Dental Care Access and Prevention Strategies for Underserved ...


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  • One study has been done that looks at treatment of gum disease during pregnancy. This study showed that pregnant women who are treated for gum disease are less likely to have a preterm baby, compared to women who have gum disease and are not treated.
  • This is a view of the minor gum changes that can occur, often referred to as pregnancy gingivitis. This condition is easily reversible with increased hygiene and a cleaning. Pregnancy gingivitis can progress to gum disease if it is not treated. Pregnancy hormones, particularly progesterone, can cause loss of the bone that supports the teeth if gum disease is present. It is very important to see your dentist to prevent gum disease and bone loss.
  • Dry and paint, dry and paint.
  • Dental Care Access and Prevention Strategies for Underserved ...

    1. 1. Dental Care Access and Prevention Strategies for Underserved Populations Abscess Peter Milgrom DDS [email_address] May 18, 2006
    2. 2. Objectives <ul><li>Learn the basic concepts regarding maternal and child oral health with a focus on pregnancy outcomes and prevention of early tooth decay in children. </li></ul><ul><li>Become familiar with how two community-based intervention programs are addressing these issues. </li></ul>
    3. 3. Basic Issue #1 Poor Oral Health Results in Poorer Pregnancy Outcomes
    4. 4. Dental Care During Pregnancy <ul><li>Dental treatment can be rendered safely any time during pregnancy* </li></ul>*American College of Obstetrics and Gynecology, 2000
    5. 5. Spontaneous preterm birth in women with gum disease Jeffcoat et al. (2003) Periodontal disease and preterm birth: results of a pilot intervention study. Spontaneous Preterm Births
    6. 6. Gum Problems <ul><li>Pregnancy Gingivitis </li></ul><ul><ul><li>Red edges </li></ul></ul><ul><ul><li>Swollen or puffy </li></ul></ul><ul><ul><li>Tender </li></ul></ul><ul><ul><li>Bleed easily during brushing </li></ul></ul>
    7. 7. Basic Issue #2 Treating Dental Disease in Pregnant Women & New Mothers Reduces Tooth Decay in Children
    8. 8. Maternal Transmission Preventive care for children requires redefining prenatal care to include oral health. Mother is generally the vector for infection of the child
    9. 9. Anticipatory Guidance?
    10. 10. Xylitol gum--impact of preventing transmission Xylitol is a naturally occurring sugar alcohol with 1/3 less calories than sucrose. FDA approved food additive. Effective dose 6-10 g/day in gum or mints in 3 doses per day
    11. 11. Treatment of the Mother Resulted in Less Disease in the Child <ul><li>Mothers chewed gum for 2 y beginning 3 mo post partum </li></ul><ul><li>At 5 years the need for treatment was 71-75% lower in the Xylitol group </li></ul>(Isokangas et al., JDR 2000)
    12. 12. Basic Issue #3 When a child is born with dental disease, treatments for that disease must begin as part of well baby care.
    13. 13. EARLY CHILDHOOD CARIES <ul><li>Bacteria grow in a biofilm and are largely resistant to bodily defenses </li></ul><ul><li>Bacteria produce lactic acid as a by product of metabolism of simple sugars and demineralize the teeth </li></ul>
    14. 14. Oral health is important to overall health <ul><li>ECC has been associated with failure to thrive </li></ul><ul><li>Low-income children suffer 12 times the number of restricted activity days due to dental problems compared to more affluent children* </li></ul>*Lewis et. al., Pediatrics, December 6, 2000
    15. 15. White Spots/Before Cavitation
    16. 17. Home Visits <ul><li>Can improve attendance, parental knowledge, and tooth brushing skills </li></ul><ul><li>Unlikely to reduce tooth decay alone </li></ul><ul><li>Message must be succinct, targeted </li></ul><ul><li>Need to use MI strategies </li></ul>*Blinkhorn et al., Brit Dent J 2003;195:395-400
    17. 18. When should children been seen? <ul><li>AAP and AAPD recommend that the first dental visit should occur at 1 year of age </li></ul>
    18. 19. Toothpaste=A highly effective fluoride delivery system A small pea size amount of toothpaste weighs 0.4 gm=0.6 mg Fluoride
    19. 20. Manchester Postal Study <ul><li>Distributed toothpaste to 5 year olds at home by mail in a randomized design </li></ul><ul><li>Low income families, no fluoridation </li></ul><ul><li>Reduced tooth decay by about 16% </li></ul><ul><li>Cost effective </li></ul>*Davies et al., Community Dental Health 2003;20(4):207-10 & 2002;19(3):131-6
    20. 21. Fluoride Varnish <ul><li>33% reduction in tooth decay in 2 per year applications* </li></ul>* Helfenstein and Steiner, Community Dentistry and Oral Epidemiology, 1994 **Cochrane Library, Issue 4, 2003.
