June 17, 2024

Vinod Miriyala, BDS, MPH, CAGS, DDS

Vinod Miriyala, DDS, MPH, CAGS, BDSJune, 2010

Dentist Vinod Miriyala Joins ACU Board

Vinod Miriyala, DDS, MPH, CAGS, BDS, a pediatric dentist based in Huntington, WV, accepted an invitation to join the ACU Board of Directors. In this interview, Dr. Miriyala discussed ACU’s early childhood caries project and wider efforts to eliminate oral health disparities in the U.S.

Q. How do you see the trandisciplinary model and ACU’s early childhood caries training program contributing to reducing oral health disparities?

A. Considering the preventable nature of the disease, early detection and oral health education are keys to reducing the disparities. It is necessary to work with parents at an early stage such as prenatal visits and well baby child visits to incorporate good oral health practices. Identifying the high risk patients early and concentrating our limited resources on them will help us reducing the burden of disease in the future.

The Early Childhood Caries (ECC) training helps both medical and dental practitioners identify preventable oral health problems in children and fosters collaboration between medical and oral health clinicians. Although the training is geared for the medical team, it also refreshes the dental team in the increasing need for early intervention in children. The training highlights the fact that oral health is not a separate entity and that it is part of overall health.

Although there has been a decrease in the caries rate compared to the 1970’s, the caries burden is disproportionately distributed. Eighty percent of dental disease in children is concentrated in 25 percent of kids. Children from poor families face high barriers to getting care.

Q. What can be done to further integration of oral health into the idea of a health care home?

A. One strategy is already in existence in many areas – coexistence of services under one roof, such as in Federally Qualified Health Centers (FQHC’s). Many federal grant dollars are available only to health centers that have dental clinics or are planning to start a dental clinic under their organizational structure. When a collocation is not possible, stronger referral systems should be in place. This can be a reality with use of electronic records becoming more common.

Also, all practitioners should be cross trained in basic health care issues which are common to all specialties, including prevention. This type of training has already started in some places and needs to be emphasized at four year college programs that train pre-medical and pre-dental students and at the graduate and postgraduate levels. Some medical and dental schools have established rotations where students from both schools work together in treating patients, thus incorporating the idea of a health home model. And these efforts should not stop at involving physicians and nurses but should include other fields like behavioral health, vision and allied health sciences.

Continuing education courses like ACU’s Early Childhood Caries prevention training course will help in retraining professionals who have been trained years and even decades ago to think and practice a health home concept.

In this new era of health care reform, the culture of both and providers of health care needs to change to reflect an integrated transdisciplinary health care model.

Q. What are the implications of the health care reform law for oral health care in the U.S?

Overall, the Patient Protection and Affordable Care Act (PPACA) brings oral health into the forefront by treating it as a necessary service like other medical services. This has been a great achievement in the field of oral health in the United States.

It contains a number of provisions for oral health care, including:

  • Increased funding for public health infrastructure, including Centers for Disease Control and Prevention (CDC) oral health programs and national oral health surveillance programs;
  • Additional funding for school-based health center facilities and FQHCs;
  • Increased Title VII grant program opportunities for general, pediatric or public health dentists;
  • Funding for the National Health Services Corps loan repayment programs;
  • Expanded Medicaid eligibility from 100% of federal poverty level to 133%;
  • A requirement that state health insurance exchanges to include pediatric services, including oral and vision care as a required benefit in their medical plans. Stand alone dental coverage will also be allowed to compete in these exchanges;
  • Guaranteed oral health coverage for children and resources to extend oral disease prevention measures in every state. Over time, these provisions can help to increase access to care for all ages;
  • School-based sealant programs in all 50 states, and an oral health education program targeting vulnerable populations, including children, pregnant women and older Americans;
  • Grants totaling $60 million to be awarded to up to 15 programs to train or employ alternative dental health providers, so as to address the issues of access to care

The bottom line is that the states have to implement the health care reform act. The law mandates care but does not sufficiently fund implementation. It is up to the states to find the funding to implement some or most of these provisions. In the current economy, the states do not have funds to fulfill these provisions and only time will tell how the states implement them.

Apart from the health care reform act, the U.S. Department of Health and Human Services (HHS) in late April unveiled the HHS Oral Health Initiative 2010, designed to get preventive care to Medicaid and Head Start children, strengthen the dental workforce, and increase oral health research and public awareness in the U.S.