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  1. 1. Oral Health and Health CareSplash pageGraphics: Flash graphics with sequential build of photos of (a) pregnant women, (b) diverse young mothers/ black, white, latina, asian, (c) infants, toddlers, preschoolers, (d) young children with apparent “special need” e.g. Down’s kid, CP kid or other child showing impairment.Text:Banner: Opening the MouthText: building sequentially“Did you know that? o Oral is intimately linked to general health -- and oral disease may account for a substantial portion of unexplained prematurity and low birth weight o Tooth decay remains the single most prevalent disease of childhood o Three times more Americans are without dental insurance than medical insurance o An estimated 5 million US children each day experience pain or dysfunction from a toothache o Dental problems are the single most common unmet healthcare need of children – including children with special healthcare needsThis website is for you if you o want to learn about maternal and child oral health or o are looking for ideas about how to address oral health within maternal and child health programClick here to enter”Credit: “This self-learning website was developed in 2005 by Columbia University with supportfrom the Maternal and Child Health Bureau through the MCH Continuing Education andDevelopment Program, Grant ___-_________.”WelcomeThis part of the introduction will be done as a videoTalking points: 1. Many MCH professionals are aware that dental problems continue to challenge mothers’ and children’s health and quality of life. 2. But there are few opportunities for MCH professionals to learn about dental issues. In fact, a 2003 Columbia University study conducted for the Maternal and Child Health Bureau found that there are almost no opportunities in public health education or professional continuing education to learn about oral health.
  2. 2. 3. MCH professionals hold tremendous opportunities to improve mothers’ and children’s oral health. Most of these opportunities are grounded in the understanding that oral health is an essential component of general health and of primary care. 4. This self-learning module is designed to give MCH professionals a quick and pleasant introduction and update on four topics important to oral health programming: 1. “The Parent”: pregnancy-related oral health issues 2. “The Child”: early childhood caries as an infectious and transmissible disease 3. “The Treatment”: classical and new-science options for managing caries 4. “Action Steps”: specific actions recommended by the AMCHP based on findings of a US Surgeon General’s Workshop on Children and Oral Health 5. This self-learning module follows the fictional Mrs. Inez Perez – a 32 year old pregnant woman – through her experience with periodontal disease, her premature delivery of a low-birthweight baby, transmission of caries-causing bacteria from Mrs. Perez to her new child, and the child’s experience with dental caries over the first years of life. Mrs. Perez’ experience typifies a variety of issues confronting MCH programming around oral health: opportunities for prevention, treatment, and systems change to improve oral health.Introduction to the health problem)Textual navigation links (Mike, do you think the “part” notations are needed?): 1. Part I: Oral health (was “introduction”) 2. Part II: Conception to Birth (was “parent”) 3. Part III: Early Childhood Caries (was “child”) 4. Part IV: Treatment (was “treatment”) 5. Part V: Action Steps (was “action steps”)Text:(something like)“You can follow Mrs. Perez and her baby from pregnancy through the child’ssecond year by clicking on the photos below”Graphical navigation links as timeline (photos or drawings): 1. pregnant Latina 2. infant 3. initial decalcifications on teeth (Edelstein photo) 4. rampant early childhood caries (Edelstein photo) 5. child in OR (Edelstein photo) 6. photo suggesting policy, e.g. small group of women at conference table
  3. 3. Despite great strides in improving oral health, profound and consequential disparities still existacross population groups (Mike: Insert (1) a thumbnail pop-up of the CDHP DisparitiesFact Sheet which is located at and labelit “Oral Health Disparity Fact Sheet.” Please copy the actual fact sheet into the product.Also insert (2) a thumbnail photo of the Congressional staff briefing found at andcreate a link to that site (or preferably, copy that entire entry from my web site into theproduct so we don’t have to worry about a lost link later).According to Healthy People 2010’s Oral Health Chapter and the US Surgeon General’s Report,Oral Health In America, those suffering the worst oral health are: o The poor, particularly young children and older Americans o Racial and ethnic minorities o Medically and developmentally compromised individuals.