Explanation of Toolkit
The purpose of this page is to enable other practices to start portable, assisted oral hygiene, and guided oral hygiene programs. We provide these outlines and documents free of charge. We ask that if you do choose to use our resources you keep the disclaimer on the bottom to give credit to the funders and creators. Feel free to use these at no charge to start your own program. Feel free to add your own logo. Our goal is to enable you. We wish you well on your journey.
Step 1 : Create Your Basic Program Design
Your program needs to be what you want it to be. Think about how much time you want to dedicate to your program. Will it be your full time business, or something you do occasionally to serve the community. Both have value. Start small and add as you desire. It is easier to add services than to get rid of them. ANY PRACTICE of ANY SIZE can make a difference. If you are a small practice who is looking for a way to help, start with agreeing to help 10 residents.
- Full time financially successful business vs side gig as a community service?
- Ratio of Private pay to Medicaid
- How successful are other portable services (beauty shop)?
- What are your opportunities for expansion (if full time desired)?
- small business "Ma and Pa" facilities are usually easier to work with and lower stress
- large business "cooperate" facilities are usually easier to expand and have more residents to great.
- What geographic area do you want to serve?
- What Services will you offer?
- prevention and referral
- basic comprehensive dentistry
- full "menu" comprehensive dentistry
- Who on your team will provide what services?
- Dentists- supervisory? screenings? comprehensive care? - Don't do comprehensive exams if you don't offer comprehensive care. The dentist's most important role is reviewing the medical history and ensuring that treatment delivered is appropriate and safe. When will the dentist talk to the families?
- Hygienists: Are they full time or part time? How often will they go out? How many facilities will they work with? Will they be hired for this or will they be your regular hygienist who does this a few times a year? Is their body physically strong enough to do this as often as they want to or as often as you desire them to? Do they understand the ergonomic and technological challenges this presents? The hygienist's most important role is to design home hygiene programs, provide professional hygiene services, and screen patients for problems that may need the dentist's treatment. Most of the time in this population the hygienist will need an assistant. When will the hygienist be the one to contact the families?
- Assistants:- Will they set up and haul instruments, along with the traditional assistant role? Will they provided assisted oral hygiene? When will the assistant be the one to contact the families?
- CNA's: Will they assist chairside to help calm the patient? Will they be paid by you or will you contract their help from the facility? Will they provide assisted oral hygiene? Do they have to work at the facility to be your hired on CNA? When will they be the one to contact the family?
- Other? (will you have a receptionist? will you have a driver or someone to haul equipment? Will you have a manager or biller?)
Step 2 : Make Sure it is Legal
Statutes and Rules vary state to state and also can change over time. Before investing in equipment and program design, become familiar with the Rules and Statutes in your state.
Statutes are from the Legislature and Rules are from the Board of Dentistry.
When starting a program it is best to read the applicable rules and statutes, make sure your desired design works within the law. Then take the model to the board to proactively address any issues they may see.
- If your design does not fit within the Statutes you will need to go through the legislature to change the statute, you can start by talking with your dental association, their lobbyist, and your state senators/representatives. This will take a long time.
- If your design does not fit within the Rules you will need to go through the board of dentistry. They are generally easier to get approach but it is still recommended to approach it with your professional association when possible.
It is important to note that your ADA affiliated state dental association is not the same as your state board of dentistry. Though your state component of the ADA is not the "board of dentistry", and they are not the ones that make the rules, they are often very knowledgeable and are well positioned to help you find the resources and contacts you need. In this toolkit, we are not giving legal advice or implying this is all you need to do, we are simply showing you what we did and providing you with resources we have.
