AMRITA SCHOOL OF DENTISTRY

1. ORAL HEALTH
PROGRAM –
A CASE STUDY
FROM US
Seminar 21
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2. CONTENTS
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Introduction
Demographics
Essential PH services to promote oral health in the US
State oral health infrastructure and capacity
Basic strategies for oral public health program
Implementation of evidence-based preventive
interventions
Oral health program plans
Conclusion
References

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• The Surgeon General's Report on Oral Health is a significant
milestone in the history of oral health in America and
emphasizes oral health's importance to overall well-being.
• Progress made in understanding oral diseases, but disparities
persist among vulnerable groups.
• Oral health affects craniofacial tissues and indicates systemic
diseases.
• Report promotes health promotion and disease prevention,
considering risk factors like tobacco and diet.
• Aligns with national plan for improving overall health.
• Research advances understanding and treatment of oral
diseases.
• Need for coordinated policies, resources, and dental
INTRODUCTION
Oral Health In America: Surgeon General’s Report (2000)

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• The Surgeon General's report highlights challenges in
accessing oral health care, addressing risk behaviors,
and tackling societal issues like substance use disorders
and mental health concerns.
• Advances include technology advancements, increased
access to fluoridated water, improved preventive
measures, enhanced understanding of the oral-health
connection to overall health, and increased awareness
and education.
• Recommendations include increasing access to care,
improving oral health education, addressing social
determinants of health, investing in research, and
promoting collaboration among stakeholders.
Oral Health in America: Advances and Challenges (2021)

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DEMOGRAPHICS
• The Region of the Americas shows the highest
amounts, with US$ 157 billion total and
US$ 155 per capita annual expenditure.
Cost of oral health care
• Case numbers more than doubled in all WHO
regions, except for the European Region
(30% increase) and the Region of the Americas
(88% increase).
• Almost two thirds of all “dental assistants and
therapists” work in the European Region and the
Region of the Americas; only about 4% work in
the African Region.
Trends in disease burden 1990–2019
GBD-2019

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STATE INFRASTRUCTURE DENTAL WORKFORCE
ORAL HEALTH PROGRAMS
Source: https://www.astdd.org/

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10 ESSENTIAL PH SERVICES TO PROMOTE ORAL HEALTH IN THE US
• Assess oral health status and implement an oral health surveillance system
• Analyze determinants of oral health and respond to health hazards in the community
• Assess public perceptions about oral health issues and educate/empower people to achieve
and maintain optimal oral health
Assessment
• Mobilize community partners to leverage resources and advocate for/act on oral health issues
• Develop and implement policies and systematic plans that support state and community oral
health efforts
Policy Development
• Review, educate about and enforce laws and regulations that promote oral health and ensure
safe oral health practices
• Reduce barriers to care and assure utilization of personal and population-based oral health
services
• Assure an adequate and competent public and private oral health workforce
• Evaluate effectiveness, accessibility and quality of personal and population-based oral health
promotion activities and oral health services
• Conduct and review research for new insights and innovative solutions to oral health problems
Assurance

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STATE ORAL HEALTH INFRASTRUCTURE AND CAPACITY

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Resources
• Diversified funding is
crucial for a successful
SOHP, as relying on a
single funding source
can jeopardize the
program during
economic downturns.
• Placement within the
state's health division
is important for direct
access to the health
director and improved
negotiation abilities
for funding
opportunities.
Leadership, Staffing, and
Partnerships
• Strong and credible
leadership, along with
broad-based coalitions
and ongoing
professional
development, is
essential for successful
oral health programs.
• A continuous leader
can create
partnerships, address
public health services,
and ensure local-level
clinical services, while
partnerships with
influential partners
strengthen SOHPs.
Surveillance Capacity
• Ongoing, high-quality
oral health surveillance
and effective
dissemination drive
decision-making in
successful SOHPs.
• Sharing reader-friendly
surveillance reports
with partners and
funders enhances
understanding of oral
health importance,
disease prevention
programs, and the
value of funding such
initiatives.
State Planning,
Evaluation Capacity
• A comprehensive state
oral health plan with
practical evaluation is
crucial for SOHP
success.
• Evaluation assesses
program effectiveness,
engages stakeholders,
and enables
continuous
improvement.
• Evidence-based goals,
routine evaluation, and
program adaptation
enhance sustainability
and demonstrate
achievements in strong
SOHPs.
Evidence-Based
Prevention & Promotion
Programs & Policies
• Essential components
include dental sealants
and targeted fluorides
for high-risk
populations.
• However, local
programs focusing
solely on oral health
education without
evidence-based
approaches do not
lead to oral health
improvements in
children.

