Smiles Across MT

Dear Parents/Guardians:

ProSmiles of Montana is a mobile dental program focusing on the prevention of oral and systemic diseases, with the support of our foundation, Smiles Across Montana (SAM). ProSmiles/SAM submits for insurance reimbursement and provides scholarships. ProSmiles/SAM delivers continuity of care by striving to see each enrolled student at least 3 times per school year. Each enrolled student will be seen by a registered dental hygienist working under the direct/ general supervision of a dentist and will receive one or more of the following preventative services:

• Prophylaxis (cleanings): Removal of hard and soft materials that form on the teeth.

• Sealants: A thin plastic coating that fills in the deep grooves on the chewing part of the tooth. They are easy, painless and will help prevent decay as your child grows.

• Fluoride Varnish Treatments: A protective coating that is painted on the teeth to help strengthen tooth structure helping the teeth to be more resistant to decay.

• Silver Diamine Fluoride Treatments: Aids in stopping decay as well as preventing future decay on the tooth.

• Oral Health Instructions (including tooth brushing demonstration) and Nutritional Guidance

• Referral to a Dental Home or Dentist of Record

• Exam, by a dentist, and x-rays deemed necessary and prescribed by the dentist

WHY IS DENTAL PREVENTION IMPORTANT?

• What is decay?

Decay is a cavity in either the baby tooth or the adult tooth that is caused by many different factors (diet, genetics, oral hygiene, etc.)

Decay in children’s teeth can be prevented, arrested, or treated as needed by a dentist.

Decay can be painful, life altering (missed school days, inability to concentrate, and systemic complications) and in some cases can cause irreversible problems.

HOW CAN THIS AFFECT YOUR FAMILY, HOW CAN WE HELP?

• Many families cannot take time off of work to take their children to regular preventative dental appointments and others may not have access to a dental home.

• By assisting families in the enrollment of Medicaid when applicable.

• We will provide families with a note regarding what services were provided and any recommended referral. The registered dental hygienist will notify the family following the appointment with any urgent concerns.

• Provide a list of offices accepting new Medicaid pediatric patients in case of a dental emergency, if needed.

• It allows all consented children to be seen regularly without the parent having to take time off work for preventative treatment or the child missing school.

• ProSmiles/SAM will collaborate with the dentist of record to ensure that the children receive recommended treatment. If the family has no dental home, we will work to ensure that the family is given multiple options of providers in their area.

Please return the last two pages of the completed forms to your child’s teacher/administrator. You may keep the first two pages for your own records.

IF YOUR CHILD IS SEEN AT A DENTAL OFFICE ON A REGULAR BASIS (EVERY 6 MONTHS) FOR CLEANINGS YOU MAY CHOOSE NOT TO UTILIZE SAM SERVICES, THERE IS NO NEED TO SIGN THIS CONSENT.