Oral Health


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Oral Health

  1. 1. Oral HealthOperational Definition:Through its oral health priority focus Health Foundation of South Florida willsupport proposals that aim to improve the oral health status of underservedchildren and adults in South Florida. Emphasis will be placed on preventionstrategies such as fluoride varnishes and dental sealants, education strategiessuch as public awareness activities and oral health training for physicians,capacity building strategies such as expansion of safety-net facilities, policyadvocacy strategies such as education of legislators on topics such as Medicaidreimbursement for dentists and clinical service strategies such as restorative carefor the underserved.A. BackgroundOral diseases significantly affect all facets of life, restricting activities in school,work, and home and reducing ones quality of life. While overall, Americanshave achieved “good” oral health due largely to technological advances indental care in the second half of the twentieth century, minority, rural and low-income populations face significant barriers to accessing dental care andconsequentially suffer from higher rates of dental caries (tooth decay) andrelated problems. In 2007, dental expenses in the United States totaled $95.2billion.1The 2000 Surgeon General’s report, Oral Health in America2, is considered alandmark in recognizing the “silent epidemic” of disparities in the oral diseaseburden and stressing the urgent need to promote effective oral healthinterventions. The primary message is that oral health is essential to generalhealth and well-being and that it can be achieved. Following are importantareas of concern that are identified in the report:Among children: • Tooth decay was cited as the single most common chronic disease of childhood, occurring five to eight times as frequently as asthma.1 Health Affairs. National Health Spending in 2007: Slower drug spending contributes to lowest rate of overall growth since 1998. Volume 28(1): 246-216. Accessed online at http://content.healthaffairs.org/cgi/content/abstract/28/1/2462 U.S. Department of Health and Human Services. National Call to Action to Promote Oral Health. Rockville, MD: U.S. Department of Healthand Human Services, Public Health Service, National Institutes: http://www.surgeongeneral.gov/library/oralhealth/
  2. 2. • Nationwide, over 50% of 5-9 year olds and 78% of 17 year olds have at least one cavity or filling.3 • Low-income children suffer from caries at twice the rate of their more affluent peers and their disease is more likely to be untreated. • Children living below the poverty line have more severe and untreated decay. • Uninsured children are 2.5 times less likely than insured children to receive dental care. • More than 51 million school hours are lost each year to dental-related illness. • Poor children suffer nearly 12 times more restricted-activity days than children from higher-income families. • Hispanic children are the least likely group to receive preventive dental care4Among adults: • Over 40 percent of low-income adults have at least one untreated decayed tooth compared to 16% of non-poor adults.5 • Employed adults lose more than 164 million hours of work each year due to dental disease or dental visits. • For every adult 19 years or older without medical insurance, there are three without dental insurance. • A little less than two thirds of adults report having visited a dentist in the past 12 months. • Those with incomes at or above the poverty level are twice as likely to report a dental visit in the past 12 months as those who are below the poverty level.Perhaps the most disheartening aspect of the tooth decay epidemic is that thisdecay is largely preventable through healthy lifestyle behaviors and regulardental care. Lifestyle behaviors, clinical services and community basedinterventions all contribute to producing positive oral health outcomes. Anumber of strategies promoted by the Foundation have been identified as costeffective and efficient means to improve the oral health status of high needspopulations. These include application of fluoride varnishes, application ofdental sealants, public awareness campaigns, training physicians to providepreventive dental services, expanding the dental safety-net, targeting primarypreventive care to young children, advocating for increased Medicaidreimbursement for dentists and increasing the number of dentists in public healthsettings.3 Centers for Disease Control and Prevention: Children’s Oral Health Fact Sheet.http://www.cdc.gov/OralHealth/publications/factsheets/sgr2000_fs3.htm4 Grantmakers in Health. Behind the Smile: How Funders Can Improve Oral Health. August 14 2006.http://www.gih.org/usr_doc/Issue_Focus_8-14-06.pdf5 Centers for Disease Control and Prevention: Oral Health for Adults. http://www.cdc.gov/OralHealth/publications/factsheets/adult.htm
