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Eureka Pediatrics - Eureka, CA |
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Program Description |
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Eureka Pediatrics is a private pediatric practice of 5 pediatricians and 3 midlevel practitioners. The practice is a Federally Qualified Rural Health center (FQHC). There is a main office in Eureka, a small satellite clinic 20 miles north, and also a rural health center 70 miles south. The practice has 23,345 patient visits per year, 45% of which are Medi-Cal insured. Humbolt County is designated as a Dental Health Professional Shortage Area. It has about 70 dentists in general family dental practices and 4 pediatric practices (of which only 1 practice is accepting new patients, less than 5 of the private dental practices accept Medi-Cal (Denti-Cal) insurance, and no pediatric dentist accepts insurance). There are also 13 dentist who work in 7 community clinics, 2 of which are Native American (US Indian Health Services and K'ima:w). Although all clinics take Medic-Cal insurance, none will take patients under the age of 3 unless there is an acute need and not for routine care. Currently the community clinics have long waiting lists, usually over 4 months, some as long as 6 months, to be seen.
Humboldt County is a leader in its collaborative efforts to address the children's dental epidemic. The Dental Advisory Group (DAG) was formed in 1999 and produced the "Humboldt County Children's Oral Health Report" and "The Framework for Action" with a task force made up of Dental professionals, public health, local foundations, non-profit organizations, and other concerned advocates. Building on this movement, the DAG members created the Circle of Smiles Partnership that was awarded funding from the California Endowment to increase preventive education, access to care, and partnerships. The Circle of Smiles partnership includes a yearly dental sealant program that hosts volunteer dental professionals who apply sealants on over 300 at-risk children. Other programs that highlight dental collaboration include a dental "Angel Fund" to support needy children's dental treatment, mobile dental services to outlying and high-risk schools, open mouth screenings by volunteer dentists of over 1600 children in the last 3 years and assisting the most urgent cases. Dentists both from private practices and community clinics, are important partners in the DAG and the county's effort to address the children's dental epidemic with almost 35% of all children at high risk elementary schools have active dental decay and very few dentist to treat them.
Even with such unique collaborative programs, the DAG partners recognized the need for greater preventive and fluoridation efforts on many levels. Currently only 2 of the 4 largest cities in the county have fluoridated water. Small rural outlying communities with the greatest dental disease and least access to care do not have fluoridated water.
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Preceptor |
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Rama Oskouian, DMD, is a graduate of the University of Pennsylvania's, School of Dental Medicine where she graduated in 2000. Enjoying her time on the east coast, she completed a fellowship in pediatric dentistry at the prestigious Children's Hospital of Philadelphia. Following her fellowship, she completed two years of residency training in pediatric dentistry at Cincinnati Children's Hospital Medical Center.In 2003 she enrolled in a two year fellowship in pediatric dentistry at the University of Washington. In between training new dentists on how to be pediatric dentists, she earned a Master of Public Health degree with a specialty in Maternal Child Health in the fall of 2005 and earned a certificate in the Teaching Scholars program.
She has also been actively involved in training Pediatricians, Pediatric and Family medicine residents and medical students about pediatric oral health. Dr Oskouian has given multiple presentations at national, regional and local meetings and local hospitals. She is passionate about helping children access dental services, and training primary care providers in helping provide preventive services. Dr Oskouian also has extensive experience in the use of fluoride varnish and in the education of dental and non-dental personnel in doing oral health assessments and recognizing early signs of dental decay through the ABCD program in Washington State.
Dr Rama is also thrilled to be the Washington State Dental Director for the Special Olympics, where she screens athletes and educates them and their families about oral health. She also practices part-time at the Tulalip Indian Health Clinic. She is also active with the AAP training of medical professionals in oral health and helping reduce the caries risk in population.
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| Training Day |
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Grand Rounds: Redwood Memorial Hospital, Fortuna, CA Redwood Pediatrics, Fortuna, CA |
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Presentation and Demonstration at Eureka Pediatrics Eureka, CA |
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Lunch Grand Rounds: St. Joseph's Hospital, Eureka, CA |
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Presentation and Demonstration at Open Door Clinic, Arcata, CA |
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Presentation and Demonstration Physician's Office, Arcata, CA |
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Dinner Grand Rounds: Mad River Community Hospital, Arcata, CA |
The selected sites are ones that see the highest number of higher risk kids. The Grand Rounds reached area pediatricians, family practitioners and mid-levels. The lecture covered disease incidence, risk factors and caries physiology, the parent interview, exam positions and techniques, anticipatory guidance.
Not all pediatricians and family practitioners provide fluoride supplements. In addition, fluoride varnish is a virtually unknown practice in the county. A fluoride varnish program would be of tremendous benefit to the children for whom dental access is extremely difficult. A list of dental providers who provide care to children under 3 years of age and to Medical patients, and the kind of services they provide was distributed. |
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| Next Steps |
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The area pediatrician's offices participating in the training will be implementing the Oral Health Risk Assessment into their well child visits. Dr Klinke will continue to provide information and training to those interested in general pediatric dental care and fluoride varnish application. The Oral Health Risk Assessment and fluoride varnish application training will be offered to all the area public health nurses, school nurses, and area physicians through the local medical society bulletin. Investigation into reimbursement for varnish application is a priority and an area that Dr Oskouian will help the practices investigate.
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