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Department of Health and Family Services


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Department of Health and Family Services

  1. 1. Wisconsin Department of Health and Family Services Oral Health Programs Nancy McKenney, RDH, MS State Dental Hygiene Officer November 18, 2004
  2. 2. Program Characteristics <ul><li>Accessible </li></ul><ul><li>Affordable </li></ul><ul><li>Acceptable </li></ul><ul><li>Effective </li></ul><ul><li>Evidence-Based </li></ul><ul><li>Consistent with Healthiest Wisconsin 2010 (State Health Plan) </li></ul>
  3. 3. Levels of Prevention <ul><ul><ul><ul><li>Primary (removing or reducing risks, pre-disease initiation) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Secondary (screening, early detection, intervene to arrest the progress of disease after it occurs) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Tertiary (rehabilitation and restoration of structure and function) </li></ul></ul></ul></ul>
  4. 5. State-Based Data Collection Plan
  5. 6. Wisconsin Youth Oral Health Data Collection Plan Report <ul><li>Factors Affecting Youth Oral Health In </li></ul><ul><li>Wisconsin </li></ul><ul><li>Most recent publication 2001-02 </li></ul>
  6. 7. Purpose <ul><li>Share information on oral health of Wisconsin children </li></ul><ul><li>Identify key data elements, existing data and studies </li></ul><ul><li>Describe factors affecting youth oral health </li></ul><ul><li>Provide regional summaries </li></ul><ul><li>Describe available resources </li></ul><ul><li>Serve as baseline for monitoring factors affecting youth oral health </li></ul>
  7. 8. Make Your Smile Count Survey Third-Grade Children
  8. 9. Purpose <ul><li>To establish a baseline for monitoring children’s oral health status </li></ul><ul><li>To assess the extent of children’s oral health needs </li></ul><ul><li>To describe risk factors </li></ul>
  9. 10. Sampling <ul><li>Self-weighting stratified sample of elementary schools for each of five DHFS regions </li></ul><ul><li>Third-grade children </li></ul><ul><li>Combination of positive and passive consent </li></ul><ul><li>Statewide response rate was 67 percent </li></ul>
  10. 11. Methods <ul><li>Basic Screening Surveys: An Approach to Monitoring Community Oral Health (ASTDD) </li></ul><ul><li>5 dental hygienists - trained and calibrated </li></ul>
  11. 13. 2003 Healthy Smiles for a Head Start
  12. 14. Sampling <ul><li>Random sample of Head Start grantees within each DHFS geographic region </li></ul><ul><li>Number screened proportional to the number of children in that region enrolled in Head Start </li></ul><ul><li>Representative of Head Start children, not all preschool children in Wisconsin </li></ul><ul><li>Needed positive consent form </li></ul>
  13. 15. Methods <ul><li>Methods outlined in Basic Screening Surveys: An Approach to Monitoring Community Oral Health (ASTDD) </li></ul><ul><li>Trained and calibrated screener </li></ul><ul><li>Information collected: </li></ul><ul><ul><ul><li>Child’s date of birth, age, gender, race, and ethnicity </li></ul></ul></ul><ul><ul><ul><li>Caries experience in the primary dentition (no, yes) </li></ul></ul></ul><ul><ul><ul><li>Untreated cavities (no, yes) </li></ul></ul></ul><ul><ul><ul><li>Early Childhood Caries – decay and/or fillings in the upper anterior teeth (no, yes) </li></ul></ul></ul><ul><ul><ul><li>Treatment urgency (urgent need for dental care, early dental care is needed, no obvious problems) </li></ul></ul></ul>
  14. 16. Maternal and Early Childhood Oral Health Programs
  15. 17. Maternal Oral Health <ul><li>Preconceptional, prenatal and postnatal oral health </li></ul><ul><li>Educate primary healthcare providers </li></ul><ul><li>Promote healthy birth outcomes </li></ul>
  16. 18. Early Childhood Oral Health <ul><li>Transmissible, bacterial infection </li></ul><ul><li>Unique characteristics and risk factors </li></ul><ul><li>DHFS oral health consultants train medical/ dental personnel, health dept., rural clinics </li></ul><ul><li>Training: </li></ul><ul><ul><li>Basic screening survey </li></ul></ul><ul><ul><li>Anticipatory guidance </li></ul></ul><ul><ul><li>Fluoride varnish application </li></ul></ul><ul><ul><li>Referral </li></ul></ul>
  17. 23. Other Fluoride Programs
  18. 24. Community Water Fluoridation Programs <ul><li>Evidence-based prevention program </li></ul><ul><li>Reduces health disparities, benefits all ages and socioeconomic status </li></ul><ul><li>Reaches 63% of total Wisconsin population </li></ul><ul><li>90% of Wisconsin population on community water supplies </li></ul><ul><li>Wisconsin is 12th highest in nation </li></ul>
  19. 26. Dietary Fluoride Supplement Programs <ul><li>Used since 1940’s </li></ul><ul><li>Children living in households with inadequate levels of fluoridated water </li></ul><ul><li>Prescribed for children six months - six years </li></ul><ul><ul><li>Water supplies must be tested </li></ul></ul><ul><ul><li>Other water sources taken into consideration (example: day care) </li></ul></ul><ul><li>DHFS-supported programs serve approximately 2,245 children </li></ul>
