School Dental Program Overview

Dental pain is often the reason a child misses school. To make your child's visit to the dentist as easy as possible, Little River Medical Center offers a mobile dental program, Miles for Smiles!

Our Professional and experienced dental team provides dental care at your child's school, or a nearby location in your community, throughout the school year. Your child can receive: Exams and X-Rays; Cleanings and Flouride Treatments; Sealants; Fillings; Extractions and more. Parents are kept informed of their child's dental needs and the planned course of treatment.

Parent enjoys the convenience of:

• Your child not missing school
• No time away from your busy schedule

Lo Que El Programa Dental Escolar Ofrece

Dolor dental es una de las razones por la cual un niño falta a la escuela. Para hacer la visita al dentista lo mas facil posible para su hijo, Little River Medical Center
ofrece un programa dental móvil, Miles for Smiles!

Nuestro equipo dental profesional y experimentado brinda atención dental en la escuela de su hijo, o en un lugar cercano, durante todo el año escolar. Su hijo puede recibir: examenes y rayos X; limpiezas y tratamientos de fluoruro; Selladores; rellenos; extracciones y mas. Los paderes son mantiniedos informados de las necesidades dentales de su hijo al igual que los planes de tratamiento.

Los padres disfrutan de la convenencia de:

• Su hijo no falta a la escuela
• Usted no toma tiempo de su agenda apretada

Informed Consent for Mobile Dental Care/Consentimiento informado para el cuidado dental móvil

Consent to treat your child/Consentimiento para tratar a su hijo

THIS CONSENT WILL REMAIN IN EFFECT UNTIL I REVOKE IT IN WRITING.YES, I authorize a SC licensed dentist or Associate with LRMC Mobile Dental Clinic to provide to my child a dental exam, x-rays, cleaning, fluoride, sealants, extractions, SDF, and any other restorative work as needed on the mobile dental unit or at school without my presence. I understand that if my child doesn’t have Medicaid/ Insurance and not funded through LRMC Miles for Smiles, I am financially responsible for the services performed. I grant permission for the above child to receive services outlined above on the mobile dental unit that may be located at a school location or in your community. For the safety and security of patients and staff, Little River Medical Center, Inc. utilizes video surveillance on its mobile dental units. No video or photographs will be released without the explicit consent of the patient/parent/guardian. If you have questions regarding the use of the video surveillance equipment, please contact LRMC’s Compliance Office at 843-663-8002.

Éste consentimiento permanece en efecto hasta que lo revoque por escrito. Si, autoriza un dentista con licencia de S.C. o Asociado de la Clínica Dental Móvil de LRMC a proporcionarle a mi hijo, según sea necesario un examen dental, Radiografía, limpieza,  fluoruro, sellantes, extracciones, SDF y cualquier trabajo de restauración en la unidad dental móvil o en su escuela sin mi presencia. Entiendo que si mi hijo no está inscrito en Medicaid/ Seguranza dental y no recibe fondos a través de LRMC Miles for Smiles, soy financieramente responsable de los servicios presentados. Doy permiso para que el niño arriba mencionado reciba los servicios descritos anteriormente en la unidad dental móvil o en su colegio. Para la seguridad de los pacientes y el personal, de Little River Medical Center, Inc. utiliza video vigilancia en sus unidades dentales móviles. No se publicarán videos o fotografías sin el explícito consentimiento del paciente/padre/tutor. Si tiene preguntas sobre el uso del equipo de video vigilancia, Comuníquese con la oficina de cumplimiento de LRMC al 843-663-8002. 

LRMC DENTAL CENTER INFORMED CONSENT FOR SILVER DIAMINE FLUORIDE/Little River Medical Center Informó a Consnet Sobre el Fluoruro de Diamina de Plata

Facts for consideration/Hechos Para su Consideración:

  Silver Diamine (SDF) is an antibiotic liquid. We use SDF on cavities to help stop tooth decay. We also use it to treat tooth sensitivity. SDF application every 6-12 months is necessary./Silver Diamine (SDF) es un antibiótico líquido. Usamos SDF en caries para ayudar a detener la caries dental. También lo usamos para tratar la sensibilidad dental. Es necesaria la aplicación de SDF cada 6-12 meses.