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Developing program leadership and capacity.
Developing and coordinating partnerships, coalitions and collaborations with a focus on prevention interventions.
Developing or enhancing oral health surveillance.
Building or enhancing evaluation capacity.
Assessing facilitators and barriers to advancing oral health.
Developing plans for oral health programs and activities.
Implementing communication activities to promote oral disease prevention.
BASIC STRATEGIES FOR ORAL PUBLIC HEALTH PROGRAM

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Program Leadership & Staff Capacity
• Strong leadership and skilled staff are
crucial for improving oral health in a state
program.
• Preferred skill sets for state oral health
programs include dental professionals with
public health training, epidemiologists with
oral health data expertise, program
coordinators with grant implementation
experience, public health educators with
health communication skills, and policy
analysts with oral health policy assessment
abilities.
Partnerships, Coalitions & Collaborations
• By engaging stakeholders and
organizations, the program can develop
effective strategies to address oral health
needs and disparities.
• For example, forming partnerships with
national/state organizations and local
partners, and building diverse coalitions,
can educate the community and guide
program activities.
• Collaboration with other public health
programs enhances capacity and resources
for improved oral health outcomes.

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Data Collection & Surveillance
• Monitoring oral disease in a state is
crucial for effective planning and
evaluation of oral health programs. By
assessing available data sources and
resources, states can develop a
surveillance system.
• An example tool is the ASTDD Best
Practices Approach Report, which helps
collect key oral health indicators and
supports data dissemination through
documents or interactive websites.
Program Evaluation
• Program evaluation is crucial for
assessing the effectiveness of public
health programs. By involving
stakeholders, defining goals, collecting
and analyzing data, and sharing
lessons, programs can improve and be
accountable.
• State oral health programs can seek
expert assistance and collaborate with
partners to enhance evaluation efforts
and utilize available resources.

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Facilitators & Barriers to Advancing Oral
Health
• State oral health programs should regularly
assess laws, policies, and strategies to
identify opportunities for reducing oral
diseases. This assessment helps overcome
barriers, leverage assets, and educate
policymakers.
• Examples include mandates for water
fluoridation and increased Medicaid
reimbursement for oral health services to
improve outcomes.
Plans for State Oral Health Programs &
Activities
• A state oral health plan is a collaborative
roadmap to reduce oral disease prevalence.
It guides personnel and funding decisions,
enhances competitiveness for funding, and
demonstrates effective resource utilization.
• The plan should include state-specific data,
S.M.A.R.T. objectives, a logic model,
infrastructure, knowledge gap
identification, priority populations,
partners, a communication plan, evaluation
activities, best practices, and a maintenance
plan for updates every 3-5 years.

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Communications to Promote Oral Disease
Prevention
• Effective state oral health programs use targeted
communication strategies to raise awareness of
the connection between oral health and overall
well-being.
• This includes assessing perceptions, engaging
change agents, involving stakeholders, using
data and stories, developing risk communication
strategies, and using health economics to
demonstrate the value of oral health programs.

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Expand sealant delivery in low-income and rural schools.
Increase the proportion of the population with access to optimally
fluoridated water.
Implement strategies to affect the delivery of targeted clinical
preventative services and health systems change.
IMPLEMENTATION OF EVIDENCE-BASED PREVENTIVE INTERVENTIONS

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School-Based and School-Linked Dental Sealant
Programs
• Effective program to prevent tooth decay in children.
They provide sealants in schools or refer children to
dental clinics for placement. Strategies for implementing
SBSP include using evidence-based practices,
developing referral networks, increasing efficiency
through collaboration with schools, and collecting data
for program evaluation.
• CDC grantee states must report measures related to
SBSP coverage and effectiveness, conduct program
analysis, and demonstrate progress and leadership. This
includes providing training, sharing best practices, and
ensuring program sustainability through funding and

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Coordinate Community Water Fluoridation
Programs
• State water fluoridation programs aim to
promote, implement, and maintain fluoridation
efforts.
• They monitor water systems, incorporate CDC
recommendations, identify equipment needs,
measure progress, establish quality-control
programs, provide training, evaluate
accomplishments, and participate in proficiency
testing.
• These efforts contribute to the prevention of
tooth decay and ensure the safety and
effectiveness of community water fluoridation

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Targeted Clinical Preventive Services & Health
Systems Changes
State oral health programs should collaborate with
Medicaid providers to improve access to pediatric
oral health services, pilot initiatives to enhance oral
health literacy, integrate oral health into overall
healthcare through collaborations, address
disparities in oral health, and increase awareness of
infection prevention guidelines.