  3. 3. In Florida, like many places in the US, barriers to accessing dental care includesocioeconomic status, lack of community based oral health interventions,structural barriers to obtaining care (lack of transportation, school absencepolicies, discriminatory treatment, and difficulty locating providers who acceptMedicaid), lack of resources to pay for care (e.g., dental insurance) andinsufficient public dental programs.6 Florida Behavioral Risk Factor SurveillanceData (BRFSS) data for 2004 indicates that 33.6% of the population did not visitthe dentist or dental clinic within the past year, 32.8% of the population did nothave their teeth cleaned by a dentist or dental hygienist within the past yearand 32% of the state population with public water systems did not receivefluoridated water. In Florida in 2008, 28% of white non-Hispanic adults did nothave an annual dental visit, compared to 32.6% of Hispanic adults and 40.4% ofAfrican-American adults who did not have visits. Almost 91% of eligible childrenin Florida do not receive sealants in school-based programs.The following matrix represents available oral health indicators for South Floridacounties.7Indicator/County Miami-Dade Broward Monroe% adults with annual 71.2% 72.3% 71.1%dental visit (2007)% low-income adults 60% 61.7% 58.6%with annual dental visit# active licensed 1,442 1,173 33dentistsActive dentist to 59 67 40population ratio (per100,000)# active licensed 1000 1,019 39dental hygienists# children and adults 600,000 262,050 7,989enrolled in Medicaid# dentists enrolled as 215 173 0active MedicaidprovidersOverall Goal6 CDC National Center for Chronic Disease Prevention and Health Promotion. Florida State Synopsis: Oral Health Profile.http://apps.nccd.cdc.gov/synopses/StateDataV.asp?StateID=FL&Year=20087 State Oral Health Improvement Plan for Disadvantaged Floridians (SOHIP) County Profiles: http://www.oralhealthflorida.com/
  4. 4. Given that low-income, uninsured, and underinsured minority populations sufferthe majority of the oral disease burden, The Foundation’s goal within funding fororal health services is to increase access to preventive oral heath care, regulardental visits and dental education for individuals and communities in thesepopulations in South Florida.Areas of Interest: Health Foundation of South Florida will give priority to proposalsthat aim to improve the oral health status of underserved children and adults inSouth Florida. Emphasis will be placed on projects that incorporating thefollowing strategies, identified as cost effective and efficient: • prevention strategies such as application of fluoride varnishes and application of dental sealants • education strategies such as public awareness activities and oral health training for physicians • capacity building strategies such as expansion of safety-net facilities • clinical service strategies such as restorative care for the underserved • public policy advocacy activities such as education of legislators on topics such as increased Medicaid reimbursement for dentists and increasing the number of dentists in the public health settingSettings of interest: The Foundation will give priority to proposals that work withinthe following settings (includes services outside the clinic setting such asoutreach programs as well as services within the clinical setting): • Child care centers • Schools • Community Health Centers • Physician’s offices • Mobile vans • Safety-net dental clinicsB. Potential OutcomesOutcomes are framed in the following categories: access, efficiency, services,education and environment/policy change. The following outcome objectivesare divided into two sections. The first is a listing of outcome objectives that theFoundation will be tracking in many of its oral health projects. These areincluded in the Foundation’s online application. The second section listsadditional outcome objectives that you may wish to consider when framingyour project. Please note that you will be asked to provide baselines and targetprojections when proposing outcome objectives.Potential Outcomes (1)