The procedure/El Procedimiento:

     1.) Dry the cavity area/seque el área afectada.    

     2.) Place a small amount of SDF on the cavity area/coloque una pequeña cantidad de SDF en el área afectada.

     3.) Allow SDF to dry for one minute/deje que el SDF se seque durante un minute.   

     4.) Rinse/enjuague.

Benefits of receiving SDF/Los Riesgos Relacionados con SDF Incluyen, Entre Otros: 

·   SDF can help stop cavities.

·   SDF can help sensitive teeth.

Risks related to SDF include, but are not limited to:

·  The cavity will stain black permanently. Healthy tooth will not stain. The stain can be fixed with a filling or a crown.

·  Tooth-colored fillings and crowns may turn dark if SDF is applied to them.  Color changes on the surface can normally be polished off. The area between a tooth and filling may keep the dark color.

·   If accidentally gets on the skin or gums, a brown or white stain may appear that causes no harm, cannot be washed off, and will go away in 1-3 weeks.

·   Some people may notice a metal taste. This will go away quickly.

·   If the cavity is not stopped, the cavity will get worse. In this case, the tooth will require further treatment, such repeat SDF, a filling or crown, root canal treatment, or extraction.

·   These are some of the side effects reported by the manufacturer. If you notice other symptoms, please contact your dental provider.

·   Every effort will be made to ensure the success of SDF treatment. There is a chance the procedure will not stop the cavity and there is no guarantee that this will work.

Alternatives to SDF, not limited to the following: 

· No treatment, this may lead to the cavity getting worse if treatment is not completed.

Depending on the location and extent of the cavity, other treatment may be needed like a fluoride treatment, a filling or crown, extraction, or referral for advanced treatment.

Summary of Privacy Practices

In accordance with the Privacy Regulations and Accountability ACT of 1996 (HIPAA) Notice of Privacy Practice and Bill of Rights, we are required to maintain the confidentiality of your health information. We will use and disclose your protected health information to carry out treatment, payment of health care operations and for other purposes that are permitted or required by law. I authorize Little River Medical Center (LRMC) to release information regarding treatment to thrid party payers or others for the purpose of continuity and coordination of care.

For a full copy of the HIPAA Notice of Privacy Practices and Patient Bill of Rights, please call LRMC School Dental program at 843.663.8403 or 843.455.8234. You may also find a copy online at http://lrmcenter.com or email: smiles@lrmcenter.com

Resumen de las prácticas de privacidad

De acuerdo con el Aviso de Práctica de Privacidad y Carta de Privacidad de 1996 (HIPAA) de 1996 (HIPAA), estamos obligados a mantener la confidencialidad de su información médica. Usaremos y revelaremos su información médica protegida para llevar a cabo el tratamiento, el pago de operaciones médicas y para otros razones que estén permitidos o requeridos por la ley. Autorizo a Little River Medical Center (LRMC) a revelar información sobre el tratamiento a los pagadores de terceros o otros con el propósito de continuidad y coordinación de la atención.

Para obtener una copia completa del Aviso de Prácticas de Privacidad y La Carta de Derechos del Paciente de la HIPAA, llame al programa LRMC School Dental al 843.663.8403 o al 843.455.8234. También puede encontrar una copia en línea en http://lrmcenter.com o correo electrónico: smiles@lrmcenter.com

LITTLE RIVER MEDICAL CENTER SLIDING FEE SCHEDULE APPLICATION

Upon submitting this form you will be automatically directed to our sliding fee, finanical assistance, application.

ONLY complete this form if you do NOT have insurance or your insurance does NOT have dental benefits.

Thank you for choosing Little River Medical Center as your dental provider.