The importance of oral health in Kentucky along with the value of Kindergarten Oral Health Screening

1. STEP UP for Kids: ORAL HEALTH
Blueprint for Kentucky’s Children Event
December 1, 2014
Nikki Stone, DMD, Chair, KOHC

2. The Blueprint for Kentucky’s Children believes all
children should have the opportunity to succeed.

3. Importance of Oral Health
 In the USA, dental care remains the greatest unmet health
need among children.
 KY ranks 45th in the percentage of children with untreated
dental decay (34.6%).
 KY was given a grade of “C” in children’s oral health by the
Pew Center on States report.
 In 2012, only 40% of KY children enrolled in Medicaid or
KCHIP received even a single dental service.
 KY ranks 5th in the nation for “toothlessness” (25% of
adults age 65 and older have had all their natural teeth
removed).

4. Oral Health and LEARNING
 Good oral health is an integral component of optimal
childhood LEARNING.
 Children free from dental pain and infection can focus
on their schooling.
 Access to preventative dental services significantly
improves school attendance and developmental
growth.

5. Poor Oral Health Affects
Children’s Learning Abilities
80
70
60
50
40
30
20
10
0
1 2 3 4 5 6 7 8 9 10 11 12
The two schools with the LOWEST untreated tooth decay rates are
the two schools with the HIGHEST standardized test scores 07/08.

6. 2015 ORAL HEALTH Policy Agenda
 2015 Policy Agenda FACT SHEET includes:
 General Oral Health Information
 History of the Legislation
 Barriers to Achieving Desired Impact
 Pertinent Facts
 SOLUTION: Strengthen the Kindergarten Entry Oral
Health Screening Requirements

7. Oral Health
 Good oral health is CRITICAL to good overall health.
 Tooth decay and other oral diseases can have long-lasting
impacts on a child’s ability to LEARN, SPEAK,
and EAT.
 It is critical for families to begin receiving routine
dental care for their children during EARLY
CHILDHOOD.

8. History of the Legislation
 The Blueprint helped craft a bill requiring children
enrolling in schools to get a dental screening or exam.
 The bill passed and was signed into law on April 15,
2008.
 The bill requires dental screenings for all children
entering kindergarten.
 The purpose was so that oral health problems could
be addressed early and not interfere with learning.

9. The Legislation
 Kentucky law, KRS 156.160(i),
requires proof of a dental
screening or examination by a
dentist, dental hygienist,
physician, registered nurse,
advanced registered nurse
practitioner, or physician
assistant. This evidence shall be
presented to the school no
later than January 1 of the first
year that a five (5) or six (6)
year old is enrolled in public
school.

10. Barriers to Achieving Desired Impact
 Several key elements in
implementation are
necessary to ensure the
requirement achieves the
intended impact.
 In school year 2013/14, at
least 48% of incoming
kindergarteners did NOT
receive a dental screening
or their school district did
not report the data.
YES
NO
48%

11. Pertinent Facts
 1. Kindergarten oral health screenings help keep
children healthy.
 2. Poor oral health hinders children’s ability to learn.
 3. Kentucky has not collected comprehensive
information on children’s oral health for over a
decade.

12. 1. KINDERGARTEN ORAL HEALTH SCREENINGS
HELP KEEP CHILDREN HEALTHY
 Tooth decay is a transmissible bacterial infection, usually
passed from mother to child before age one.
 Tooth decay is the #1 most common CHRONIC childhood
disease in the USA (chronic means it is a lifelong struggle).
 Tooth decay is often established by the time a child enters
preschool.
 Untreated tooth decay can lead to serious infections in the
mouth and in the body and cause pain, infection, and even
death.
 Untreated tooth decay and gum disease are linked with
chronic conditions in adults such as heart disease, diabetes,
and stroke.

13. The bacteria that causes caries is transmissible.
Streptococcus Mutans transmission from mother to child

14. BABIES GET CAVITIES!

15. 10 Volunteers

16. In our four county service area,
in Head Start children ages 2-5,
58% had untreated tooth decay in 2007/08

17. 6 out of 10 PRESCHOOLERS
in East KY Age 3-5 Have Cavities

18. In our four county service area,
in elementary children ages 6-12,
68% have untreated tooth decay in 2007/08
This is a permanent
six year molar, not
even fully erupted,
already decayed &
infected because of
untreated decay in
baby teeth.
This is a decayed
baby tooth that
never got treatment.
URGENT dental needs in this group are also 20%.

19. 7 out of 10 ELEMENTARY KIDS
in East KY Age 6-12 Have Cavities

20. ORAL HEALTH SCREENINGS
CAN CATCH TOOTH DECAY
EARLY SO IT CAN BE TREATED

21. 2. POOR ORAL HEALTH HINDERS
CHILDREN’S ABILITY TO LEARN
 Children in pain cannot effectively concentrate in
school.
 Children who do not receive appropriate dental care
are more likely to miss school days and fall behind
academically.

22. Poor Oral Health Affects
Children’s Learning Abilities
80
70
60
50
40
30
20
10
0
1 2 3 4 5 6 7 8 9 10 11 12
The two schools with the LOWEST untreated tooth decay rates are
the two schools with the HIGHEST standardized test scores 07/08.

23. CHILDREN IN PAIN CANNOT LEARN
Infection
20 out of
20 teeth
decayed
(rampant)
Pain

24. 2 out of 10
East KY Kids Are in PAIN
OUCH! OUCH!

