access to care. Thanks to new state legislation, Maggie Smet, RDH, and Kathy Hunt, RDH, are now using Extended Care Permits (ECP) to pave the way for underserved Kansans to receive preventive oral care in nursing homes and public schools. Their entrepreneurial initiatives are lighting a torch for all like-minded hygienists to follow.

Before the new legislation was on the drawing board, Smet was among a small group of Kansas hygienists who worked tirelessly for years to expand access to care, but to no avail. Then a profound, astrological shift must have taken place over the skies of Kansas. The Kansas Dental Hygienists’ Association and the Kansas Dental Association began working on a bill that would allow qualified hygienists to provide preventive care to underserved populations in several community settings.

With the assistance of Kim Moore, president of the United Methodist Health Ministry Fund (Health Fund) in Hutchinson, Kan., and Virginia Elliot, vice president of the Health Fund’s programs, and support from other agencies, a unified approach formed. The Health Fund was ready to give healthy mouths to thousands of people if care could be provided. Following months of planning and negotiations, Governor Kathleen Sebelius signed the landmark legislation into action. Kansas hygienists could now apply for two types of ECP.

Maggie's story: three minds work better than one

Maggie Smet’s background in dentistry explains her love for the profession. Her professional roots took hold when she graduated from a dental assisting program. She wanted to expand her career, so she pursued an associate’s degree in dental hygiene from Wichita State University.

Fifteen years later, with the ECP legislation in sight, Smet began networking like an entrepreneurial pro. While working in private practice in Newton, Kan., she asked her patient Dan March, a nursing home administrator, to consider offering on-site, clinical dental hygiene services to his residents. As soon as ECPs were available, she jumped at the chance to apply for the ECP II. Several months later, March asked Smet to team with him on a grant proposal to provide preventive oral care to his residents at Wheat State Manor (WSM) in Whitewater, Kan. Since the new law required Smet to work with a sponsoring dentist, she solicited the assistance of Dr. Brett Roufs, a Newton dentist she had worked with on oral health projects throughout the state.

In one week, March, Smet, and Roufs wrote a grant proposal to the Health Fund, and the three-year, $43,000 grant was approved.

“Since this particular grant is generally awarded to 501(c) (3), not-for-profit organizations, Dan worked on the objectives and outcomes while Dr. Brett and I put together the budget,” Smet said. “With Dan’s strong geriatric background, he was able to target significant oral health outcomes that were essential to the overall health of the residents. As a result, the WeSMile Mobile Preventive Oral Hygiene Program was born.”

A mobile dental chair, portable dental unit, laptop computer, printer, software, dental instruments, and an array of oral hygiene aids were included in the program’s start-up costs.

Rampant decay

After WSM informed residents of the WeSMile’s services, Smet began receiving the all-important, consent-to-treat forms.

“Then I scheduled on-site appointments, reviewed medical histories, added essential information to my computer files, and screened for premedication needs,” she said.

Depending on available space, Smet assembles her mobile unit in a nursing home living room or beauty shop.

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“Since I don’t need very much space, I use whatever is open at the time,” she said. “The dental chair folds up like an ironing board, which allows me to lower clients slowly into a working position, and the chair can hold up to 500 pounds.”

The WeSMiles’ screenings process is as follows:

• Visual exam
Oral cancer screening - head and neck, tongue, cheeks, lips
• Periodontal screening - gum tissue health
• Chart probe readings - periodontal measurements
• Looking for suspicious areas - decay or broken teeth
• Appliance check - denture or partials
• Dental cleaning and fluoride varnish application
• Oral hygiene instructions and recommendations
• Follow-up: oral fitness report sent to family

Following treatment, each client receives a tongue scraper, Reach® floss handle, and spin or denture brush, depending on the client’s needs.

“During the past two years, I’ve treated more than 100 clients. Most were women with a mean age of 85, and believe it or not, I haven’t seen a lot of pocketing. Gingivitis is prevalent and decay rampant,” said Smet.

After Dr. Roufs reviews the dental charts, findings are sent to each client’s dentist. Families are informed that the program’s services do not replace routine oral care by their dentist.

Sustainability and motivation

When they received the grant application, Health Fund officials asked if the project would continue after the grant funds ended. If the answer was yes, they asked how the program’s long-term funding would be sustained. Since WSM was the grant recipient, WeSMile’s fee for service was paid by Medicaid or private pay, depending on the client’s contract. Then Smet, working as an independent contractor, was paid by WSM. Part of the fee also helped sustain the program’s sponsorship and supplies.

Under the guidance of WSM’s new administrator, Jo Mead, WeSMile’s future looks bright.

“If our services continue to expand, I will train other hygienists to provide care,” Smet said. “We’re currently serving eight nursing homes in four Kansas counties.”

Smet’s motivation was something that had been with her for a long time.

“After the elderly enter a nursing home, their dental needs are often forgotten. I wanted to fill those needs with care,” she said.

Along with maintaining a private practice schedule, Smet is in her second term as president of the Kansas Dental Hygienists’ Association.