(Mike: please create internet hot links to the two publications in red. Links are: 1. HP 2010: 2. SG Report: two most prevalent oral diseases are Tooth Decay (Dental Caries) and Periodontal Disease. o Both are infectious, chronic, progressive, and highly prevalent. o Both - if left untreated – result in pain, infection, dysfunction, and missed work or school. o Both are overwhelmingly preventable through self-care. o Both can be approached through disease management strategies in early stages yet require surgical interventions if allowed to progress.Caries is primarily a disease of childhood – typically established during infant and toddler yearsand continuing throughout life. Periodontal disease is primarily a disease of adulthood – typicallyestablished during the adolescent years and also continuing throughout life.(Mike: For each of the green items -- which link internally to the product -- please addrollover pop-up links so that the reader can go directly to Tooth Decay/ prevalence,/distribution, /unmet need,/ Consequence; or Periodontal Disease/ prevalence, /association withlow birth weight.)Tooth decayAlthough preventable – dental caries remains the single most common, chronic disease ofchildhood; 5 times more prevalent than asthma (1).Prevalence: One quarter (23%) of all US children have cavities by age 4. By second grade, one-half (52%) of all US children have experienced caries. This tremendous but unrecognizedprevalence explains why Surgeon General David Satcher called pediatric caries “the nation’ssilent epidemic.”(Mike: need to insert a bar graph with y axis showing “percent of children with cavities”and child-silhouette shaped bars showing 23% for 2-4 year olds and 52% for 6-8 yearolds. A credit should cite “HP2010 2004 Updates, US Centers for Disease Control andPrevention”)
  4. 4. Distribution: This disease is highly concentrated in low-income and minority children as 80% ofthe disease is localized in only 25% of children(Mike: need to insert a graph showing that 25% of children represent 80% of the diseaseburden with citation “NHANES III, US Centers for Disease Control and Prevention”)Unmet need: Among children reported by their parents to have one or more unmet healthcareneeds, three times more children have unmet needs for dental care than medical. Fully one-quarter of parents whose children have special healthcare needs report unmet needs for dentalcare. (references are Newacheck’s two papers)(Mike: need bar graph showing unmet need for various types of health care replicatingFigure 1 from the Newacheck paper that I’m emailing to you with this update. Referenceis that paper listed as “Newacheck et al Pediatrics 2000 from NHIS”)Consequence: Untreated dental disease results in pain, infection, dysfunction, distraction fromlearning, and may inhibit general growth and development because of associated nutritionalliabilities (HRSA publication by Edelstein).(Mike: need photo of sad looking child with swollen face that I’ll supply)Periodontal diseasePeriodontitis is a chronic infectious and inflammatory disease of the gums and tooth-supportingbone. It is the single most common cause of adult oral dysfunction and tooth loss. It is typicallypainless until well advanced and produces few signs other than bleeding gums.Prevalence: Periodontal disease affects half (48%) of US adults and is particularly destructive inone-fifth (22%) of US adults (ref: HP 2010)Distribution: Like childhood caries, periodontal disease disproportionately impacts people with lowincome, minority status, and low educational attainment.Consequence: Periodontal disease is a recognized risk factors for heart disease, inadequateglycemic control in diabetics and putatively for poor pregnancy and birth outcomes. The USSurgeon General alerted the public to the link between periodontal disease and poor birthoutcome in 2001. (Mike: graphic: photo of US Surgeon General David Satcher attached tothe following quote) “The evidence associating moderate to severe periodontal disease inpregnant women with low-weight preterm births warrants attention to the importance ofmaintaining optimal oral health in pregnancy. The oral care clinician can contribute to birth defectprevention not only by treating oral disease, but also by providing educational messages topatients to promote the birth of healthy, full-term babies.”The public policy issue: Although the science is as yet uncertain and clinical intervention trials arenow underway at NIH, a number of leading public and private agencies have begun to alertwomen of childbearing age about the mouth-pregnancy relationship.(Mike: insert thumbnails of MOD, and others from the attached power point). (This is theintro regarding that “this is real, this is happening, this is not goofy”).
  5. 5. Overall Learning Objectives * Understand the connection between oral health and overall health * Understand that dental caries is an infectious, transmissible, communicable disease * Understand the prevalence, acuity and consequence of dental disease * Understand dental care finance, delivery and workforce issues * Be able to list general action steps that can be taken to decrease oral health disparities * Describe action steps specific to Title V Maternal and Child Health Federal Block Grant programs that can be taken to decrease oral health disparities(Mike: what goes next to lead people into the next section)