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ORAL HEALTH PROGRAM PLANS
No plans
identified:
Arkansas
Connecticut
Hawaii
Iowa
Missouri
Monatana
New Jersey
Wyoming

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Availability of Dental Care
• Number of dentists per
100,000 people
• Employment of dentists
• Reason for not visiting the
dentist among those without a
visit in the past 12 months –
Cost
• Reason for not visiting a
dentist among those without a
visit in the last 12 months –
Trouble finding a dentist
• Medicaid adult dental benefits
• Water fluoridation
Dental Habits
• Percentage of all adults who
visited a dentist in the past
year
• Percentage of young adults
who visited a dentist in the
past year
• Percentage of adults who
reported smoking at least 100
cigarettes in their lifetime and
currently smoke daily or some
days
• Strongly agree with I need to
see the dentist twice a year
among all income groups
• Reason for not visiting a
dentist among those without a
visit in the last 12 months –
Afraid of dentist
INDICATORS

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Oral Health Status
• Percentage of adults aged 65 or older who reported having all teeth removed due to decay or gum
disease
• Poor overall condition of mouth and teeth among all income levels
• Poor overall condition of mouth and teeth among low-income level
• Very good overall condition of mouth and teeth among all income levels
• Life in general is very often less satisfying due to condition of mouth and teeth among all income
levels
• Life in general is very often less satisfying due to condition of mouth and teeth among low-income
level
• Life in general is never less satisfying due to condition of mouth and teeth among high-income level
• Appearance of mouth and teeth affects ability to interview for a job among all income levels
• Appearance of mouth and teeth affects ability to interview for a job among low-income level
• Experienced dry mouth very often in the last 12 months due to condition of mouth and teeth among
all income groups
• Experienced difficulty biting/chewing very often in the last 12 months due to condition of mouth and
teeth among all income groups
• Experienced pain very often in the last 12 months due to condition of mouth and teeth among all
income groups
• Took days off very often in the last 12 months due to condition of mouth and teeth among all income
groups

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Source: https://www.ada.org/en/resources/research/health-policy-institute

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27. State Actions to Improve Oral Health Outcomes (DP-
1810):
Core activities: (Up to 5 years $370,000 per year)
• manage school sealant programs (includes
to infection prevention guidelines),
• support and increase access to community water
• conduct oral health surveillance.
Partner Actions to Improve Oral Health Outcomes (DP-
1811) :
• The Association of State and Territorial Dental Directors receives an average award of $400,000.
• The National Association of Chronic Disease Directors receives an average annual award of
$150,000 to work with the five states funded to support medical-dental integration (MDI) efforts.
CDC- FUNDED PROGRAMS
Source: https://www.cdc.gov/oralhealth/funded_programs/cooperative_agreements/index.htm
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Key Findings:
• Financing and affordability often
individuals use the oral health care
• Federal and state government play a
strengthening the oral health
• Many people face significant barriers
health care services
• Emerging trends impact the success of
interventions
• More research is needed to better
effectiveness of laws and policies that
access to oral health care and reduce
using services

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INTERNATIONAL ORGANISATIONS

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Methodology
• Familial,
sociocultural, and
structural factors
that contribute to
these disparities,
and used the social
ecological model
and Healthy People
2020 to analyze.
Reason
• Structural factors
such as lack of
access to oral health
care services,
sociocultural factors
such as food choices
and cultural beliefs
about oral health,
and familial factors
such as parental
education and
involvement in oral
health care for their
children.
Recommendation
• To improve oral
health care, focus on
increasing access
through policy-level
processes,
enhancing the
patient-provider
relationship and
treatment
autonomy,
addressing
sociocultural factors
influencing food
choices, increasing
parental
involvement in
children's oral health
care, and
implementing
community-based
interventions for
African American
children.