25. Thank You to the Volunteers

26. ENSURING EVERY
KINDERGARTENER RECEIVES AN
ORAL HEALTH SCREENING WILL
RESULT IN STUDENTS WHO ARE
BETTER PREPARED TO LEARN

27. 3. KENTUCKY HAS NOT COLLECTED
COMPREHENSIVE INFORMATION ON CHILDREN’S
ORAL HEALTH FOR OVER A DECADE
 The last state-wide study on children’s oral health was
done in 2001.
 Therefore, Kentucky relies on the kindergarten oral
health screening data to see where we stand on
children’s oral health.
 Currently, there is inconsistent data entry from the
screening forms, so we lack reliable, quality data.

28. 2001 KCOHS
Kentucky Children’s Oral Health Survey
 Prevalence of Early Childhood Caries (under age 5):
 USA reported 12%
 KCOHS reported 31%
 The new regional dental program in Hazard collected
county-level data and found rates were 58% !!!
 HealthyPeople 2010 set the target GOAL as 9%...
 WE NEED GOOD DATA TO TRACK THE PROBLEM!!

29. Service Area
Southeastern KY – the Heart of Rural Appalachia
Letcher
Knott
Perry
Leslie
Over 2,400 children are
seen every year at 40
different sites in area
Head Start centers
and elementary schools.

30. 2nd Highest Tooth Decay Rates in USA
(58% of preschool & 69% of elementary kids had
untreated tooth decay in eastern Kentucky in 2007/08)
70
60
50
40
30
20
10
0
Pre-School (ages 2-5) Elementary (ages 6-12)
White Black Mexican
American
EASTERN
KENTUCKY
Alaskan
Native
American
Compared with National Data (NHANES)

31. ORAL HEALTH DATA IS NECESSARY
FOR INFORMING POLICY MAKERS
ON THIS CRITICAL HEALTH ISSUE
FACING KENTUCKY’S CHILDREN

32. ECONOMIC IMPACT
Would you hire this person for a job?

33. ECONOMIC IMPACT
 http://www.nydailynews.com/celebrities-teeth-gallery-
1.1305882#pmSlide=0
 http://www.sadanduseless.com/2013/03/
celebrities-without-teeth/

34. PSYCHOLOGICAL IMPACT
Will this child have high self esteem?
“The other kids call me “Snaggle Tooth.” “The other kids said I have ugly teeth.”

35. Bad Teeth & Gums Cause:
 Pain, infection
 Abscess can spread to brain causing death
 Bad breath
 Digestive problems
 Self-confidence / self-esteem / self-image
 Distraction / trouble concentrating
 Can’t learn in school / bad grades
 Can’t get a job
 Expensive to fix and replace lost teeth

36. 2015 Policy Agenda
SOLUTION:
Improve child health:
Strengthen the
kindergarten entry
oral health screening
requirements.

37. Kentucky Oral Health Coalition
Received Input on the Issues
 Lack of clarity on who can conduct the screenings.
 Lack of clarity on training required for conducting
screenings.
 Confusion on how to fill out the screening form.
 Lack of accountability in following the regulations at
the school and district levels.
 Lack of guidance or process to ensure that children
get treatment if there are urgent needs found.

38. Kentucky Oral Health Coalition’s
Recommendations
 Establish a systematic referral process for children identified
with tooth decay.
 Expand training to nurses and other health professionals such as
pediatricians.
 Require, enforce, and incentivize data entry from the screening
form (at least in the aggregate).
 Create linkage agreements with community health professionals
and schools.
 Update the form for clarity and standardization.
 Ensure that the form is distributed to those who need it, such as
dentists, nurses and pediatricians.
 Provide education on how to use the form.

39. 2015 Policy Agenda:
Strengthen kindergarten entry oral
health screening requirements.
STEP UP for Kids !
Attend the Annual Children’s Advocacy
Day at the Capitol on February 5, 2015.

40. What if…?
 Every pregnant woman had all of her oral health needs taken
care of either before or during pregnancy…
 Every new mother received the education she needed to know
how to properly feed her child and clean her child’s gums and
newly erupting teeth…
 Every medical provider and health department was trained on
and discussed with parents the importance of oral health at
every well-child visit…
 Every preschool or Head Start child received dental visits and
fluoride varnishes at their own school…
 Every preschool or Head Start parent received training in caring
for the oral health of their family…

41. What if…?
 Every child had a dental screening before entering
Kindergarten…
 …and every child with dental needs was linked with a local
dental office and received the care he/she needed…
 Every elementary student received a dental visit at his/her own
school every school year which included an exam, cleaning,
fluoride, and sealants placed on permanent molars…
 Every elementary student received science-based classroom
education in oral health every school year…
 Every family established a “dental home” in their own
community and made oral health a priority…

42. Focus on PREVENTION
42
When a forest fire is burning out of
control, fire fighters focus their
efforts on the mountain that is not on
fire yet, SOAKING it down, so that it
doesn’t catch fire… a different
approach… PREVENTION !!
We can SOAK the kids with fluoride &
sealants.
Trying to fight tooth
decay in Eastern KY
is like trying to put
out a forest fire with
a squirt gun…
This approach has failed for decades!

43. Preventive Dental Outreach Program
LOWERS Tooth Decay Rates
80
70
60
50
40
30
20
10
0
80 DOWN 19%
70
60
50
40
30
20
10
0
 % Elementary Children with
Untreated Tooth Decay
 % Head Start Children with
Untreated Tooth Decay
69%
51%
58%
39%
DOWN 18%

44. “You can’t stay in your
corner of the woods
waiting for others to
come to you. ..
You have to go to them
sometimes.”
~Winnie the Pooh

45. QUESTIONS ???