Imagine If You Will ...
The Scene: Flashback to the original “Saturday Night Live”, Jane Curtin behind the news desk to deliver the Weekend Update. To her right, Roseanne Roseannadanna, who begins her weekly commentary:
“A Dr. John Tooth of East Armpit, Minnesota writes in to ask, ‘What’s all this I hear about Baby Screaming Slurpees? Who wants a teeny slush drink, and why would anyone want to listen to screaming anyway? I prefer to rely on feelings, fears, and frustration to inform me on issues of importance like this. Sometimes I get together to vent with my buddies, but when they don’t agree with me, boy, that ticks me off. I’ve got my comfort zone, you know, and this screaming slush stuff is just simply off my radar. What’s it to me? Why should I care? I like green tea. This stuff mystifies me! Call me set in my ways. Or call me successful doin’ it my way. But don’t call me late for dinner!”’
“Well, Dr. Tooth, I agree with you 100%! Screaming is for horror movies. As for the beverage... yuck!”
Jane interrupts with a patented glare: “It’s Basic Screening Survey. Not Baby Screaming Slurpees! BSS; a standard set of measures for oral health screening of population groups. Try to understand!”
“Oh. Sorry.” A turn to the viewers. “Never mind.”
Gilda Radner’s Roseanne Rosannadanna was not meek. She also wasn’t accurate, going off on tangents and digressing into tirades until Jane Curtin interrupted her, at which time her answer invariably was “Well, Jane, it just goes to show you, it’s always something.”
In real life too it is most often the “something”, off the radar and about which we do not have much factual information, which can mystify us and lead us off on tangents. The purpose of this article is to inform dentists, dental hygienists, and the dental team about ASTDD BSS and its use in the context of community collaborative practice. The simplicity, efficiency, and adaptability of collaborative practice for improving access to dental care are highlighted, as well as the importance of communication, relationships, and trust building.
What are ASTDD and BSS?
ASTDD stands for “Association of State and Territorial Dental Directors”, the United States national non-profit organization representing the directors and staff of state public health agency programs for oral health. BSS stands for “Basic Screening Survey”. Are your eyes glazing over already?
Recognizing the need for community-level oral health status and dental care access data, ASTDD developed the Basic Screening Survey (BSS) in 1999. The primary purpose of the BSS is to provide a framework for obtaining oral health data that is inexpensive, easy to implement, and consistent. The Basic Screening Survey manual describes a standard set of measures for oral health screening of population groups. The American Dental Association encourages dental professionals to assist state and local health agencies to collect data to monitor the oral health status of communities.
Here in Minnesota we have begun a five-year process of developing a Minnesota Oral Health Plan including an oral health assessment. To help accurately determine our oral health status as a whole, the Minnesota Department of Health is planning a Basic Screening Survey of a representative sample of third graders across the state. The state oral health plan needs to be based on an accurate assessment of the burden of oral disease in Minnesota. Consistent, standardized information (data) needs to be collected, and the collection process must be easy to perform and yield useful information.
Since 2006, Minnesota Head Start programs have had state and federal approval to use an adaptation of the BSS to perform standardized “assessment, triage, and referral services” for enrolled children. Dental hygienists working under collaborative agreement with dentists perform these services in various community settings.
What follows is how we recently used the BSS as a tool in a calibration exercise screening Head Start children. (Note: No “Slurpees” were involved in conducting this calibration — just pizza and coffee!)
On Friday, April 17, a number of parents and guardians brought their Head Start children to the Northern Dental Access Center in Bemidji, Minnesota. Their willingness to do so allowed the assembled dentists and hygienists to combine a BSS calibration exercise with completion of the Head Start oral assessment requirement for the children.
There were two main goals for the day:
1) To calibrate dentists and hygienists in conducting a Basic Screening Survey. The day was promoted as and intended for people who are ready to provide services in a Head Start program by establishing a collaborative agreement between dentist and hygienist, and be in relationship with a Head Start program, and
2) To advance the understanding of collaborative practice — what it can include, its requirements, how to develop an agreement, and how to build referral resources.
The dozen attendees reviewed the ASTDD material before the calibration exercise. They then viewed a training DVD and had their questions addressed. To be useful and valid, it is essential that all screeners collect data in the same fashion.
Three simple screening stations were set up, one each for a team of three learners and one calibration teacher. A station consisted of two reception area chairs set to face one another; a tray with gloves, a cotton tip applicator and LED flashlight; and a disposable mouth mirror and toothbrush which the child could take home along with a “goodie bag”.
Participants were encouraged to try using both a headlight and penlight to see what worked best for them. No explorers are used per ASTDD recommendations. The toothbrush from the student’s care bag was used to remove debris and aid visibility if needed. A station for follow-up with parent/Head Start staff after each child was screened was set up to finish the process.
Approximately 12 children were seen that day. As a team, the learners performed the Basic Survey Screening independently. After each person had an opportunity to record his or her BSS observations, the results were compared and reasons for differences in findings were discussed among the team, along with possible re-evaluation of practice subjects. ASTDD recommends that each screener should screen 10-20 children. One key to having a valid calibration is having a sufficient number of children with cavitated lesions.
The children and parents were outstanding as they allowed three, four, sometimes as many as five or six dental professionals to “take a look”. And when the last “looker” had completed the BSS, fluoride varnish was applied before the child was helped on his or her way.
We found a variety of screening indicators and treatment urgency among the children, including the two- and three-year-olds. Every child left with a nice goodie bag of oral hygiene items, play things, and coupons for cool stuff! Their parents left with information and assistance as needed for further care.
After the last flashlight had clicked off, the group retired to pizza and a debriefing. Discussion about the BSS exercise, sharing of resource information, and examples of collaborative agreements wrapped up the day. A dozen more providers had learned about Head Start dental needs, more about the regulations and requirements for developing a collaborative agreement and working with Head Start — they had collaborative agreements demystified!
While impossible to capture all the details in an article, we hope that the “demystifying” process about collaborative practice and the Basic Screening Survey has begun for you, too. If this has at least whetted your appetite to learn more, you can do so through the following resources. And if you hear someone off on a less than accurate tangent about collaborative practice, you might prompt them to say, “Never mind.”
For more information: www.astdd.org www.normandale.edu/dental
(for more information about collaborative practice) www.mnheadstart.org www.dentalboard.state.mn.us (Minnesota Statute 150A.10, Subd. 1a. “Limited authorization for dental hygienists”) www.mndental.org (MDA collaborative agreement template) www.mchoralhealth.org/HeadStart/FAQs/
•Dr. Lueth practices general dentistry in Bemidji and chairs the MDA Community Service Committee.
** Ms. Jacobi is Director of Policy and Advocacy for Apple Tree Dental.
†. Ms. Kelly is Executive Director of Minnesota Head Start Association.
Others who were involved in the Bemidji calibration exercise were Cathy Jo Gunvalson, RDH, and Becky Lommen, RDH.