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Alberta oral heatlh action plan

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May 29th 2017

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Alberta oral heatlh action plan

  1. 1. Alberta Oral Health Action Plan May 29, 2017 Dr. Rafael Figueiredo Provincial Dental Public Health Officer
  2. 2. Background Oral Health Action Plan OHAP 2016 Domains: • Health Promotion • Prevention Services • Treatment Services • Research & Surveillance Outline
  3. 3. Background
  4. 4.  Dental care operates as a private fee-for-service system  Private dental insurance  Out-of-pocket  Public dental insurance Canadian Dental Health Care System
  5. 5.  62% private dental insurance (usually an employee benefit)  32% no dental insurance  6% public insurance Dental Health Care System
  6. 6. Dental Public Health Spending Ref: Canadian Academy of Health Sciences, 2014
  7. 7. Publicly Funded Share of Total Expenditures for Dental Services in Canada Canadian Dental Association
  8. 8.  Individuals with low income  Young children in low income families  Individuals with no employment-related dental insurance  Elderly living in LTC or with low income  Indigenous people  Refugees and immigrants  Individuals with disabilities  People living in rural/remote areas Vulnerable Populations in Canada
  9. 9. Who is Vulnerable? 17% avoid dentists 12% avoid eating 12% have pain 2Xs more needs
  10. 10. Alberta Oral Health Action Plan OHAP - 2016
  11. 11. Provincial Oral Health Office
  12. 12. Provincial Oral Health Office To improve the oral health status of Albertans
  13. 13. Provincial Oral Health Office To provide leadership and strategic direction to respond to Albertans’ oral health needs
  14. 14. Provincial Oral Health Office • Every Albertan deserves good oral health as part of good health • Access to oral health care improves health, well-being, and quality of life • Partnership and collaboration create a supportive environment for oral health • Evidence-based dentistry enables a cost-effective utilization of resources • Oral health standards of care ensure quality services • Leadership and communication improve capacity to meet public health needs
  15. 15. Population Health Approach
  16. 16. • Identify populations • Direct services • Standardize services • Evidence-based practice • Upstream initiatives • Multiple interventions • Collaboration Creating Equity
  17. 17. Planning & Evaluation
  18. 18. 1. Evidence-based prevention strategies 2. Target vulnerable & disadvantaged 3. Standard across province Oral Health Action Plan (OHAP)
  19. 19. OHAP Domains
  20. 20. Health Promotion • Community Water Fluoridation • Oral Health Information • Seniors’ Mouth Care • Reporting Oral Health Indicators Health Promotion
  21. 21. Community Water Fluoridation “It is the controlled adjustment of the natural fluoride concentration in a public water supply up to the level recommended for preventing tooth decay.” CDC (2005)
  22. 22. Prevention Services Prevention Services • Preschool Fluoride Varnish • School Fluoride Varnish • School Dental Sealants • Seniors’ Oral Health
  23. 23. Preschool Program
  24. 24. 5,492* 10,983* 16,475* 21,967* 0 5,000 10,000 15,000 20,000 25,000 Ages12-35MthsPopulation Preschool First Fluoride Varnish (FV) Apr 2015 - Mar 2016 20% Ages 12 -35 Months 15% Ages 12 - 35 Months 10% Ages 12-35 Months 5% Ages 12-35 Months 5,499 5% of Alberta children population received 1st FV application *Alberta Health, Surveillance & Assessment Branch Interactive Health Data Application – Population Projections October 2013
  25. 25. 5,710 3,042 1,446 676 0 2,000 4,000 6,000 8,000 #ofChildrenAges12-35Mths FV Applications Provincial Preschool Fluoride Varnish (FV) Apr 2015 - Mar 2016 1st Application 2nd Application - 54% of 1st Application 3rd Application - 25% of 1st Application 4th Application - 11% of 1st application
  26. 26. School Program
  27. 27. 16,177* 32,354* 0 5,000 10,000 15,000 20,000 25,000 30,000 35,000 Children-K,Gr1&2Population Children - K, Gr 1&2 Provincial School Fluoride Varnish Sep 2015 - Jun 2016 20% K, Gr 1&2 10% K, Gr 1&2 25,813 16% of Alberta children population received FV services *Alberta Health, Surveillance & Assessment Branch Interactive Health Data Application – Population Projections October 2013
  28. 28. 47,110 26,817 25,813 21,662 0 10,000 20,000 30,000 40,000 50,000 60,000 70,000 EligibleChildren-K,Gr1&2 Children - K, Gr 1&2 Provincial School Fluoride Varnish (FV) Sep 2015 - Jun 2016 Consent Forms Sent Consent Forms Returned - 57% 1st FV Application - 96% of Consent Forms Returned 2nd FV Application - 84% of 1st FV Application
  29. 29. 18,470 10,585 9,974 6,498 6,067 5,789 0 5,000 10,000 15,000 20,000 25,000 EligibleChildren-Gr1&2 Children - Gr 1&2 Provincial School Dental Sealant (DS) Sep 2015 - Jun 2016 Consent Forms Sent Consent Forms Returned - 57% Children Observed for DS - 94% of Consent Forms Returned Children Referred for DS - 65% of Children Observed Children Received DS - 93% of Children Referred Received at Least One DS Children Completed All DS - 89% of Children Referred Note: 9,974 children observed for DS represents 9% of the Gr 1&2 children population.
