Dr. Wendy Mouradian's Presentation at Oral Health Summit

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Dr. Wendy Mouradian's Presentation at Oral Health Summit

  1. 1. Medical-Dental Partnerships To Promote Oral Health Wendy E. Mouradian, MS, MD Pediatrics, Pediatric Dentistry, Health Services (Public Health) Children’s Hospital Regional Medical Ctr University of Washington
  2. 2. Acknowledgements <ul><li>Comprehensive Center for Oral Health Research (NIH - NIDCR) </li></ul><ul><li>Maternal and Child Health Bureau, HRSA (Leadership Education in Pediatric Dentistry) </li></ul><ul><li>Bureau of Health Professions, HRSA (Interdisciplinary Children’s Oral Health Promotion) </li></ul>
  3. 5. Summit Themes <ul><li>Whatcom County: </li></ul><ul><li>Engage community members </li></ul><ul><li>Present local data </li></ul><ul><li>Discuss “best practices” </li></ul><ul><li>Raise awareness of dental caries as an infectious disease </li></ul><ul><li>Problem solve: children, adults, elderly </li></ul>
  4. 6. Surgeon General’s Report on Oral Health (2000) <ul><li>Oral diseases are common and consequential </li></ul><ul><li>Linked to overall health and well-being </li></ul><ul><li>Profound disparities in oral health status </li></ul><ul><li>Disparities: SES, rural, minorities, vulnerable Preventive measures exist </li></ul><ul><li>Research / translation of science needed </li></ul><ul><ul><li>http://www.nidcr.nih.gov/sgr/sgr.htm </li></ul></ul>
  5. 7. Vulnerable Populations <ul><li>Children </li></ul><ul><li>Elderly </li></ul><ul><li>Special Needs </li></ul><ul><li>Adult populations </li></ul>
  6. 8. Medical-dental Educational Collaborations <ul><li>Journal of Dental Education –Aug 2003 </li></ul><ul><li>Overview and commentary – children’s oral health </li></ul><ul><li>Washington State (family medicine residents) </li></ul><ul><ul><li>Mouradian et al </li></ul></ul><ul><li>North Carolina (pediatricians, family physicians) </li></ul><ul><ul><li>Rozier et al </li></ul></ul>
  7. 9. Medical-dental Educational Collaborations <ul><li>Journal of Dental Education –Dec 2003 </li></ul><ul><li>Overview and commentary – special pop. </li></ul><ul><li>Elderly populations </li></ul><ul><ul><li>Pyle et al </li></ul></ul><ul><li>Mental retardation, other special needs </li></ul><ul><ul><li>Fenton et al </li></ul></ul>
  8. 10. Medical-dental Educational Collaborations <ul><li>Journal of Dental Education –Apr 2004 </li></ul><ul><li>Overview and commentary -Public health approaches </li></ul><ul><li>Kids Get Care (case management model) </li></ul><ul><ul><li>Hennessey et al </li></ul></ul><ul><li>OPENWIDE (CT – Head Start) </li></ul><ul><ul><li>Wolfe et al </li></ul></ul>
  9. 11. Children’s Oral Health <ul><li>Dental care is most common unmet health need of children </li></ul><ul><li>More likely to lack dental insurance </li></ul><ul><li>Access to dental care limited u/ Medicaid </li></ul><ul><li>Disparities by SES, rural areas, special health needs/disabilities </li></ul>
  10. 12. Impact on Children <ul><li>Disease burden - 52 million school hours </li></ul><ul><li>Pain, infection, growth problems, ER visits </li></ul><ul><li>Hospitalizations and surgeries </li></ul><ul><li>Long term impact on economic, quality of life </li></ul><ul><li>Children with special needs: impact on general health </li></ul>
  11. 13. Reach Children Early <ul><li>Prevention works </li></ul><ul><li>Dental disease develops early <1-2 yrs </li></ul><ul><li>Disease transmitted from mother </li></ul><ul><li>Reach in primary care, child care, Head Start, educational, social systems </li></ul>
  12. 14. Washington State Smiles Survey, 2000 <ul><li>Disparities in oral health outcomes by race/ethnicity, SES </li></ul><ul><li>Many children lack access to dental care </li></ul><ul><li>Washington state data do not compare favorably with national data </li></ul><ul><ul><li>Kathy Phipps, MPH, DrPH, consulting epidemiologist </li></ul></ul>
  13. 15. Prevalence of ECC Washington 1-year-olds Washington 2-year-olds NHANES III 2-year-olds
