Dr. Pete Domoto's Presentation at Oral Health Summit - PowerPoint ...


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  • PHOTO – Univ Crest
  • MMWR 2001; 50: No. RR-21 94% of dentate adults have caries
  • Cited in the MMWR November 30, 2001; 50: No. RR-21 4. Kaste LM et al. Coronal caries in the primary and permanent dentition of children and adolescents 1-17 years of age: US 1988-1991. J Dent Res 1996; 75 Spec No: 631-41 6. Brown LL et al. Dental carie and sealant usage in US children 1988-1991: Selected findings from the Third National Health and Nutrition Examination Survey. J Am Dent Assoc 1996; 127: 335-43. 7. US Dept of Health and Human Services. Health People 2010, vols. I and II. 2 nd ed. Washington DC; US Govt Printing Office, 2000
  • This is a 4 year Bosnian girl with her mother and uncle, who is acting as an interpreter.
  • MMWR November 30, 2001. Lower-income, Mexican-American, and African-American children and adults have more untreated decayed teeth than their higher-income or nor non-Hispanic white couterparts. 4. Kaste et al.1996 5. Winn DM et al. Coronal and root caries in the dentition of adults in the US, 1988-1991. J Dent Res 1996, 75 Spec. No. 642-51 8. US Dept of Health and Human Services. Oral health in America: a report of the Surgeon General. Rockville, MD: US Dept of Health and Human Services, National Institutes of Health, National Institute of Craniofacial Research, 2000. 9. Vargas et al. Sociodemographic distribution of pediatric dental caries: NHANES III, 1988-1994. J Am Dent Assoc 1998; 129-:1229-38.
  • Doubled: ~600 in 2000 to ~1400 in 2002. This coincides with our Access to Baby and Child Dentistry program: ABCD coordinator connects children from infancy thru 5 who have Medicaid insurance to private practice dentists. Participating dentists receive an enhanced reimbursement from DSHS for serving children enrolled in ABCD program.
  • Dr. Pete Domoto's Presentation at Oral Health Summit - PowerPoint ...

    1. 2. Primary Oral Health Care and Coalition Building
    2. 3. ORAL HEALTH <ul><li>Tooth decay </li></ul><ul><li>Gum diseases </li></ul><ul><li>Oral cancer </li></ul>
    3. 4. Many health problems begin with poor oral hygiene By Karen Uhlenhuth Knight Ridder Newspapers January 4, 2004
    4. 5. Dr. Marjorie Jeffcoat , Dean of the University of Pennsylvania School of Dental Medicine Editor Journal of the American Dental Association
    5. 6. GUM DISEASE a Chronic Infection <ul><li>Increase the risk of heart attack and stroke. </li></ul><ul><li>Increase the incidence of premature, low-birthweight babies. </li></ul><ul><li>Exacerbate diabetes, which now affects 17 million Americans. </li></ul><ul><li>Possibly contribute to grave lung disorders such as pneumonia and emphysema. </li></ul>
    6. 7. Gum Disease <ul><li>25% to 35% of people 35 to 60 years old have the disease </li></ul><ul><li>Among people older than 60, that rate escalates to 60 - 75% </li></ul>
    7. 8. Risk Factors <ul><li>Poor dental hygiene. You should brush and floss daily to maintain healthy gums. </li></ul><ul><li>Cigarette smoking. It's been identified as one of the leading causes of periodontal disease. </li></ul><ul><li>Genes. About 30 percent of people have an inherited susceptibility. </li></ul>
    8. 9. Risk Factors <ul><li>Stress. It interferes with the body's ability to fight periodontitis and other infections. </li></ul><ul><li>Diabetes. Diabetics are more susceptible to all infections, including those in the mouth. </li></ul><ul><li>Some drugs. They include oral contraceptives, antidepressants and some heart medications </li></ul>
    9. 10. Gum Disease and Fetal Health <ul><li>A pregnant woman with periodontal disease is more likely than a noninfected woman to give birth prematurely and to deliver a small baby </li></ul><ul><li>In a severe case of periodontitis, she is about seven times more likely </li></ul>
    10. 11. 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.
