Marguerite (Peg) DiMarco PhD, RN, CPNP is an Associate Professor in nursing at Case Western Reserve University where she received her PhD. She has been a pediatric nurse for 40 years, taught nursing for 35 years and practices as a pediatric nurse practitioner for the last 19 years. Her research interests involve health/dental care of poor children. She has international/national presentations, publications, and funded research projects in this area. She had NIH funding for her dissertation “Access/Utilization of Dental Care by Homeless Children”. Her latest interdisciplinary project received a $1+ million from Kellogg to provide oral healthcare/education to WIC mothers/children.


The CDC (2011) report on oral health found that preschool children have increasing incidence of dental caries especially in lower-income families. Fewer than 3% of Medicaid children see a dentist before the age of three, but 78% of children under 3 years of age see a primary healthcare provider. Primary healthcare providers can bill Medicaid for fluoride varnishes to preschoolers to help prevent cavities. The purpose of this project is to improve the oral health of vulnerable children through a unique interdisciplinary model at the Supplemental Nutrition Program for Women, Infants, and Children (WIC). This model integrates oral health assessments, dental referrals, education and fluoride varnishing into regular practice at two WIC sites utilizing Registered Dieticians, Nurse Practitioners, and students to deliver services. The program is finishing the third and final year. After over 2.5 years, 3646 children were enrolled and received fluoride varnish. Children at the urban and rural WIC sites had a higher percentage of children seeing the dentist between the 2nd and 3rd visits (p<.001). This new delivery model with Nutrition and Nursing collaboration has shown improved oral health between decayed teeth at first visit and decayed teeth at second visit for children at the urban WIC site(mean=.461; p=.022). However, even at the third visit the urban site reported that 51.1% of the children drank more than one cup of a sweet drink per day compared to the rural site children (21.9%). Interdisciplinary cooperation is needed to tackle this increasing problem of dental decay.

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