Oral Health, Health Disparities and Programs to Improve Access to Dental Care in the US and Washingt

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Oral Health, Health Disparities and Programs to
Improve Access to Dental Care in the US and
Washington State

• Peter Milgrom, DDS
• Professor of Dental Public Health Sciences
• Director, Northwest/Alaska Center to Reduce Oral
  Health Disparities

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Self Instruction Program

• Before beginning this program, please first
  review the Surgeon Generals report material in
  the required readings.
• Study the slides in this program.
• Complete the self-assessment. There is a link to
  the self assessment in the last panel.
• You will not receive credit for completing the
  assignment without doing the self-assessment.

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I. Oral Health

• Learning Objectives
• To recognize groups within the population that
  are most susceptible to dental disease.
• To understand the issue of access to care.
• Be able to discuss the importance of a delicate
  workforce balance. Identify trends of dental
  supply, demand and need.
• To understand how sources of payment for dental
  treatment contributes to access to care.
• To reconcile The Surgeon Generals Report and
  oral health disparities

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Each child is an adventure into a better life-
an opportunity to change the old pattern and make
it new. Hubert H. Humphrey, Senator and Vice
President of the US
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Most common conditions among 5-17 year olds in
the United States
Includes decayed, filled and missing permanent
teeth NCHS 1996
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Disparities in Dental DiseasePoor and non-poor
children aged 2-7 percent of decayed teeth
untreated per person by ethnicity
NCHS 1996
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Prevalence of Oral Disease Preschool Children 2-5
Years Old in Alaska
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American Indian/Alaska Native Preschool
ChildrenPercentage With Severe Early Childhood
Caries
National Rate for ECC is less than 5
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Disparities in Dental DiseasePoor and non-poor
children aged 12-17 percent of decayed teeth
untreated per person by ethnicity
NCHS 1996
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Disparities in Dental DiseasePoor and non-poor
adults 18 and older percent of decayed teeth
untreated per person by ethnicity
NCHS 1996
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Disparities in Dental Disease percent of persons
with at least on site with severe periodontal
disease by ethnicity and age group
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Oral pharyngeal cancer rates by race and sex
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Disparities in oral cavity pharynx cancer
percent of persons with 5-year survival rates and
stage of dx. for African Americans and
Non-Hispanic Whites
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US Adults 1977, 1987, 1996
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Disparities in Access to CarePercentage of
persons accessing dental care within one year by
Income Status for 1996
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Disparities in Access to CarePercentage of
persons accessing dental care within one year by
Income Status for 1996
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Disparities in Access to CarePercentage of
persons accessing dental care within one year by
ethnicity for 1996
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of US school children with untreated tooth
decay by race
Rates are higher in Hispanic and AI preschool
children
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Unmet treatment need in adults (D/DMFT) by race
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Children with preventive dental services by
income and race
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Disparities in Access to CarePercentage of
persons accessing dental care within one year by
years of education for 1996
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Disparities in Access to CarePercentage of
persons accessing dental care within one year by
assessed health status for 1989
Differences are correct but absolute values
inflated
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Delicate Workforce Balance
Need
Demand
Productivity
Population Growth
Insurance
Safety Net
Supply
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Selected National Dentist Trends

• 12 decline in dentists per capita (86-96)
• Increase in percent female (more part-time)
• Leveling of female in dental school
• WA dentist graduating numbers flat
• 9 increase in dental hygienists

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86-96 Change Dental WF Grads Per 100K Population
WA is 14th in dentists, 11th in hygienists, and
2nd in DAs per capita in the US.
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Washington Dentist Findings

• Work hours same as nationally
• Older than nationally
• Half reported retirement by 2013
• Relatively fewer dentists in rural places
• Volume limited by lack of hygienists
• Source 2001 Survey of Washington Dentists,
  Gary Hart

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Proportion of Rural Counties in the US without a
dentist in 1990

• Northeast 9.1
• Midwest 31.3
• South 46.3
• West 37.7

More than 1,000 counties in the US have been
defined as dentist shortage areas
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dfs DFS by county, third grade,Washington
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Treatment Need, 3rd Grade Washington, 1995

• Percent with untreated decay 30
• Range by county 15 to 54
• Percent without sealants 66
• Range by county 54 to 71

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Payment for Dental ServicesFunding by income and
source, 1987-1996
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Sources of Payment, US 1996
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Adult Funding by income and source, 1996
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Dental Insurance by income, 1996
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Impact of Insurance on access, by income 1996
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Policy Implications(Surgeon Generals Report)

• Change perceptions regarding oral health and
  disease so that oral health becomes an accepted
  component of general health.
• Public, Policymakers and Providers
• Build an effective health infrastructure that
  meets the oral health needs of all American and
  integrates oral health effectively into overall
  health.
• Remove known barriers between people and oral
  health services.
• Use public private partnerships to improve the
  oral health if those who still suffer
  disproportionately from oral diseases.

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Review Questions

• What is the most common health condition among
  children in the U.S.?
• What is the trend of dental disease and access to
  care?
• Reconcile the trends of the dental workforce and
  dental treatment need.
• What is the importance of discussing insurance?

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Link to the Self-Assessment

• To receive credit for this assignment, please
  complete the self-assessment. Paste the link to
  the assessment below in your web browser. Your
  record will automatically sent to the course
  director. Let us know if you encounter
  difficulty.
• URL https//catalysttools.washington.edu/tools/s
  urvey/?sid25882ownerdfrc