  5. 5. Non-clinical settings (e.g., outreach programs): • Increase the number of children age 4 and under who have received a varnish treatment • Increase the number of children who have received sealants • Increase the number of dental encounters/visits • Increase the number of unduplicated patientsClinical settings: • Increase the number of unduplicated patients • Increase the number of dental encounters/visits • Increase the percentage of children and adults who exhibit that they are regularly carrying out proper self-care • Increase the percentage of children who have received sealants • Increase the percentage of children age 4 and under who have had a fluoride varnish treatmentPotential Outcomes (2)Access • Increase the number of individuals that receive dental care • Increase the number of children who have received a preventive visit (exam, cleaning, possibly x-rays) • Increase the number of individuals that have a “dental home” • Increase the number of sites that offer dental care • Increase the number of safety-net operatories (treatment rooms) • Increase the number oral health providers (dentists, dental hygienists, dental assistants) • Increase the number of active patients in safety-net dental clinics • Increase the number of completed dental treatments in safety net dental clinics • Increase the number of oral health prevention programsServices • Increase the number of children in day care centers that receive fluoride varnish • Increase the number of children who are assessed by a dentist by age 3 • Increase the number of children age 3 or under who have had an oral health assessment by a physician • Increase the number of physicians providing oral assessments, fluoride varnish application to children age 4 and/or parent education • Increase the number of dental emergencies that are treated
  6. 6. Efficiency • Decrease patient wait time for appointments (wait time = the number of working days it takes to obtain an appointment) • Decrease patient wait time in dentist’s office • Decrease patient no-show rate • Decrease schedule turn-a-round time (wait for repeat appointments) • Reduce the use of obsolete codes in safety-net dental clinicsEducation • Increase the number of pediatricians that are trained to provide oral health assessments and fluoride varnish applications during well child visits. • Increase the number of children and / or adults who understand the importance of proper oral hygiene • Increase the number of individuals who regularly practice basic oral hygiene skills, i.e. brushing and flossing • Increase the number of parents who believe it is important to have their children’s teeth examined by a dentist before the age of 3 • Increase the number of parents who know it is important to remove a baby’s bottle from his/her mouth after she/he is finished drinkingEnvironment / Policy ChangeOrganizational changes: • Increase the number of schools that offer oral health education • Increase the number of schools that offer oral health care • Increase the number of day care centers with fluoride toothpaste tooth brushing programs • Increase the number of physicians billing for oral assessments, varnish, and/or parent education • Increase the number of patients who pay at the time of service in safety- net dental clinics • Increase the number of claims processed in safety-net dental clinics • Decrease the number of billing denials in safety-net dental clinics • Decrease the number of outstanding claims in safety net dental clinics Public Policy Changes: • Increased reimbursement for Medicaid oral health providers • Allow dental hygienists to apply sealants without a dentist supervision • Mandatory dental screening for children entering school • Increased financial support for safety net dental clinics
  7. 7. C. Evidence-Based Program ModelsThe following lists successful programs nationwide than may be used as modelswhen designing your program. It is neither an exclusive list of successfulprograms nor an exclusive list of programs the Foundation is willing to support.Project websites are included. o Access to Baby and Child Dentistry (ABCD): First implemented in Spokane, Washington, in 1995, ABCD focuses on providing preventive and restorative dental care from birth to age six, with emphasis on enrollment by age one. ABCD is based on the premise that providing dental visits as early as possible yields positive behaviors by both parents and children, controlling both dental caries and associated costs. http://www.abcd- dental.org/ o Arizona Dental Sealant Program: A nationally recognized “best-practice” school sealant program targeted to 2nd and 6th grade students in schools with a high proportion of children from low-income families. Portable dental equipment is brought to schools, dentists prescribe