    11. 12. 2020 vision: What will you be treating in 20 years? <ul><li>There will be more older people and their oral health will be better than previous generations </li></ul><ul><li>More and more of our patients will have complex medical conditions </li></ul><ul><li>Marjorie K. Jeffcoat, JADA 134: Dec 2003 </li></ul>
    12. 13. What’s up with tooth decay in the USA <ul><li>Caries is a transmissible infection that is diet dependent and saliva mediated </li></ul><ul><li>Caries prevention has been effective with a large proportion of the population </li></ul>
    13. 14. Pathogenesis of Dental Caries <ul><li>Caries is a transmissible infection </li></ul><ul><ul><li>Mother to child (Berkowitz 1981) </li></ul></ul><ul><ul><li>Window of Infectivity, 12-30 months (Caufield 1989) </li></ul></ul><ul><ul><li>20% of 14 month old infants infected (Mohan 1998) </li></ul></ul><ul><ul><li>Predentate infants infected (Milgrom 1998) </li></ul></ul>
    14. 16. Essential Cause of Tooth Decay <ul><li>Susceptible tooth </li></ul><ul><li>Bacteria </li></ul><ul><li>Fermentable carbohydrate </li></ul><ul><li>Time </li></ul>
    15. 17. White Spots <ul><li>Subsurface </li></ul><ul><li>demineralization </li></ul>
    16. 22. Why do some people get more cavities than others? <ul><li>Caries is a transmissible infection that is diet dependent and saliva mediated </li></ul><ul><li>Biofilms, complex communities of microorganisms, where acid production occurs </li></ul><ul><li>All biofilms are not alike </li></ul><ul><li> Joel Berg DDS, MS-Professor & Chair of Pediatric Dentistry, Univ. of Washington, Scientific American, Feb. 2003, p.93 </li></ul>
    17. 23. Nature of the Problem <ul><li>High risk group – 25% experience 80% of decay </li></ul><ul><li>Traditional treatment is inaccessible and expensive </li></ul><ul><li>Effective preventive measures are feasible </li></ul>
    18. 26. 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, 134:1630-1640
    19. 27. Results <ul><li>The good news! </li></ul><ul><ul><li>91% of the general dentists treated children </li></ul></ul>
    20. 28. Results <ul><li>The bad news! </li></ul><ul><ul><li>Few children younger than 4 years received treatment </li></ul></ul><ul><ul><li>Children funded by Medicaid were represented in very low numbers </li></ul></ul><ul><ul><li>Few children with high decay rates were treated </li></ul></ul>
    21. 29. Results <ul><li>Only 15% of the respondents identified the age of 1 year as the appropriate age for the first dental visit </li></ul><ul><li>There was a significant association of types of child patients in practice and with the intensity of the respondents’ educational experiences </li></ul>
    22. 30. Results <ul><li>Practitioners in rural locations were significantly more likely to treat Medicaid-covered patients </li></ul><ul><li>More than 40% indicated further education in oral sedation, nitrous oxide sedation and atraumatic restorative technique </li></ul>
    23. 31. Pete’s Conclusions <ul><li>General practitioners provide 90% of the dental care for children </li></ul><ul><li>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 </li></ul>
    24. 32. The Problem <ul><li>Poverty </li></ul><ul><li>Social and cultural isolation </li></ul><ul><li>Fear </li></ul><ul><li>Outdated concepts </li></ul>
    25. 33. <ul><li>An Example of Coalition Building </li></ul>
    26. 34. ABCD Counties 1995-2004 18 of 39 counties >200,000 eligible for ABCD
    27. 35. <ul><li>Started in Spokane in 1995 </li></ul><ul><li>17 counties currently participating </li></ul><ul><li>>200,000 children, 5 and under, eligible </li></ul>
    28. 36. Spokane ABCD <ul><li>Begun in 1995 and still going strong </li></ul><ul><li>43% of children enrolled in the ABCD program visited a dentist in the past year </li></ul><ul><li>12% of Medicaid-enrolled children not in the ABCD program visited a dentist in the past year </li></ul><ul><li>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 </li></ul><ul><li>An ABCD child was 6 times more likely to have received preventive services </li></ul>
    29. 37. Four Components <ul><li>Outreach </li></ul><ul><li>Training and certification of dental professionals </li></ul><ul><li>New and enhanced dental benefits </li></ul><ul><li>Enhanced dental fees </li></ul>
    30. 38. <ul><li>Three fluoride varnish treatments </li></ul><ul><li>Family Oral Hygiene Instruction </li></ul><ul><li>Other new Medicaid procedures </li></ul><ul><li>Enhanced fees </li></ul>Reimbursement
    31. 39. Qualitative Research Results <ul><li>Increased awareness of the need for early prevention and/or intervention in pre-school children </li></ul><ul><li>The program reduced dental fear and increased parent satisfaction </li></ul>
    32. 40. The Efficacy and Cost-Effectiveness of the ABCD Program M. KOBAYSHI D. CHI, S. COLDWELL, P. DOMOTO and P. MILGROM Submitted
    33. 41. Results <ul><li>Children in ABCD county were healthier than the non-ABCD county </li></ul><ul><li>ABCD expenditures were $33 per child for each cavity averted </li></ul><ul><li>Expenditures for alternatives ranged from $59 to $273 </li></ul>
    34. 42. 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
    35. 43. Whatcom County Partnerships <ul><li>Mt. Baker District Dental Society </li></ul><ul><li>Whatcom County Health Department </li></ul><ul><li>St. Joseph Hospital </li></ul><ul><li>Opportunity Council </li></ul><ul><li>Madrona Pediatrics </li></ul><ul><li>Interfaith Coalition </li></ul><ul><li>Washington Medicaid/CSO </li></ul><ul><li>Washington Dental Service Foundation </li></ul><ul><li>University of Washington </li></ul>
    36. 44. Whatcom County Health Department <ul><li>Enrolls patients in ABCD </li></ul><ul><li>Sends more infants and toddlers to dentists </li></ul><ul><li>Provides orientation for families </li></ul><ul><li>Assists in problem solving-please call </li></ul>
    37. 45. Goals <ul><li>Establishing a therapeutic alliance with families </li></ul><ul><li>Getting children and parents to return </li></ul><ul><li>Providing continuity of care </li></ul>
    38. 46. <ul><li>Reducing the extent of disparities in oral health </li></ul><ul><li>Increasing access to preventive dental care among preschool children from birth up to 5 years of age served by the Medicaid program </li></ul><ul><li>Joint programs by dentists, health departments and Medicaid in counties all over the State. </li></ul>
    39. 47. AAPD Filling Gaps 2001
    40. 48. ]Increase in Service to Young Children w/ Medicaid <ul><li>Between 2000 and 2002, the number of children under 6 that were seen by private practice dentists more than doubled </li></ul><ul><li>Children under 2 years of age that were seen jumped from 10% to 18% </li></ul><ul><li>Diane Lowry, MPH, MSW </li></ul>