Primary Oral Health Care and Coalition Building

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Primary Oral Health Care and Coalition Building
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ORAL HEALTH

• Tooth decay
• Gum diseases
• Oral cancer

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Many health problems begin with poor oral hygiene

• By Karen UhlenhuthKnight Ridder Newspapers
• January 4, 2004

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Dr. Marjorie Jeffcoat,

• Dean of the University of Pennsylvania School of
  Dental Medicine
• Editor Journal of the American Dental Association

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GUM DISEASEa Chronic Infection

• Increase the risk of heart attack and stroke.
• Increase the incidence of premature,
  low-birthweight babies.
• Exacerbate diabetes, which now affects 17 million
  Americans.
• Possibly contribute to grave lung disorders such
  as pneumonia and emphysema.

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Gum Disease

• 25 to 35 of people 35 to 60 years old have the
  disease
• Among people older than 60, that rate escalates
  to 60 - 75

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Risk Factors

• Poor dental hygiene. You should brush and floss
  daily to maintain healthy gums.
• Cigarette smoking. It's been identified as one
  of the leading causes of periodontal disease.
• Genes. About 30 percent of people have an
  inherited susceptibility.

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Risk Factors

• Stress. It interferes with the body's ability to
  fight periodontitis and other infections.
• Diabetes. Diabetics are more susceptible to all
  infections, including those in the mouth.
• Some drugs. They include oral contraceptives,
  antidepressants and some heart medications

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Gum Disease and Fetal Health

• A pregnant woman with periodontal disease is
  more likely than a noninfected woman to give
  birth prematurely and to deliver a small baby
• In a severe case of periodontitis, she is about
  seven times more likely

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Dr. Jeffcoat

• It is time for us not to think of our mouths as
  somehow disconnected from the rest of our bodies.
  The same blood flows through them, the same
  nerves go to them. To have a healthy body, you
  need a healthy mouth.

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2020 vision What will you be treating in 20
years?

• There will be more older people and their oral
  health will be better than previous generations
• More and more of our patients will have complex
  medical conditions
• Marjorie K. Jeffcoat, JADA 134 Dec 2003

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Whats up with tooth decay in the USA

• Caries is a transmissible infection that is diet
  dependent and saliva mediated
• Caries prevention has been effective with a large
  proportion of the population

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Pathogenesis of Dental Caries

• Caries is a transmissible infection
• Mother to child (Berkowitz 1981)
• Window of Infectivity, 12-30 months (Caufield
  1989)
• 20 of 14 month old infants infected (Mohan 1998)
• Predentate infants infected (Milgrom 1998)

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Essential Cause of Tooth Decay

• Susceptible tooth
• Bacteria
• Fermentable carbohydrate
• Time

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White Spots

• Subsurface
• demineralization

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Why do some people get more cavities than others?

• Caries is a transmissible infection that is diet
  dependent and saliva mediated
• Biofilms, complex communities of microorganisms,
  where acid production occurs
• All biofilms are not alike
• Joel Berg DDS, MS-Professor Chair of
  Pediatric Dentistry, Univ. of Washington,
  Scientific American, Feb. 2003, p.93

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Nature of the Problem

• High risk group 25 experience 80 of decay
• Traditional treatment is inaccessible and
  expensive
• Effective preventive measures are feasible

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Access to dental care for children in the United
States A survey of general practitioners

• N. Sue Seale, DDS, MSD
• Paul Casamassimo, DDS, MS
• JADA Dec 2003, 1341630-1640

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Results

• The good news!
• 91 of the general dentists treated children

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Results

• The bad news!
• Few children younger than 4 years received
  treatment
• Children funded by Medicaid were represented in
  very low numbers
• Few children with high decay rates were treated

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Results

• Only 15 of the respondents identified the age of
  1 year as the appropriate age for the first
  dental visit
• There was a significant association of types of
  child patients in practice and with the
  intensity of the respondents educational
  experiences

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Results

• Practitioners in rural locations were
  significantly more likely to treat
  Medicaid-covered patients
• More than 40 indicated further education in oral
  sedation, nitrous oxide sedation and atraumatic
  restorative technique

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Petes Conclusions

• General practitioners provide 90 of the dental
  care for children
• Expansion of access to oral health care by
  general dentists for young children,
  Medicaid-funded children, and high-risk for decay
  children will begin to turn the tide

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The Problem

• Poverty
• Social and cultural isolation
• Fear
• Outdated concepts

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• An Example of Coalition Building

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ABCD Counties 1995-2004
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• Started in Spokane in 1995
• 17 counties currently participating
• gt200,000 children, 5 and under, eligible

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Spokane ABCD

• Begun in 1995 and still going strong
• 43 of children enrolled in the ABCD program
  visited a dentist in the past year
• 12 of Medicaid-enrolled children not in the ABCD
  program visited a dentist in the past year
• An ABCD child was 5.3 times more likely to have
  had at least one dental visit than a child not
  enrolled in the ABCD program
• An ABCD child was 6 times more likely to have
  received preventive services

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Four Components

• Outreach
• Training and certification of dental
  professionals
• New and enhanced dental benefits
• Enhanced dental fees

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Reimbursement

• Three fluoride varnish treatments
• Family Oral Hygiene Instruction
• Other new Medicaid procedures
• Enhanced fees

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Qualitative Research Results

• Increased awareness of the need for early
  prevention and/or intervention in pre-school
  children
• The program reduced dental fear and increased
  parent satisfaction

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The Efficacy and Cost-Effectiveness of the ABCD
ProgramM. KOBAYSHID. CHI, S. COLDWELL, P.
DOMOTO and P. MILGROMSubmitted
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Results

• Children in ABCD county were healthier than the
  non-ABCD county
• ABCD expenditures were 33 per child for each
  cavity averted
• Expenditures for alternatives ranged from 59 to
  273

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Conclusions

• ABCD improves the health of preschoolers and has
  the potential to save up to 1.3 million per year
  in Spokane and Pierce counties alone

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Whatcom County Partnerships

• Mt. Baker District Dental Society
• Whatcom County Health Department
• St. Joseph Hospital
• Opportunity Council
• Madrona Pediatrics
• Interfaith Coalition
• Washington Medicaid/CSO
• Washington Dental Service Foundation
• University of Washington

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Whatcom County Health Department

• Enrolls patients in ABCD
• Sends more infants and toddlers to dentists
• Provides orientation for families
• Assists in problem solving-please call

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Goals

• Establishing a therapeutic alliance with families
• Getting children and parents to return
• Providing continuity of care

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• Reducing the extent of disparities in oral health
• Increasing access to preventive dental care among
  preschool children from birth up to 5 years of
  age served by the Medicaid program
• Joint programs by dentists, health departments
  and Medicaid in counties all over the State.

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AAPD Filling Gaps 2001
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Increase in Service to Young Children w/ Medicaid

• Between 2000 and 2002, the number of children
  under 6 that were seen by private practice
  dentists more than doubled
• Children under 2 years of age that were seen
  jumped from 10 to 18
• Diane Lowry, MPH, MSW