• Oral Health Home

• About Oral Health
• Contacts

 

Into the Mouths of Babes (IMB)

Medical Providers: Partner with us to improve your child patients’ oral health

The Into the Mouths of Babes (IMB) program trains medical providers to deliver preventive oral health services to young children insured by NC Medicaid. Services are provided from the time of tooth eruption until age 3½ (42 months), including oral evaluation and risk assessment, parent/caregiver counseling, fluoride varnish application, and referral to a dental home. Goals include preventing and reducing early childhood tooth decay and increasing referral of high risk children to a dental home. The medical provider is reimbursed through N.C. Medicaid.

The Oral Preventive Procedure

The Oral Preventive Procedure consists of three equally important parts:

1. Oral Evaluation and Risk Assessment
2. Counseling with Primary Caregivers
3. Application of Topical Fluoride Varnish

Application of fluoride varnish can be compared to having a fluoride treatment at the dental office. Topical fluorides, including varnish, are most effective at preventing tooth decay when applied at regular intervals .

Medicaid-insured children may have the procedure a maximum of six times from tooth eruption until 3 ½ years of age (42 months). The procedure is recommended every three to six months and is most successfully incorporated as part of a well-child visit. Medicaid requires a 60-day time interval between procedures.

Training

NC Medicaid requires training for medical professionals and staff providing IMB services. The NC Oral Health Section offers a live 1-hour session in which CME credit is awarded. Contact the Oral Health Section at 919-707-5480.

The 1-hour live CME session includes:

• oral evaluation
• priority risk assessment and referral
• parent counseling
• fluoride varnish application
• Medicaid coding and billing
• supply information

Previously trained medical providers and staff may train others in their practice using the IMB online oral health toolkit.

Responsibility for Procedures

1. Oral evaluation and caries risk assessment:
   • Physician, physician assistant, nurse practitioner
   • In public health clinics a registered nurse or licensed practical nurse under physician standing orders
2. Counseling with primary caregivers:
   • Medical provider may delegate to trained staff
3. Fluoride varnish application:
   • Medical provider may delegate to trained staff

Reimbursement

As a partner in the IMB program, N.C. Medicaid reimburses medical providers for the procedure. A child can have the procedure a total of six times from tooth eruption until 3½ years of age (42 months).

Dentists and medical professionals may both provide preventive oral health services to Medicaid-insured infants and toddlers up to age 3½ (42 months), receiving NC Medicaid payment independently of each other. 

In 2014 the US Preventive Services Task Force recommended that primary care clinicians apply fluoride varnish to the teeth of all infants and children starting at the age of primary tooth eruption and continuing through five years of age.  Private medical insurers are now covering this service. For more information, please refer to the individual company’s provider portal on their website.

Moyer, VA. Prevention of dental caries in children from birth through age 5 years: US Preventive Services Task Force recommendation statement. Pediatrics 2014; 133: 1-10.

Evaluation and Outcomes

Ongoing evaluation of the Into the Mouths of Babes program is conducted by the UNC Gillings School of Global Public Health.

Published Highlights Include:

• For children receiving four or more IMB visits before three years of age, there is a 21% reduction in hospitalizations for dental treatment.

Stearns SC, Rozier RG, Kranz AM, Pahel BT, Quinonez RB. Cost-effectiveness of preventive oral health care in medical offices for young Medicaid enrollees. Archives of Pediatric and Adolescent Medicine. 2012;166(10):945-951. (doi:10.1001/archpediatrics.2012.797)

• On average, children receiving four or more IMB visits before three years of age show a 17.7% reduction in caries.

Kranz AM, Preisser JS, Rozier RG. Effects of physician-based preventive oral health services on dental caries. Pediatrics 2015 Vol.136 No.1 pp.107 -114 (doi: 10.1542/peds.2014-2775)

• IMB has contributed to a statewide decline in dental caries rates since 2004 and helped reduce the gap in tooth decay between children from low- and other-income families at the community level.

Achembong LN, Kranz AM, Rozier RG. Office-based preventive dental program and statewide trends in dental caries. Pediatrics 2014 Vol. 133 No. 4 pp. e827 -e834 (doi: 10.1542/peds.2013-2561)