In Idaho you need to be familiar with the following: (which can all be found at this website https://isbd.idaho.gov/IBODPortal/BoardAdditional.aspx?Board=BOD&BoardLinkID=70 )
- Dental Practice Act: https://legislature.idaho.gov/statutesrules/idstat/Title54/T54CH9/
- Administrative Rules: https://adminrules.idaho.gov/rules/current/24/243101.pdf
- Idaho Virtual Care Access Act : https://legislature.idaho.gov/statutesrules/idstat/title54/t54ch57/
- Idaho Board of Dentistry Website: https://isbd.idaho.gov/IBODPortal/Home.aspx
- Contact for Board of Dentistry
IDAHO BOARD OF DENTISTRY
11341 W. Chinden Blvd., Building #4
Boise, ID 83714
Ph: 208 334-2369
Fax: 208 334-3536
The Idaho State Dental Association is helpful and can help connect you with information and people: https://www.theisda.org/
The Idaho Oral Health Program is helpful and can connect you with information and people: https://www.idahooralhealth.org/idahos-oral-health-program/
Here is a white paper that talks about teledentistry in Idaho and other programs that exist (or existed during the time of the grant) in Idaho: https://publicdocuments.dhw.idaho.gov/WebLink/DocView.aspx?id=26881&dbid=0&repo=PUBLIC-DOCUMENTS&cr=1
Step 3 : Find Your People
Choose a Pilot Facility: Start with just one or two facilities. If you work with a small and locally owned facility you will have an easier time meeting with administrators and implementing programs. You also will likely have more help and administrative support. We only work with small locally owned facilities for this reason. There are also advantages working with larger chains. You will have more potential for expansion . You also may have more space in a larger facility. Find what works well for you. Meet with administrators and make sure your goals align. When selecting these facilities look at turnover rates. It is very hard to start a program when there is a revolving door of administrators. You will need to design and sign a contract with the facility. It is our advice to you that if they have a lawyer looking over the contract, you should as well. It is never a bad idea to have legal help, but for sure when developing and signing contracts you want the teams to be even.
If you would like to see an example contract, here is an example contract:
Choose Your Team: Your existing team may be perfect, or you may need to look into adding to your team to add these services. Make sure you find people who enjoy working with this population and are physically capable of doing so.
- These patients need people who truly care about them and enjoy being around them. It should your team's primary goal to be a bright spot in the resident's day and the dentistry is secondary. Patience is key. The "production first" mentality does not work well with this population.
- This work is a bit more physical than traditional dentistry. Make sure the team understands that there will be different stresses on their bodies and that they are okay with moving equipment and sometimes being in positions that are physically difficult to maintain. Some team members who do not require accommodations in the office may require them in a portable setting.
- It is a good idea to have someone shadow before hiring or interviewing so they know what they are getting into with portable dentistry.
If you would like to see an example job application, here is a job application for various positions:
Your hiring process can look a lot like your regular hiring process (with strong recommendation to have them at least shadow before offering/accepting)
Step 4 : Train Your People
This type of dentistry is different than dentistry in the traditional office, however a lot of it is the same. It is valuable to have an employee manual and structured training. 2023 Employee Basic Training Outline The following are trainings we have people undergo prior to providing services:
- HIPAA: Whatever HIPAA training you normally provide, but you also must include how you will use and protect information while providing these services. You may need to alter your HIPAA form. Our forms for you to use as a reference are located on this page: AOH/GOH/Portable Dentistry
- OSHA: Whatever OSHA training you normally provide PLUS if they are transporting instruments you need training on the safe transport of sharps. Here is a link to our page that has a video that talks about projectiles . You also need for them to know where they can go if they have an occupational exposure after hours. This should be part of the employee manual.
- Fraud Waste and Abuse: Whatever fraud waste and abuse training is typically required is also required for portable.
- Teledentistry: We find the easiest way to train people on the use of the camera is to have them borrow one to take home an use with their family and friends. We have our experienced team members train them first, then let them go and practice before they use this with the residents. We do this when we have supplies available to do this. Here is a link to our page that has videos that give tips on how to capture good photos and videos
- Silver Diamine Fluoride: We have a formal program to train our non-dental providers on the application of silver diamine fluoride. It consists of a short video, a written exam, and a practical exam. Here is a link to our page with the training video. If you want our exam and practical exam contact us directly as we do not publish it online. We also use the video with our dental providers and in our practice we supervise each team member's first few applications of SDF.
- Disability Etiquette : We utilize videos that are on Youtube that were produced with people who have disabilities to teach disability etiquette. Our main focus is attitude. Just like neurotypical people have different preferences in how they are treated (formal vs informal ect) people who have disabilities can have different preferences as well. Some people prefer language called "person first" language where you put the person before the disability. For example, "He is a young man who has autism" Others prefer what is called "identity first" language. For example "He is an autistic young man". It is okay to ask what a person prefers.