Kathy's story: a coordinated effort

In the beginning of her professional career, Kathy Hunt, RDH, attended Dodge City Community College, where she majored in early childhood education. When ECP became available, it wasn’t surprising that after 25 years in private practice, she wanted to pursue a lifelong goal - providing preventive oral care to low-income school children. ECP opened that door.

Following months of research and networking, Hunt’s Healthy Smiles School Dental Hygiene Program emerged from her home in Wamego, Kan. Her primary considerations were finding a population that needed preventive services, and working with supportive school administrators.

With a mission in mind and no financial resources at hand, Hunt approached Rick Doll, a superintendent at Rock Creek School District in northeast Kansas. Doll was initially tentative due to budget constraints; however, after Hunt apprised him of the fact that her services would be provided at no cost to the school district, he became interested.

Subsequently, two school districts were included in her four-month pilot program.

Initially, each school distributed Healthy Smiles’ information and consent forms to parents of students receiving federal free and reduced lunches.

“School nurses helped verify information on the consent forms. Next, I began scheduling on-site visits,” said Hunt. “On the days I worked at the schools, I really didn’t schedule appointments like I would in private practice. Once I had a list of students for a particular day, I asked the front office to page them, or I called the student’s classroom. I also allowed parents to be present during the cleaning.”

Maggie Smet talks to a client at Via Christi HOPE about oral hygiene care.
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Following dental treatment, a Healthy Smiles’ Oral Report Card was sent to each parent. If any dental concerns were noted, case management skills were used to answer questions and assist in locating dentists who participated in the state’s insurance program. Weekly activity reports were sent to the school’s nurse and Healthy Smiles’ sponsoring dentist, Dr. Jose Lopez, who worked for the Marian Clinic in Topeka, Kan.

From left: Marcia Manter, Kathy Hunt, and Maggie Smet take a break from presenting at an Extended Care Permits workshop.
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“Since this particular dental clinic provides dental care to low-income families in Topeka and surrounding communities, Dr. Lopez was incredibly helpful and supportive throughout my pilot project,” Hunt said.

Kathy Hunt provides clinical dental hygiene care at an elementary school.
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She added, “But most importantly, I wouldn’t have connected with Dr. Lopez without Marcia Manter, oral health project consultant with Oral Health Kansas. Throughout the ECP process, Marcia’s assistance has been invaluable.”

Maggie's daughter, Emmaleah, plays ball with a nursing home resident while her mother is working at the home.
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During four months averaging one day a week at each school, plus her private practice schedule, Hunt provided preventive oral hygiene care to 52 students with the following services:

Kathy Hunt teaches an elementary school child how to brush his teeth.
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• Dental assessment
• DIAGNOdent screening
• Dental cleaning and fluoride varnish application
• Dental sealants
• Oral health education and recommendations
• Oral report card for parents

Lots of healthy smiles

Once Hunt realized her venture as an independent service provider was successful, she partnered with a 501 (c) (3), non-profit agency, Community Health Ministry, in Wamego, Kan., to apply for a grant. Until this point, Hunt had personally financed the Healthy Smiles program with the aid of borrowed dental equipment. Grants from the Health Fund and the Topeka Community Foundation allowed her to purchase more up-to-date equipment and supplies.

“The mobile equipment I used during the pilot project had been to Bosnia and back, so you can imagine what shape it was in,” said Hunt. “The schools with the greatest needs were the most appreciative,” she observed. “Although 100 percent participation was not attained, the children who took advantage of the program were thrilled. They came up to me in the halls and asked, ‘Do I get to come see you today?’ ”

Without notoriety, Healthy Smiles has become visible enough that the program will be adding a third school district in 2006.

“Soon I’m going to open it up to the high schools, even though as students get older they sometimes feel uncomfortable with the process,” Hunt said. “Later, when time permits, I will develop a preventive, dental care program for pregnant women who receive medical care at Community Health Ministry.”

Since Hunt uses her mobile equipment only one day a week, she plans to recruit qualified hygienists to use her resources in order to extend care to Pottawatomie, Wabaunsee, and Riley counties. “I love children and have always enjoyed working with them,” concluded Hunt. “Now my ECP allows me to fulfill my passions for both children and preventive care.”

In 2005, Smet and Hunt were chosen as two of 18 participants in the first statewide Dental Champions Leadership Program. The program was designed to improve leadership skills, personal development, training, planning and organizational skills, and to update participants in state and national oral health information.

The same year, Smet received the Leading Edge Care and Services Award from the Kansas Association of Homes and Services for the Aging, and Hunt received the Outstanding Alumni Award from her alma mater, Johnson County Community College in Overland Park, Kan.

This dynamic duo’s enthusiasm for their newfound careers is clearly visible. In addition to work, family and household responsibilities, they travel throughout the state to tout the benefits of extending access to care. The light in their eyes and excitement in their voices lift the imaginations and spirits of those who attend the ECP workshops. Without a doubt, access to preventive, oral care has taken flight on the once barren plains of Kansas.

For more information, contact Maggie Smet at [email protected], and Kathy Hunt at hunthaus@