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Key factors:
Poor oral health in the US is more prevalent among low-
income, uninsured, racial/ethnic minority, immigrant, and
rural populations with limited access to quality care.
Disparities are avoidable and unfair, stemming from
insurance gaps, provider shortages, transportation issues,
language barriers, and cultural differences in health
practices.
Key interventions:
Family-based and intergenerational interventions are
effective for populations with severe oral health needs,
including older racial/ethnic minorities, immigrants, and
the homeless. Community-based programs, school-
based programs, and mobile dental clinics are also
effective. Integration of oral health care into primary
care and a life course approach are important for
disadvantaged populations. Further research is needed to
evaluate interventions and develop new approaches to
reduce oral health disparities.

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CONCLUSION
• To significantly improve the nation’s health, policy changes are needed to reduce or eliminate social,
economic, and other systematic inequities that affect oral health behaviors and access to care.
• To improve oral health for more people, dental and other healthcare professionals must work together to
provide integrated oral, medical, and behavioral health care in schools, community health centers,
nursing homes, medical care settings, and dental clinics.
• To strengthen the oral health workforce, we need to diversify the composition of the nation’s oral health
professionals, address the costs of education and training the next generation, and ensure a strong
research enterprise dedicate to improving oral health.

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REFERENCES
1. nidcr.nih.gov/research/oralhealthinamerica
2. cdc.gov/oralhealth/index
3. adea.org/StrategicDirections/
4. health.gov/healthypeople/objectives-and-data/browse-objectives/oral-conditions
5. health.gov/our-work/national-health-initiatives/healthy-people/healthy-people-2020/healthy-people-2020-law-and-
health-policy/oral-health
6. www.cdc.gov/oralhealth/funded_programs/index.htm
7. courses.minnalearn.com/en/courses/rethinking-health/looking-to-the-future/building-blocks-for-a-resilient-health-system/
8. Northridge ME, Kumar A, Kaur R. Disparities in access to oral health care. Annual review of public health. 2020 Apr
1;41:513-35.
9. Como DH, Stein Duker LI, Polido JC, Cermak SA. The persistence of oral health disparities for African American children: a
scoping review. International journal of environmental research and public health. 2019 Mar;16(5):710.
10. Building Infrastructure & Capacity in State and Territorial Oral Health Programs—April 2000
11. State Oral Health Infrastructure and Capacity: Reflecting on Progress and Charting the Future
12. US Department of Health and Human Services. Oral Health in America: A Report of the Surgeon General. Rockville, MD:
USDHHS, NIDCR, NIH. 2000. http://www.surgeongeneral.gov/library/oralhealth
13. US Department of Health and Human Services. A National Call to Action to Promote Oral Health. Rockville, MD: USDHHS,
NIDCR, NIH. 2003. http://www.surgeongeneral.gov/topics/oralhealth/nationalcalltoaction.html
14. Tomar SL. An assessment of the dental public health infrastructure in the United States. J Public Health Dentistry. 2006.
66(1):5-16. http://www.ncbi.nlm.nih.gov/pubmed/16570745
15. Association of State and Territorial Dental Directors. Competencies for State Oral Health Programs. 2009.
http://www.astdd.org/docs/CompetenciesandLevelsforStateOralHealthProgramsfinal.pd
16. U.S. Department of Health and Human Services. Oral Health in America: A Report of the Surgeon General; U.S. Department
of Health and Human Services, National Institute of Dental and Craniofacial Research, National Institutes of Health:

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About 9 out of 10 adults aged 20 to 64 years have
experienced tooth decay. Dental practitioners are
shifting to less-invasive approaches to manage the
disease.
Periodontal (gum) disease affects more than 2 in 5
adults between the ages of 45 and 64 and is associated
with nearly 60 other health problems, including diabetes,
heart conditions, and Alzheimer’s disease.
More than half of working-age adults experiencing
poverty have untreated caries, whereas only 1 out of 5
adults with incomes above the poverty level have
untreated caries.
Nearly 1 in 5 US adults experience moderate to high
dental fear and anxiety that can prevent them from
seeking needed oral care. Dental clinicians can help
these patients by building trust and creating a positive
environment for behavior change.
THANK YOU