- Talk to Me: https://www.youtube.com/watch?v=nc9aAY6-ujQ
- Assistive Devices: https://www.youtube.com/watch?v=Gv1aDEFlXq8
- Power Chair: https://www.youtube.com/watch?v=7G-JWF8C4fU
- Aphasia: https://www.youtube.com/watch?v=h2ZLBaiGQj0
- Blind or Difficulty Seeing: https://www.youtube.com/watch?v=yivppJvjMho
- Person First Language: https://www.youtube.com/watch?v=HYRXFAh_lvA
- Identity First Language: https://www.youtube.com/watch?v=lCajTVTj0-g
- Talk to Me Like an Adult: https://www.youtube.com/watch?v=CL8GMxRW_5Y&index=5&list=PLInqsEc8hk_tC8KY8qh9BNrZk7DpufUtl
- Alzheimers: https://www.youtube.com/watch?v=C1BZ1PKm5e4
- Advanced Directives, Guardianship and Consent: It is important as some of our patients are on hospice that we understand their advanced directives and how they are working with their providers. It is also important to understand and discuss with the facility who legally makes the patient's medical decisions AND who else we should talk to to make our lives easier. Perhaps one sibling legally makes the decisions, but the other sibling is upset if they are not included. To make your life easier it is good to know this and talk to them both. 2023 Employee Basic Training Outline
- Understanding Different Facility Types:
- Assisted living- may need help with activities of daily living but overall is a residential facility, often more permanent
- Skilled nursing- medical facility- have IV lines, respiratory therapy, needs a nurse 24/7, often temporary with the goal of getting someone back to home
- Memory Care- usually affiliated with assisted living, but for patients who have dementia
- Intermediate Care Facility for Individuals with Disabilities - are group living arrangements for adults or children with developmental disabilities and intense needs to support. Children and adults must meet an institutional level of care in order to live in these facilities
- Licensed Residential and Assisted Living (RALF)- are group living arrangements for four or more adults, 18 years of age or older, who have varying needs for support. For any resident who has needs requiring a nurse, the facility must assure a licensed nurse is available to meet the needs of the resident.
- Supported Living Services: Developmental Disability Agencies and Residential Habilitation Agencies offer services that allow those Adults who meet the criteria for Developmental Disabilities (DD) Waiver Services to reside in places of their own choosing while still receive care and services to meet their needs.
- Ergonomics: We worked with Dr. Trish Howard from Primary Therapy to develop a one hour course in ergonomics of portable and special care dentistry. Here is a link to our page that has this course.
- Documentation: You will want to develop a documentation system that works for your practice.
- We utilize Teledent by Mouthwatch, for charting and teledentistry
- We use Mail HIPPO, for HIPAA compliant emails
- We use paper charting in binders at the facility and with Microsoft Word to create those charts as a back up when the internet goes down.
- We also have developed the Your Special Smiles Oral Hygiene Ability Spectrum to Document the provision of assisted oral hygiene. This is a system that helps facilitate charting based on a patient's ability and cooperation levels. Here is the link for page with the paperwork you are welcome to use. Look under the handouts for the course "A new solution for daily oral hygiene in long term care" Here is the link where there is a short video that explains the system.
- Infection Control: We have special instructions for infection control. Your infection control will vary. Feel free to copy our infection control protocols or those that we created in partnership with the American Mobile and Teledentistry Alliance during the pandemic These can be found in the handouts for "We an Treat You Here or There, We can Treat You Anywhere!" You can also find our infection control protocols for Assisted Oral Hygiene on this page under the course handouts for "A new solution for daily oral hygiene in long term care" .
Step 5 : Get Started and Adjust as You Go
Once you start realize you will learn as you go. Start small and build. Customize your program to what fits you and the population you serve. As you go, you will see what you like and don't like. Don't be afraid to reach out for help and always be honest. Here are some things that help us:
- Generic Medical History Review Sheet Dr. Brooke generates this and reviews it before each hygiene visit. Feel free to modify it to fit your needs and use it accordingly.
- Generic Sign Up and Consent Forms In our program the administrators, nurses, or caregivers help us distribute these to and collect these from the families.
Other Useful Stuff:
- We have found many tools that we really love to work with
- Comfort Soft: Soft and comfortable soft tissue retraction: https://armor-dental.com/collections/comfort-mate-pro
- Silver Diamine Fluoride, Varnish, Povidone Iodine and All Day Spray: https://www.elevateoralcare.com/
- Equia Forte Glass Ionomer and Triage Sealant Material: https://www.gc.dental/america/products/operatory/glass-hybrid-restoratives/equia-forte
- Mouthwatch Cameras: https://www.mouthwatch.com/intraoral-cameras/
- And link to a sheet that has many other favorite products can be found in the handouts for the Show and Tell Course.
- Other useful Documents:
- The handouts on Dr. Brooke's speaker page have a lot of information on things you need and protocols for starting portable, teledental, and assisted oral hygiene programs. Portable equipment options are highlighted in the "We can treat you here or there" handout.