  14. 16. Trends Over Time Caries Experience 1994 19.2 40.7 Sealants 46.0 54.6 16.9 21.6 Untreated Decay 0 10 20 30 40 50 60 Percent of Children 2000
  15. 17. Adult Oral Health <ul><li>Periodontal disease is common </li></ul><ul><ul><li>Maternal periodontal disease and LBW </li></ul></ul><ul><ul><li>Periodontal and cardiovascular disease </li></ul></ul><ul><ul><li>Pulmonary impact of oral disease </li></ul></ul><ul><li>Mothers choose health care for families </li></ul><ul><li>Oral-systemic health: diabetes, others </li></ul><ul><li>Oral cancer: 8000 people die a year </li></ul>
  16. 18. Older Adults <ul><li>More periodontal disease </li></ul><ul><li>More oral-systemic health impacts </li></ul><ul><li>More oral cancer </li></ul><ul><li>Impact of medications </li></ul><ul><li>Long term care facilities </li></ul><ul><li>Complex social arrangements </li></ul>
  17. 19. Mental Retardation and Special Needs <ul><li>Lack of data on oral conditions </li></ul><ul><li>Impact of medications, conditions </li></ul><ul><ul><li>Down syndrome and periodontal disease </li></ul></ul><ul><ul><li>Effect of anti-convulsants </li></ul></ul><ul><li>Difficulty with self-care </li></ul><ul><li>Complex guardianship, living arrangements </li></ul>
  18. 20. Key themes: Special populations <ul><li>Importance of oral-systemic interactions: </li></ul><ul><li>need for interdisciplinary collaboration </li></ul><ul><li>Diminished mental/ motor capacity </li></ul><ul><li>need for special arrangements and emphasis upon prevention </li></ul><ul><li>Difficulty accessing care </li></ul><ul><li>need for better training, other solutions </li></ul><ul><li>Complex social and cultural factors </li></ul><ul><li>Lack of good data </li></ul>
  19. 21. Context <ul><li>Disparities may worsen: </li></ul><ul><li>Demographics: diversity; child poverty; survival those with special needs, elderly </li></ul><ul><li>Workforce gaps: not enough dentists; retiring; most not in Medicaid ; physicians lack training </li></ul><ul><li>Policy gaps : lack of insurance; oral care not “medically necessary” (especially impacts special needs population) </li></ul>
  20. 22. Partnership <ul><li>Department of Pediatric Dentistry </li></ul><ul><li>Department of Family Medicine </li></ul><ul><li>UW Affiliated Family Practice Residency Network </li></ul><ul><li>Department of Medical Education and Bioinformatics </li></ul>
  21. 23. ICOHP <ul><li>Goal 1: Training family medicine residents and faculty in oral health promotion </li></ul><ul><li>Objectives: </li></ul><ul><li>Develop curricula in children’s oral health, 0-5 </li></ul><ul><li>Pilot, implement in WWAMI sites </li></ul><ul><li>Evaluate effect of training on knowledge, attitudes, behavior </li></ul><ul><li>Disseminate curricula </li></ul>
  22. 24. UW FP Residency Network: Sites Alaska Washington Montana Idaho Wyoming Family Practice Residency Affiliation Under Negotiation Rural Training Track
  23. 25. Geographical barriers
  24. 26. Assumptions <ul><li>Biggest obstacle will be buy-in </li></ul><ul><li>Tailor curriculum to physician needs </li></ul><ul><li>Integration with dental sector in community critical </li></ul><ul><li>Sustainability will require additional work </li></ul>
  25. 27. Focus Groups: Faculty/ Residents, Staff <ul><li>Barriers </li></ul><ul><li>Oral health not on their radar screen; lack knowledge/self-efficacy </li></ul><ul><li>Providers busy: oral health not a priority </li></ul><ul><li>Concerned about the evidence base </li></ul><ul><li>Confusion about physician role </li></ul><ul><li>Lots of baggage about dentists </li></ul>
  26. 28. Focus Groups: Faculty/ Residents, Staff <ul><li>Opportunities </li></ul><ul><li>Care about children in pain </li></ul><ul><li>Unable to answer parents’ questions </li></ul><ul><li>Prevention is a high priority </li></ul><ul><li>Already providing health education </li></ul><ul><li>Acutely aware of access issues </li></ul><ul><li>Committed to underserved communities </li></ul>