  30. 30. Seniors’ Program
  31. 31.  To standardize oral assessment for daily oral hygiene needs  To provide training on oral hygiene to health care providers  To promote oral health to patients living in Continuing Care Designated Living Options  To prevent oral diseases resulting from poor oral hygiene Seniors’ Program
  32. 32. Seniors’ Oral Health Prevalence of Coronal Caries Dentate Adults 20.3% Prevalence of Untreated Decay Higher Income Middle Income Lower Income 13.5% 21.9% 29.8% Privately Insured Publicly Insured 15.9% 35.8% Prevalence of Root Caries Age 20-39 Age 40-59 Age 60-79 5.8% 24.9% 43.3% Privately Insured Publicly Insured 17.4% 31.4% Report on the Findings of the Oral Health Component of the Oral Health Component Canadian Health Measure Survey (CHMS) 2007-2009. Edentulism: 1972–23.6% 2009–6.4%
  33. 33. Treatment Services Treatment Services • Dental Public Health Clinics • Dental Outreach Program
  34. 34. Eligibility Criteria  Alberta citizens  No dental insurance • Children not covered by the ACHB • Adults not covered by Alberta Works, AISH, FNIB, Blue Cross  Income under LICO limits
  35. 35. Dental Procedures 2013 2014 2015 2016 Dentist Emergency exams 996 1,174 1,494 2,051 Exam of full mouth 572 526 588 754 Extractions 1,274 1,404 1,654 2,617 Fillings 2,908 2,482 2,827 3,857 Root canal 195 235 264 294 Dental Assistant Panoramic radiographs 567 656 787 1,343 Sets of BWs and sets of PA radiographs 3,287 3,775 4,382 4,800 Dental Hygienist Oral hygiene education 1,193 1,262 1,108 1,039 Fluoride varnish application 476 448 439 480 Probing, scaling and root planing 3,419 3,498 2,807 2,180 Total Patients Seen 1,646 1,961 2,310 3,040
  36. 36. Dental Outreach Program
  37. 37. Age McLennan High Level La Crete Total Group (yr) IC C IC C IC C IC C 0-8 yrs 54 53 41 23 89 30 184 106 9-15 yrs 89 83 69 20 154 73 312 176 16- yrs 586 531 591 110 345 185 1522 826 Totals 729 667 701 153 588 288 2018 1108 Table 1: Number of completed (C) and Incomplete (IC) treatment plans by age group from April 1, 2015 to March 31, 2016 Procedures Types McLennan High Level La Crete Totals (%) Patient Exams/Radiographs 1535 1011 809 3355 (38) Prevention/Periodontics 1440 830 682 2952 (33) Restorative 851 338 591 1780 (20) Oral Surgery 293 160 100 553 (6) Endodontics 27 24 33 84 (1) Prosthodontics 38 20 7 65 (1) Other 39 25 20 84 (1) Total Treatments 4223 2408 2242 8873(100) Table 2: Number of procedures and procedure types from Apr. 1, 2015 to Mar. 31, 2016
  38. 38. Research & Surveillance Research & Surveillance • Oral Health Dashboard • Water fluoridation review • Oral cancer research • Caries prevalence rates
  39. 39. • ED visit characteristics
  40. 40. • ED visit characteristics
  41. 41. Year # % 2011 27,051 16.4% 2012 27,978 16.9% 2013 28,148 17.0% 2014 28,526 17.3% 2015 27,254 16.5% 2016 26,370 16.0% Total Visits (2011-2016) 165,327 100.0% Characteristics of ED Visits for Dental Problems not Associated with Trauma by Year - Alberta 2011 to 2016
