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Into the Mouths of Babes/Connecting the Docs

Medical Providers: Partner with us to improve your child patients’ oral health

The Into the Mouths of Babes (IMB)/Connecting the Docs program trains medical providers to deliver preventive oral health services to young children insured by NC Medicaid. Services are provided from the time of tooth eruption until age 3½ (42 months), including oral evaluation and risk assessment, parent/caregiver counseling, fluoride varnish application, and referral to a dental home. Goals include preventing and reducing early childhood tooth decay and increasing referral of high risk children to a dental home. The medical provider is reimbursed through N.C. Medicaid.

The Oral Preventive Procedure

The Oral Preventive Procedure consists of three equally important parts:

  1. Oral Evaluation and Risk Assessment
  2. Counseling with Primary Caregivers
  3. Application of Topical Flouride Varnish

Application of fluoride varnish can be compared to having a fluoride treatment at the dental office. Topical fluorides, including varnish, are most effective at preventing tooth decay when applied at regular intervals .

Medicaid-insured children may have the procedure a maximum of six times from tooth eruption until 3 ½ years of age (42 months). The procedure is recommended every three to six months and is most successfully incorporated as part of a well-child visit. Medicaid requires a 60-day time interval between procedures.

Evaluation and Outcomes

Ongoing evaluation of the Into the Mouths of Babes/Connecting the Docs program is conducted by the UNC Gillings School of Global Public Health.

Published Highlights Include:

  • Greater distance to care is not a barrier to preventive oral health visits in the medical setting for young NC Medicaid-insured children.

Kranz AM, Lee J, Divaris K, Baker AD, Vann W Jr. North Carolina physician-based preventive oral health services improve access and use among young Medicaid enrollees. external link Health Aff. 2014 Dec;33(12):2144-52. (doi: 10.1377/hlthaff.2014.0927 Health Affairs 33. No. 12 (2014):2144-2152) accessed 12/11/15

  • For children receiving four or more IMB visits before three years of age, there is a 21% reduction in hospitalizations for dental treatment.

Stearns SC, Rozier RG, Kranz AM, Pahel BT, Quinonez RB. Cost-effectiveness of preventive oral health care in medical offices for young Medicaid enrollees. external link Archives of Pediatric and Adolescent Medicine. 2012;166(10):945-951. (doi:10.1001/archpediatrics.2012.797) accessed 10/7/15

  • On average, children receiving four or more IMB visits before three years of age show a 17.7% reduction in caries.

Kranz AM, Preisser JS, Rozier RG. Effects of physician-based preventive oral health services on dental caries. external link Pediatrics 2015 Vol.136 No.1 pp.107 -114 (doi: 10.1542/peds.2014-2775) accessed 10/7/15

  • IMB has contributed to a statewide decline in dental caries rates since 2004 and helped reduce the gap in tooth decay between children from low- and other-income families at the community level.

Achembong LN, Kranz AM, Rozier RG. Office-based preventive dental program and statewide trends in dental caries. external link Pediatrics 2014 Vol. 133 No. 4 pp. e827 -e834 (doi: 10.1542/peds.2013-2561) accessed 10/7/15


Training consists of a standard one-hour continuing medical education (CME) session, which is acceptable for up to 1.00 Prescribed credit(s) by the American Academy of Family Physicians and accepted by the American Medical Association. The training provides information on oral evaluation, priority risk assessment and referral, parent counseling, and fluoride varnish application. Additionally, the training includes information on Medicaid coding and billing, an online oral health toolkit containing helpful resources, and a starter kit with supplies for 10 procedures. Information for ordering supplies is included as well. 

The medical provider conducting the oral evaluation and risk assessment portion of the procedure must be a physician, physician assistant, or nurse practitioner. In public health clinics a registered or licensed nurse may perform the procedure with physician standing orders. Parent/caregiver counseling is a required part of the preventive procedure. Counseling should include information about the importance of parents brushing their child’s teeth with fluoride toothpaste and starting dental visits early. Post-operative instructions tell parents to wait and brush their child’s teeth the next day after the varnish is applied. This gives the fluoride varnish more contact time with the tooth surface, strengthening the tooth enamel.

The procedure may be documented on the provided priority oral health risk assessment and referral tool (PORRT) or directly in the patient chart. Documentation should include the parts of the procedure, any noted disease or abnormalities, and if the provider referred the child to a dentist.


As a partner in the IMB/Connecting the Docs program, N.C. Medicaid reimburses medical providers for the procedure. A child can have the procedure a total of six times from tooth eruption until 3½ years of age (42 months).

Medicaid reimbursement is approximately $50 for each of the six visits.

Time involved providing the procedure depends on the child’s age and tooth eruption patterns.

In 2014 the US Preventive Services Task Force recommended that primary care clinicians apply fluoride varnish to the teeth of all infants and children starting at the age of primary tooth eruption and continuing through five years of age.  Private medical insurers are now covering this service. For more information, please refer to the individual company’s provider portal on their website.

Moyer, VA. Prevention of dental caries in children from birth through age 5 years: US Preventive Services Task Force recommendation statement. Pediatrics 2014; 133: 1-10.

N.C. Toolkit

Toolkit for Into the Mouths of Babes/Connecting the Docs Participants

IMB / Connecting the Docs: Contact Information

For more information about IMB/Connecting the Docs, contact Kelly Close at 919-707-5485 or

If your medical practice is part of a Community Care of NC network, you may contact your CCNC Quality Improvement Specialist for information about IMB/Connecting the Docs.


The Into the Mouths of Babes (IMB) program began as the collaborative effort of six partners: The N.C. Academy of Family Physicians, the N.C. Pediatric Society, the N.C. Division of Medical Assistance, the N.C. Oral Health Section, the UNC-CH School of Dentistry, and the UNC-CH Gillings School of Global Public Health.

Today the IMB/Connecting the Docs Program is guided by the N.C. Early Childhood Oral Health Collaborative (ECOHC), which includes the original six partners and many additional partners.

Initial and past grant funding was provided by the Centers for Disease Control, the Center for Medicare and Medicaid Services, the Health Resources and Services Administration (HRSA), HRSA State Oral Health Collaborative Systems, and most recently, HRSA Targeted State MCH Oral Health Service Systems Grant Program. The IMB/Connecting the Docs program is now part of the N.C. Department of Health and Human Services, Oral Health Section, and continues to collaborate with partners throughout the state.