  27. 29. Address Barriers and Opportunities <ul><li>Increase motivation </li></ul><ul><ul><li>Oral health important </li></ul></ul><ul><ul><li>Impact on children </li></ul></ul><ul><li>Increase practitioner knowledge </li></ul><ul><ul><li>Normal dental development </li></ul></ul><ul><ul><li>Caries process </li></ul></ul>
  28. 30. Address Barriers and Opportunities <ul><li>Review evidence base (USPSTF; CDC Fluoride recommendations) </li></ul><ul><li>Frame in terms of primary care roles: </li></ul><ul><ul><li>Anticipatory guidance </li></ul></ul><ul><ul><li>Nutrition/feeding </li></ul></ul><ul><ul><li>Injury prevention; emergency management </li></ul></ul><ul><ul><li>Special issues for CSHCN </li></ul></ul>
  29. 31. Address Barriers and Opportunities <ul><li>Address resentment towards dentists: </li></ul><ul><li>Work with dentists one-on-one: </li></ul><ul><ul><li>partner with ABCD, community health clinics, pediatric dental trainees </li></ul></ul><ul><ul><li>Increase communication, lines of referral </li></ul></ul><ul><li>Reinforce principles of family-centered, culturally competent care </li></ul><ul><ul><li>already part of residency culture / training </li></ul></ul>
  30. 32. Modules: Frame to issues raised <ul><li>Module 1: Public Health Overview; Oral Health Promotion and Practice </li></ul><ul><li>Module 2: Normal Dental Development/ Pathology </li></ul><ul><li>Module 3: Dental Caries; Collaborating with Dentists </li></ul><ul><li>Module 4: Dental Trauma and Emergencies </li></ul><ul><li>Module 5: Oral-systemic Health Interactions </li></ul>
  31. 33. Respond to Requests for More Information <ul><li>Module 6: Atraumatic Restorative Technique </li></ul><ul><li>Module 7: Maternal oral health </li></ul><ul><li>Module 8: Adolescent oral health </li></ul><ul><li>Module 0: Managing the change process </li></ul>
  32. 34. Trainings to date <ul><li>Seattle </li></ul><ul><li>Yakima </li></ul><ul><li>Spokane </li></ul><ul><li>Olympia </li></ul><ul><li>Boise </li></ul><ul><li>Anchorage </li></ul><ul><li>Pending: Valley, Vancouver </li></ul>
  33. 35. Frame for Primary Care Providers <ul><li>PCP Roles: </li></ul><ul><ul><li>1. Anticipatory guidance/ counseling </li></ul></ul><ul><ul><li>2. Risk assessment - oral screening, history (maternal history) </li></ul></ul><ul><ul><li>3. Applying fluoride varnish </li></ul></ul><ul><ul><li>4. Dental referral / collaboration </li></ul></ul><ul><ul><li>5. Monitor oral-systemic health interactions </li></ul></ul><ul><ul><li>6. Manage simple dental trauma </li></ul></ul><ul><ul><li>7. Maternal oral health counseling </li></ul></ul>
  34. 36. North Carolina <ul><li>North Carolina: Statewide Medicaid program: pediatricians/family practitioners provide oral health education / screening exams / apply fluoride varnishes to young children 0-3 / dental referrals </li></ul><ul><li>Partnership: Supported by dental, pediatric, family practice societies </li></ul>
  35. 37. Others to watch <ul><li>MCH Oral Health training for non-dental providers </li></ul><ul><li>http://www.mchoralhealth.org/PediatricOH/index.htm </li></ul><ul><li>Minnesota training, fluoride varnishes </li></ul><ul><li>http://meded1.ahc.umn.edu/fluoridevarnish/xindex.htm </li></ul><ul><li>AAP –presentations for chapters – stay tuned </li></ul>
  36. 38. Medical Mantra <ul><li>Address medical training gaps </li></ul><ul><li>Change perceptions among medical professionals </li></ul><ul><li>Integrate oral health into systems of care especially for vulnerable populations </li></ul><ul><li>Develop medical-dental collaborations </li></ul><ul><li>Leadership in policy/ education </li></ul><ul><li>Standard of practice that includes oral health </li></ul>
  37. 39. Key Points <ul><li>Disparities in oral disease /access to care </li></ul><ul><li>Impact on vulnerable populations </li></ul><ul><li>Workforce critical: not enough providers </li></ul><ul><li>Prevention is key - if started early </li></ul><ul><li>Integrate oral health into overall health </li></ul><ul><li>Partnerships are needed to make this happen </li></ul>

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