  42. 42. ED Visits for Dental Problems not Associated with Trauma by Gender and Age 2011-2016
  43. 43. ICD-10-CA Code Code Description 2011 2012 2013 2014 2015 2016 2011- 2016 K04 Diseases of pulp and periapical tissues 12,267 12,551 12,599 12,844 12,263 11,713 74,237 K08 Other disorders of teeth and supporting structures 5,125 5,144 5,345 5,407 5,128 5,094 31,243 K12 Stomatitis and related lesions 1,949 2,158 2,139 2,065 2,029 1,964 12,304 K11 Diseases of salivary glands 1,179 1,349 1,383 1,522 1,391 1,383 8,207 K02 Dental caries 1,266 1,362 1,345 1,348 1,313 1,213 7,847 K05 Gingivitis and periodontal diseases 1,294 1,360 1,305 1,320 1,296 1,248 7,823 K07 Dentofacial anomalies (including malocclusion) 1,086 1,044 1,070 1,054 1,025 1,012 6,291 K13 Other diseases of lip and oral mucosa 837 865 873 897 849 801 5,122 Other K00- K14 All Other K00-K14 2,048 2,145 2,089 2,069 1,960 1,942 12,253 All K00-K14 All dental problems not associated with trauma 27,051 27,978 28,148 28,526 27,254 26,370 165,327 Frequency of ICD-10-CA Code Diagnoses of ED Visits for Dental Problems not Associated with Trauma - Alberta 2011-2016
  44. 44. Emergency Department Visits for Dental Problems in Alberta 1.2% 1.0% 0.8% 0.5% 0.5% 0.3% 0.0% 0.2% 0.4% 0.6% 0.8% 1.0% 1.2% 1.4% Dental Pneumonia Asthma Diabetes Hypertension Diseases Ischemic Heart Disease PercentageofallEDVisits Select Health Conditions Percentage of all ED Visits for Select Conditions (2011-2016)
  45. 45. Fluoride Varnish as a Population Health Preventive Service in Alberta C. Huber, S. Baran, C. de Graaff, R. Figueiredo. Submitted: Canadian Journal of Public Health Articles Submitted Emergency department visits for dental problems not associated with trauma in Alberta, Canada Figueiredo R, Fournier K, Levin L. Submitted: International Dental Journal Acute dental infections managed in an outpatient parenteral antibiotic program setting: prospective analysis and public health implications Connors WJ, Rabie H, Figueiredo R, Parkins MD. Submitted: Bio Med Central Infectious Diseases Emergency Department Visits for Dental Problems in Alberta, Canada R. Figueiredo*1, 2, D. Alabi1, L. Levin2 2016 CAPHD Oral Presentations Caries prevalence data for grade 1 students in Alberta, Canada by community deprivation index level and geography *Steven Patterson1, Lindsay McLaren2, Rafael Figueiredo3 Addressing Acute Dental Infections in Emergency Departments H. Rabie1*, W. Connors2, D. Holton3, M. Parkins3, R. Figueiredo1 The Use of a Guideline for Safe Preventive Dental Service for Children with Asthma S. Baran1*, C. Huber1, C. De Graaff1, R. Figueiredo1 2016 CAPHD Poster Presentations Fluoride Varnish as a Population Health Preventive Service in Alberta C. Huber1*, S. Baran1, C. de Graaff1, R. Figueiredo1 Oral Health Framework for Residents in Long Term Care C. De Graaff *1, C. Huber1, S. Baran1, R. Figueiredo1 Dental World Summit 2017 - Italy Dental Health Surveillance of Emergency Departments in Alberta, Canada

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