A Systemic and Coordinated Approach to Offering Oral Health Care Services to Amish Population with H

1
A Systemic and Coordinated Approach to Offering
Oral Health Care Services to Amish Population
with High Incidence of Hemophilia

• Tamar Diamond D.M.D.
• Scenic Bluffs Community Health Center, Cashton,
  WI

2
Objective

• To highlight special concerns regarding
• oral care for the Amish patient.

3
Background of Clinic and Community
4
Staffing

• There are 52 staff members including
• 1 physician
• 3 dentists
• 2 nurse practitioners
• 1 physician assistant
• 1 chiropractor
• 1 optometrist
• 2 pharmacists
• 4 dental hygienists

5
Economic Impact

• 4 million annual
• business
• Health Centers economic impact on local
  communities is 6.2 million on local communities

• Since 1994, Health Centers brought in 6.48
  million in federal grant dollars for primary care
  in our communities
• Since 2001, Health Centers secured 1.10 million
  in state grant dollars specifically targeted at
  primary care access

6
Health Center Overview

• Section 330 funded Community Health Center -
  receive federal grant funds from US Department of
  Health and Human Services, Bureau of Primary
  Health Care
• Have a published sliding fee scale Healthy
  Neighbor Plan
• Governed by a community based Board of Directors
  currently 10 members
• Serve a federally designated medically
  underserved area

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Patients and Encounters
8
Other Patient Data

• 90 of patients are white
• 6 are Hispanic
• 44 have Medicaid/BadgerCare insurance
• 26 uninsured
• 50 live at or below the federal poverty level

9
Old Order Amish Community

• Greater demand for emergency care
• Preventive care not as high a priority
• Obstacles in putting patients on recall schedule

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Caries Triad

• 1. Bacteria
• a. Mother has poor oral health and
  bacterial composition in mouth is passed to
  child
• 2. Host
• a. Importance of brushing teeth is often
  not culturally transmitted from parent to child
• b. Brushing once a week is not uncommon
• c. Heavy plaque bio-film
• 3. Sugar
• a. Very high sugar diet
• b. Bakery goods, candy, and maple syrup are
  part of the livelihoods of families
• c. Mountain Dew and other sugary drinks are
  very popular

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Common Incidence of Caries

• Early childhood caries
• Caries on newly erupted teeth
• Caries on 4 surfaces

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Cultural Barriers to Care

• 1. Misgivings about the restoration of primary
  
• teeth leading to
• a. Pain
• b. Emergency appointments
• c. Space maintenance issues
• 2. Unwillingness to have dental cleanings
• a. Fear of harming the tooth ("Stripping the
  enamel")
• b. When asked to schedule cleaning, patient says
  that they will call clinic if desired
• c. Heavy gingival bleeding during operative
  procedures

13
Hemophilia in the Amish Population

• Extensive intermarriage leading to consanguinity
• Bottle neck population
• Recessive genetic diseases become more prominent
• Levels of clotting factor remain stable for life
• Degrees of severity run in the family
• Additional clotting factor needed for routine
  dental care

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Cashton Amish Population

• Tends toward mild to moderate hemophilia
• Moderate 1 - 5 clotting factor of the normal
  range
• Spontaneous bleeding does not occur, but
  prolonged bleeding after injury does occur
• Given factor prior to treatment, a patient can
  receive the normal range of dental services
• Preventive factor improves the clinical prognosis

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Hemophilia Screening Day

• Begun as a collaboration between the clinic and
  the area blood center in nearby La Crosse
• Goal is to identify needs of hemophiliac patients
  and decrease emergency care situations
• Patients register for 15 minute screenings to
  determine urgent care needs or potential problems
• At the end of the screening, both a medical
  appointment and dental appointment are made for
  the same day
• During the medical appointment, the patient
  receives factor
• During the dental appointment, the most pressing
  dental issues are addressed

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Conclusion

• We are working to address the needs of this
  special population by
• Educating parents about the importance of primary
  teeth
• Encouraging dental cleanings
• Attempting to reduce reliance on emergency
  appointments
• Increasing awareness of the importance of oral
  hygiene in tooth retention and overall health