treatment, and hygienists apply sealants. http://www.azdhs.gov/cfhs/ooh/sealant.htm o Bright Futures in Practice: Oral Health – This program is designed to be used by many types of professionals to address the oral health needs of children and families, focusing on prevention. http://www.brightfutures.org/oralhealth/pdf/index.html o Classroom Tooth Brushing for Child Care Centers – A presentation on how to implement classroom tooth brushing in a Head Start program that could be adapted to other child care settings. http://www.mchoralhealth.org/PDFs/YoderToothbrushing.pdf o Columbia University DentCare Network (New York): DentCare is a collaboration between Columbia University School of Dental and Oral Surgery, Harlem Hospital Dental Service, and other local community- based organizations. DentCare provides full dental services to underserved communities, trains community-based dental practitioners and dental hygienists, and provides preventative dental care for HIV/Aids patients. Once completed the program will serve more than 30,000 patients per year. http://dental.columbia.edu/dentcare/index.html o First Smiles Project (California): A statewide initiative targeting dental professionals, medical professionals, and medical residents with the goal
  8. 8. of educating 30,000 dental professionals, 10,000 medical professionals and deliver intensive training to 14,000 dental professionally and over 3,500 medical professionals statewide. Education and training consists on the most current scientific information on dental disease prevention in children, prenatal to age 5. The public focus consists of educational programs for parents and caregivers reached through early childhood education providers such as WIC and Head Start. http://www.first5oralhealth.org/ o Into the Mouths of Babes (North Carolina): This program is a statewide “best-practice” program that has successfully increased access to preventive dental services for Medicaid-eligible children. The program’s objective is to train medical providers to deliver preventive oral health services to high-risk children from the time of tooth eruption until age 3, including oral screening, parent/caregiver education, and fluoride varnish application. The program’s goal is to reduce the incidence of early childhood caries. http://www.ncafp.com/imb/ o Iowa: Early and Periodic Screening, Diagnosis, and Treatment Policy Exmption (EPSDT_: The EPSDT policy exemption in Iowa allows regional dental hygienists to be reimbursed by Medicaid for oral screenings and fluoride varnish applications to Medicaid-enrolled children in areas of the state lacking sufficient dental providers maximizing service access for young children. http://www.iowaepsdt.org/ o Seal America: an online manual designed to assist health professional initiate and implement a school-based dental sealant program. http://www.mchoralhealth.org/seal/D. ResourcesThe following provides a number of Web sites that you may find useful as youdevelop your proposal:A Guide for Developing and Enhancing Community Oral Health Programshttp://www.aacdp.com/guide/A Model Framework for Community Oral Health Programshttp://www.aacdp.com/Docs/Framework.pdfAmerican Academy of Pediatric Dentistryhttp://www.aapd.org/
  9. 9. American Academy of Pediatrics Oral Health Initiativehttp://www.aap.org/commpeds/dochs/oralhealth/American Association for Community Dental Programshttp://www.aacdp.com/American Association of Public Health Dentistryhttp://www.aaphd.org/American Dental Associationhttp://www.ada.org/Association of State and Territorial Dental Directorshttp://www.astdd.org/Bright Futures in Practice: Oral Health Pocket Guidehttp://www.mchoralhealth.org/PDFs/BFOHPocketGuide.pdfCenters for Disease Control and Prevention- Oral Health Home Pagehttp://www.cdc.gov/OralHealth/Community Voices Miamihttp://www.communityvoices.org/SitePage.aspx?ID=11Florida’s State Oral Health Improvement Plan (SOHIP)http://www.doh.state.fl.us/family/dental/sohip/reports/index.htmlHealthy People 2010-- Section 21: Oral Healthhttp://www.healthypeople.gov/document/HTML/Volume2/21Oral.htmNational Maternal and Child Oral Health Resource Centerhttp://www.mchoralhealth.org/knwpathoralhealth.htmlNational Oral Health Surveillance Systemhttp://www.cdc.gov/nohss/index.htmNational Oral Health Policy Centerhttp://www.healthychild.ucla.edu/nohpc/Default.aspPublic Health Dental Program (Florida Department of Health)http://www.doh.state.fl.us/family/dental/index.htmlSimple Steps to Better Dental Health
  10. 10. http://www.simplestepsdental.com/SS/ihtSS/r.WSIHW000/st.31819/t.31819/pr.3.html