Improving Childrens Oral Health in NY

1
Improving Childrens Oral Health in NY
Dr Tim Cooke Bureau of Dental Health New York
State Department of Health Albany, NY.
2
Challenges

• Convincing the public that oral health is
• an important part of their overall health
• Improving the utilization of effective preventive
  measures
• Improving the distribution, diversity and
  flexibility of the dental workforce
• Limited data
• Policy development

3
Statewide Strategies

• CDC grant funded NY Oral Health Initiative
• Develop State Oral Health Plan
• Develop an Statewide Oral Health Coalition
• New York Oral Health Surveillance System
• Burden document
• MCH block grant funded projects
• Preventive dentistry grants
• Innovative services grants
• Technical assistance center

4
State Oral Health Plan

• State Plans are part of CDCs chronic disease
  strategy
• Steering committee convened representing key
  organizations
• Stakeholders invited to paricipate, 80
  in 5 workgroups (Access, Prevention,
  Surveillance and Research, Workforce,
  Policy)
• About two years of work

5
State Oral Health Plan

• Key Messages
• Oral health is much more than healthy teeth
• Oral health is integral to general health
• Safe, effective, easy to adopt disease prevention
  measures exist
• General health risk factors also affect oral and
  craniofacial health

6
Specific Goals
Goal 1 Develop and promote policies supporting
improved oral health Goal 2 Promote oral
health as a valued and integral part of
general health across the life cycle Goal 3
Improve access to oral health services and
eliminate disparities Goal 4 Enhance the oral
health information and knowledge- sharing
infrastructure Goal 5 Address risk factors for
oral diseases
7
Specific Goals (Contd...)
Goal 6 Increase capacity, diversity, and
flexibility of the workforce Goal 7
Promote educational opportunities and experiences
of the oral health workforce Goal 8
Encourage oral health professionals to be
competent in public health principles and
practice. Goal 9 Develop a research
agenda Goal 10 Maintain and enhance the
existing surveillance system
8
Strategies (Priorities for action)

• Explore opportunities to form regional oral
  health networks
• Formalize a statewide coalition to promote oral
  health
• Encourage stakeholders to examine and
• make recommendations on
• a. Laws and regulations
• b. Financing of dental education
• c. Effective approaches to address disparities
• d. Strengthening the dental health workforce
• e. Ways to involve retired dentists and dental
  hygienists

9
Strategies (Priorities for action)(Contd...)

• Assess gaps in dental health educational
  materials and explore ways to integrate
• oral health into health literacy programs.
• Develop and widely disseminate guidelines,
  recommendations and best practices
• Strengthen the oral health surveillance system

10
Key Strategies from the Oral Health Plan

• Integrate oral health into health literacy
  programs. Develop and disseminate educational
  materials focusing attention on topics such as
  caries in young children, maternal oral health,
  oral cancer, fluoride, dental sealants and the
  importance of good dietary habits.
• Disseminate existing guidelines, recommendations
  and best practices to the dental health work
  force, physicians, nurse practitioners,
  counselors and other appropriate health care
  workers regarding childhood caries, maternal oral
  health, tobacco and alcohol use.
• Work with primary health care training programs
  to integrate inspection of the oral tissues as
  part of routine physical examination curricula.

11
Key Strategies from the Oral Health Plan

• Integrate oral health into primary health care by
  scheduling medical and dental visits together
  where possible, and facilitating the development
  of effective referral networks. Potential link
  between poor periodontal health and pre-term/ low
  birth weight
• Work with professional groups to increase
  referrals among oral health care providers and
  other health specialists. Work with professional
  organizations of health care professionals to
  target physicians offices for integrating oral
  health screening as part of routine physical
  examinations, and providing anticipatory guidance
  to families on proper oral health care.

12
Key Strategies from the Oral Health Plan

• Improve oral care in primary care medical
  practice settings by including dental conditions
  on pre-printed primary care records.
• Explore incentives for dentists who significantly
  increase their service to Medicaid clients.
• Identify factors that affect the participation of
  the dental workforce in public health programs,
  location of practice in dental health
  professional shortage areas and provision of
  services to underserved populations.

13
Key Strategies from the Oral Health Plan

• Identify the existing data collection systems
  regarding diabetes, the elderly and pregnant
  women and explore opportunities to include oral
  health indicators.
• Expand the Pregnancy Risk Assessment and
  Monitoring System (PRAMS) to ascertain dental
  need.

14
Key Strategies from the Oral Health Plan

• Explore models from other states that allow
  dental hygienists to bill for services provided
  in schools, nursing homes, and such other public
  health settings
• Actively promote fluoridation in large
  communities (population size greater than 10,000)
  and in counties with low fluoridation penetration
  rates. Educate the public regarding the benefits
  of fluoride by incorporating effective messages
  in health campaigns.
• Encourage Article 28 facilities to establish
  school based dental health centers in schools and
  Head-Start Centers to promote preventive dental
  services in high need areas.

15
Key Strategies from the Oral Health Plan

• Collaborate with early childhood programs to
  conduct surveys and focus groups regarding the
  availability of dental care.
• Collect more comprehensive data on needed care
  for children (in addition to EPSDT visit
  assessment.)
• Collaborate with new partners such as Head Start
  Centers and WIC to collect data regarding oral
  health status and unmet treatment needs.