  20. 27. School-based Fluoride Mouthrinse Programs <ul><li>Supervised, weekly, school-based program </li></ul><ul><li>Children over age six in non-fluoridated communities </li></ul><ul><li>DHFS provides funding and technical assistance </li></ul><ul><li>DHFS-supported programs </li></ul><ul><ul><li>66 schools </li></ul></ul><ul><ul><li>Serve over 10,000 children </li></ul></ul>
  21. 28. Dental Sealant Programs
  22. 31. Healthy Smiles for Wisconsin Seal-a-Smile Program <ul><li>Dental sealants are a thin resin coating </li></ul><ul><ul><li>Covers chewing surfaces (permanent molars) </li></ul></ul><ul><ul><li>Provides a physical barrier to cavity causing bacteria and carbohydrates </li></ul></ul><ul><ul><li>Pits and fissures are most susceptible (morphology) </li></ul></ul><ul><li>Evidence-based prevention strategy </li></ul><ul><li>MA cost expenditure savings </li></ul><ul><li>Target high-risk children with low access (high free and reduced lunch school) </li></ul>
  23. 32. Healthy Smiles for Wisconsin Seal-a-Smile Programs <ul><li>47% of Wisconsin third-grade children dental sealants </li></ul><ul><li>Significantly fewer sealants in children enrolled in higher free and reduced lunch schools </li></ul><ul><li>2003-04 hosted 102 events in 14 communities </li></ul><ul><ul><li>4,255 children screened </li></ul></ul><ul><ul><li>2,898 received sealants </li></ul></ul><ul><ul><li>12,461 dental sealants placed </li></ul></ul>
  24. 33. Seal-A-Smile Program <ul><li>Year Screened Received Sealants Sealants Placed </li></ul><ul><li>2000-01 2,057 1,548 5,571 </li></ul><ul><li>2001-02 3,320 2,366 8,823 </li></ul><ul><li>2002-03 4,367 2,670 10,681 </li></ul><ul><li>2003-04 4,255 2,898 12,461 </li></ul>
  25. 34. Guardcare Sealant Program <ul><li>National Initiative, part of clinical training </li></ul><ul><li>Collaborative effort with Wisconsin Army National Guard, 13th Medical and Dental Detachment, DHFS, LHD, health professional education, community organizations, agencies </li></ul><ul><li>Free sealants to underserved </li></ul><ul><li>Since 1995: </li></ul><ul><ul><li>3,074 children served </li></ul></ul><ul><ul><li>15,070 teeth sealed </li></ul></ul>
  26. 36. Spit Tobacco Program
  27. 37. Spit Tobacco Program <ul><li>Smokeless tobacco associated with oral cancer </li></ul><ul><li>Use often begins in adolescence </li></ul><ul><li>20% reported ever using </li></ul><ul><li>9% of all students reported using in the past 30 days </li></ul><ul><ul><li>14% of males </li></ul></ul><ul><ul><li>4% of females </li></ul></ul>
  28. 38. Spit Tobacco Program <ul><li>DHFS contracts with WDA </li></ul><ul><li>Partners include: Milwaukee Brewers Baseball Club and Department of Public Instruction </li></ul><ul><li>Five-day curriculum: comic book with health messages, integrates math, science, geography </li></ul><ul><ul><li>Served 150 schools, 80,000 fifth-grade students including Brewer’s Day in the Park </li></ul></ul><ul><ul><li>Evaluation indicates teacher satisfaction with curriculum and improved child learning and attitude </li></ul></ul>
  29. 39. Program Models <ul><li>Price County </li></ul><ul><li>CESA 11 </li></ul><ul><li>Children’s Dental Health Clinic in Madison </li></ul>
  30. 41. Clinic-Based Services
  31. 42. Rural Dental Clinics <ul><li>State funding supports three rural dental clinics </li></ul><ul><ul><li>Cooperative Education Service Area (CESA 11) manages Menominee project </li></ul></ul><ul><ul><li>Marshfield Family Health Center (federally qualified health center) manages Ladysmith project , strengthening coordination of care between medical/dental clinics </li></ul></ul><ul><ul><li>Tri-County Community Dental Clinic serves Winnebago, Calumet and Outagamie counties (03-04) </li></ul></ul>
  32. 43. Marquette University School of Dentistry <ul><li>Provides comprehensive services to patients of all income levels </li></ul><ul><li>Serves over 15,000 unduplicated patients during approximately 47,500 visits </li></ul><ul><ul><li>65% paid out-of-pocket </li></ul></ul><ul><ul><li>18% Medicaid/BadgerCare </li></ul></ul><ul><ul><li>10% Medicare </li></ul></ul><ul><ul><li>7% private insurance </li></ul></ul>
  33. 44. Marquette University School of Dentistry <ul><li>Clinics </li></ul><ul><ul><li>Marquette University School of Dentistry Clinic (Milwaukee) </li></ul></ul><ul><ul><li>Isaac Coggs Community Health Center (Milwaukee) </li></ul></ul><ul><ul><li>Johnston Community Health Center (Milwaukee) </li></ul></ul><ul><ul><li>Oneida Community Health Center (Oneida) </li></ul></ul><ul><ul><li>Tri-County Community Dental Clinic (Fox Valley) </li></ul></ul>
  34. 45. Donated Dental Services <ul><li>The Foundation for the Handicapped </li></ul><ul><ul><li>National charitable organization </li></ul></ul><ul><ul><li>Started to assist medically compromised, aged, indigent, and people with disabilities </li></ul></ul><ul><ul><li>Wisconsin Foundation for the Handicapped is an affiliate </li></ul></ul><ul><li>Wisconsin provides state funds annually for a program coordinator at WDA </li></ul><ul><ul><li>Dentists provide donated services </li></ul></ul><ul><ul><li>DHFS monitors contract </li></ul></ul>