    21. 22. Topical Fluoride in Medical and Public Health Settings <ul><li>Varnish can be applied by family doctors, pediatricians, nurses. </li></ul><ul><li>Medicaid reimbursement in some states </li></ul><ul><li>Can be tied to well baby visits </li></ul>
    22. 24. Adapting Fluoride Varnish to Migrant Populations <ul><li>Use massed applications </li></ul><ul><li>Apply fluoride 3 times within 2 weeks once per year </li></ul><ul><li>Equivalent to 2 times per year </li></ul>
    23. 26. Kwoj konan ke bwe en Emman Ni ko nin ajiri nejim? Kojerbal Bouta in ni ko ewor Fluoride ie University of Washington Northwest/Alaska Center to Reduce Oral Health Disparities
    24. 28. Xylitol reduces cavity-causing bacteria
    25. 30. Example #1 Interventions During the Perinatal Period for Mothers and Child
    26. 31. Early Caries Prevention Community Partners <ul><li>Klamath County Health Department </li></ul><ul><li>Advantage Dental Plan, Capitol Dental </li></ul><ul><li>WIC </li></ul><ul><li>Oregon Institute of Technology </li></ul><ul><li>CHC and Medical Plans </li></ul><ul><li>University of Washington </li></ul><ul><li>Oregon Department of Health </li></ul>
    27. 32. Program Goal <ul><li>100% of 2-year old children on Medicaid will have no cavities. </li></ul>
    28. 33. Program Components Based on Solid Research <ul><li>Home visits </li></ul><ul><ul><li>Parent education on dental disease transmission/ECC. </li></ul></ul><ul><ul><li>Follow-up at WIC. </li></ul></ul><ul><ul><li>Tool Kits </li></ul></ul><ul><li>Case management to eliminate barriers to dental care. </li></ul><ul><li>Fluoride toothpaste provided to mother and child with instructions to apply to teeth daily from 1st tooth. </li></ul><ul><li>Every pregnant woman and newborn assigned a dental home (managed care) for necessary treatment. </li></ul><ul><li>Chlorhexidine rinses during pregnancy and xylitol gum for the new mother. Fluoride varnish for child per risk. </li></ul>
    29. 35. Challenge: Increase the proportion of pregnant women who receive anticipatory guidance at home 80.5% 339/421 * * 2/2004 to 1/2006
    30. 36. Challenge: Increase the number of pregnant women using dental care <ul><li>55.8% (eligibles) </li></ul><ul><li>69.3% </li></ul><ul><li>(of those who received a prenatal visit) </li></ul>No show rate = 9%
    31. 37. Challenge <ul><li>Keep in contact with the new moms and get the babies in to the dental home </li></ul>Solution: Staff training, motivational interviewing, better contact information
    32. 38. Example #2 Interventions for Young Children
    33. 39. The ABCD Program in Washington State A Partnership to Make Medicaid Child Dental Services Work
    34. 40. ABCD Goals <ul><li>Focus on preschool children from birth </li></ul><ul><li>Intervene early to prevent disease </li></ul><ul><li>Set children up for positive dental experiences </li></ul><ul><li>Teach parents to care for their children’s teeth </li></ul>
    35. 41. Partners <ul><li>Local dental societies </li></ul><ul><li>Medicaid </li></ul><ul><li>Local health departments </li></ul><ul><li>University of Washington </li></ul><ul><li>Washington Dental Service Foundation </li></ul><ul><li>United Way </li></ul>
    36. 42. Getting Dentists Involved <ul><li>Appropriate services for high risk children </li></ul><ul><li>Enhanced skills </li></ul><ul><li>Eliminate no-shows </li></ul><ul><li>Pay fair fees </li></ul><ul><li>Pay promptly </li></ul>
    37. 43. The Client Perspective ABCD Administration Early Childhood Agencies Dental Offices UW Training
    38. 44. Proportion of children with at least one claim in Spokane County <ul><li>AGE NON ABCD ABCD </li></ul><ul><li><12 135/5577 (2.4%) 45/1004 (4.5%) </li></ul><ul><li>12-23 72/2295 (3.3%) 257/882 (29.1%) </li></ul><ul><li>24-35 159/2069 (7.7%) 377/943 (39.9%) </li></ul><ul><li>36-47 363/2112 (17.2%) 519/908 (57.1%) </li></ul><ul><li>48-60 958/2638 (36.3%) 346/407 (85.0%) </li></ul>
    39. 45. Mom & Me-Yakima Outcomes: Focus on a Latino Agricultural Community <ul><li>4,705 children enrolled (1999-2001) </li></ul><ul><li>51% visited a dentist </li></ul><ul><li>MAA dentists increased from 15 to 38 </li></ul><ul><li>No show rate: 7.3% </li></ul><ul><li>Spanish speaking outreach worker </li></ul><ul><li>Access to packing sheds </li></ul>Nagahama et al. JADA 133:1251-1257, Sept. 2002
    40. 46. Alaska Community Health Aides <ul><li>Midlevel dental primary care providers </li></ul><ul><li>High school plus experience, 2 yrs training </li></ul><ul><li>Provide basic pediatric and adult dental care including anesthesia, fillings and extractions </li></ul><ul><li>Work under distant supervision by dentists </li></ul>
    41. 47. Thanks to … <ul><li>National Institute of Dental and Craniofacial Research, NIH </li></ul>