16
Priorities

• Establish oral health networks
• Increase the number of school-based and
  school-linked programs
• Develop and disseminate guidelines for oral
  health care of pregnant women and young children
• Collect data using the re-registration process
  for assessing underserved areas
• Develop educational materials
• Eliminate administrative barriers

17
Issues in Pregnant Women and Young Children
18
Infants and Toddlers

• Prevalence of dental caries in 2-5 year old is
  27.9
• Of children aged 1-5 years old enrolled in EPSDT
  (Medicaid), only 16 received any preventive
  service

• In New York, over 2900 children (admitted to a hospital for the treatment of
  dental caries (1m)

19
Early Childhood Caries (ECC)

• Any dental caries in a child under 6 years of
  age
• Severe ECC affects certain groups who usually dont access the oral
  health care system, e.g.
• Low income
• Minorities
• Migrants
• Very limited state data on disease in young
  children

20
Caries Patterns
ECC
21
Caries Patterns
22
Specific Perinatal Issues

• NY has a strong history of providing school based
  care BUT many children have oral health problems
  by the time they reach school age
• Children with dental caries at a young age are
  more likely to continue to have caries
• Primary care givers with oral health problems can
  pass these on to children
• Access to care is often a problem for both
  pregnant women and children (especially age 1-3)

23
Dental visit () during pregnancy By race and
participation in Medicaid
White
Black
Yes
No
Total
Race
Medicaid Status
Source PRAMS, 2002
24
Use of dental services in Medicaid Children
Annual Dental Visit in 2003
Source
25
Evidence Based Solution

• Primary care givers (usually mother) oral health
  impacts childs oral health
• Risk factors for oral disease can be assessed at
  a young age
• Certain parenting practices increase risk
• Disease can be prevented if detected early but
  the window of opportunity is short
• Intervention in pregnancy and early childhood
  can be effective!

26
Other Factors

• Pregnancy may be the only time a woman has dental
  insurance
• There is an association between poor oral health
  an birth outcomes
• There MAY be a causal link between poor oral
  health an birth outcomes, but the evidence is not
  yet conclusive

27
Key Points from Dr Iida

• Dental caries is the most common chronic disease
  of children (5x as common as asthma)
• Most dental disease is concentrated in a small
  number of children
• Early Childhood Caries
• Caries in young children
• Often progresses fast
• Mostly in low income groups
• Expensive to repair
• High rate of relapse

28
Key Points from Dr Iida

• Many factors involved that predict disease
• Parental behavior
• Parental attitude
• Bacteria from primary care giver
• Pregnancy is a good time to promote oral health
• Receptive patient
• Multiple healthcare visits
• Insurance
• Interventions aimed at child health that ignore
  the welfare of the mother are likely to be less
  successful than those that also address the
  mothers' needs.

29
Key Points from Dr Iido

• Guidelines Oral Health Care During Pregnancy
  and Early Childhood
• - Improve awareness of the importance of oral
  health care among professionals and the public
• - Correct misconceptions among professionals and
  patients
• - Facilitate coordinated and appropriate dental
  care during pregnancy and early childhood
• - Establish oral health care as a key component
  of prenatal care

30
IOM When Guidelines are Needed

• Problem is common or expensive
• Great variation exists in practice patterns
• Enough scientific evidence to determine
  appropriate/optimal practice

31
Guidelines Address Key Issues

• Few low income and minority women receive any
  dental visit during pregnancy
• Dentists are unwilling to provide needed
  treatment and preventive interventions in
  pregnancy
• Advice for dentists is not consistent
• Oral health is not addressed in pre-natal visits
• Potential link between poor periodontal health
  and pre-term/ low birth weight

32
Oral Health Guidelines

• Outlines responsibilities of prenatal, dental and
  pediatric providers
• Encourages referral of pregnant women to oral
  health care providers
• Emphasizes that
• most dental care is safe and effective during
  pregnancy
• all necessary care should be carried out
• Outlines key role of pediatric providers in
  childrens oral health and oral development

33
Guidelines are Written What Now?

• Inform providers
• Provide information in a medium that providers
  will use
• Increase awareness of the importance of oral
  health care
• Educate everyone involved in perinatal and infant
  care about what oral health care women and
  children should receive
• Educate patients and raise expectations
• Standards of care

34
Local Issues
35
Number Of Dentists And Population Per Dentist By
Region In New York State
State Education Dept Licence Data, 2004
36
Ratio of Dentists to Dental Hygienists in New
York State
Source
37
Fluoridation
38
Grant Funding

• Bureau of Dental Health distributes MCH block
  grant money in two grant programs
• Preventive Dental Services Grants
• Innovative Oral Health Initiative

39
Preventive Dental Services Grants

• 2000-2006 Funded 25 programs with 900,000
  annually
• most focused on school aged children
• two targeted the prenatal and perinatal
  population
• New grants will soon be announced
• more programs focus on pregnancy/ early
  childhood
• almost all programs address these issues even if
  they focus on school children

40
Innovative Oral Health Initiative

• 2003-2006 Funded 7 programs with 1,350,000
  annually
• programs could design innovative models to meet
  local needs
• Funded a Technical Assistance Center
  (www.oralhealthtac.org) to provided help
  statewide in developing oral health projects and
  overcoming barriers
• New grant RFA will be released in 2007
• Will be targeted at integrating oral health into
  existing networks (perinatal, rural health)

41

• Web Links
• Guidelines (link for now)
• http//cdhp.org/Projects/PPMCHResources.asp
• Oral Health Plan
• http//www.health.state.ny.us/prevention/dental/or
  al_health_plan.htm
• Oral Health Coalition (under development)
• http//www.nyspha.org/nysphaor/nysohp/index.shtml
  
• National Maternal and Child Health Oral Health
  Resource Center)
• http//www.mchoralhealth.org/

42
Dr Tim Cooke tlc06_at_health.state.ny.us (518)
474-1961