An innovative oral health program that has helped hundreds of thousands of lower-income children and established Washington state as a national leader in children’s dental care access turns 20.
Access to Baby and Child Dentistry (ABCD), which connects Medicaid-insured children up to age 6 with dentists specially trained to treat babies, toddlers and preschoolers, celebrates two decades of helping kids gain a healthy start in life. What began in Spokane as an effort among local dentists and physicians to get more kids the oral health care they need, has since expanded to serve children throughout the state.
Less than one in five eligible children – about 20% – saw a dentist in 1999. Today, more than half of Washington’s Apple Health (our state’s Medicaid program) kids from birth to six – 54% – are receiving essential preventive oral health care and early dental treatments.
The number of eligible children who receive care has more than tripled throughout the state from 52,000 in 1999 to nearly 180,000 in 2018. As a result, the rate of untreated decay among lower-income preschoolers has been cut by 35% since 2005. In King County, just 23% (10,770) lower-income children saw a dentist in 1999. By 2018, the number of kids accessing essential dental care more than tripled to a total of 34,272 (48%).
“Oral health is critical for young children because the pain and health impacts of cavities can harm their ability to eat, sleep, focus and learn in school, and can lead to life-long problems,” said Dr. Cody Mast, who has served as a King County ABCD Dental Champion since the program was established in 2003. “ABCD helps improve children’s overall health and gives them a better opportunity for a bright future.”
Success of the nationally recognized ABCD program has helped make Washington a leader in providing oral health care for young children. Pew Center on the States praised ABCD for achieving significant results while “delivering a strong return on taxpayers’ investment.” ABCD also has been lauded by many others, including the American Academy of Pediatric Dentistry, the Association of State and Territorial Dental Directors and the W.K. Kellogg Foundation, and has been featured in many national publications including Health Affairs, the Journal of the American Dental Association (JADA), and the American Journal of Public Health.
A number of other states, including California, Connecticut, Georgia, Montana, South Carolina, Tennessee and Virginia among others, have modeled their efforts after Washington’s ABCD program. In the mid-1990’s, dentists, medical providers and legislators in Spokane joined forces to combat a serious problem. They saw a very high rate of dental decay in young Medicaid-enrolled children and very few of those children were getting care. The problem was especially acute in Spokane because the city is the largest in the state without fluoridated water to strengthen teeth and prevent cavities.
Together, health providers and lawmakers piloted a system of care (ABCD) that addressed two key issues. First, the need for family education about the importance of early dental care. Second, training for dentists in the care of very young children. In 1999, Arcora Foundation (then known as Washington Dental Service Foundation) began providing three-year startup grants to replicate the successful Spokane model and develop ABCD programs in other counties. Today ABCD serves all 39 counties in Washington.
“ABCD has made significant progress, but children of color and those from low-income families still have higher rates of untreated decay. The program should be strengthened to reach these underserved communities because oral health is essential to overall health. ABCD can help ensure that every child has a fair start in life,” said Diane Oakes, President and CEO of Arcora Foundation.
ABCD-certified dentists receive enhanced fees for certain procedures and support working with the Apple Health billing system. In addition to treating cavities, ABCD dentists provide preventive services, including fluoride varnish and education to provide families information they need to care for their children at home.
“A core ABCD message is that children should have their first oral health check-up by the first birthday. The University of Washington School of Dentistry is proud to help make this possible by training more than 2,200 of our region’s dentists over the past twenty years in the behavioral and clinical care of very young children,” said Travis Nelson, DDS, MSD, MPH, Acting Chair of Pediatric Dentistry, University of Washington School of Dentistry.
Local ABCD programs connect eligible children with an ABCD-certified dentist and coach parents about the importance of early dental care. They also assist families needing extra help making and keeping dental appointments and help families overcome barriers to care such as transportation, when needed.
