Children and Oral Health

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Children and Oral Health

• Wendy E. Mouradian, M.D.
• National Institute of Dental and Craniofacial
  Research, NIH Childrens Hospital and Regional
  Medical Center
• University of Washington, Seattle

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Introduction

• Oral health is a forgotten area
• Children suffer as a consequence
• Indicator of health /social problems
• Oral health raises key policy issues

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Critical Oral Health Issues for MCH population

• Dental Caries
• CSHCN
• Impact of maternal factors

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What is Oral Health?

• Oral and craniofacial structures
• Oral and systemic health linkages
• Oral manifestations of systemic disease
• Systemic complications of oral disease

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Oral Health is teeth and

• Oral and craniofacial disorders
• Tobacco
• Trauma
• Tumors
• Transplants
• Pain mechanisms

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Impact of Oral Health

• Nutrition, speech, hearing, taste, appearance
• Burden of disease
• 50 million hours lost from school
• Economic impact
• Psychosocial and quality of life

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Dental Caries

• Epidemiology
• 25 of children have 80 of the disease
• Low SES and minority
• by adolescence gt 80 have evidence of disease
• Most common infectious disease of childhood
• Little progress on Healthy People 2000 goals

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Sociodemographic Distribution of Pediatric Dental
Caries

• NHANES III 1988-94
• Vargas CM, Crall JJ, and Schneider DA.
• JADA 1998 1291229--1238

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Percent of Children with Decayed and Filled
Primary Teeth by Household Income Level ( of
Federal Poverty Level)
50
0-100
40
101-200
30
201-300
20
301
10
0
Decayed
Decayed
Filled 2-5
Filled 6-12 year olds
2-5 year olds
6-12
year
year
olds
olds
10
Percent with Decayed and Filled Permanent Teeth
by Household Income Level ( of Federal Poverty
Level)
70
60
0-100
50
40
101-200
30
201-300
20
10
301
0
Decayed
Decayed
Filled 6-14 year olds
Filled
6-14
15-18
15-18 year olds
year
year
olds
olds
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Percent of Untreated Decayed Primary and
Permanent Teeth in Children with Decay by
Household Income Level ( FPL)
80
70
60
0-100
50
101-200
40
201-300
30
20
301
10
0
Age 2-5
Age 6-14
Age 6-14
Age 15-18
Primary
Primary
Permanent
Permanent
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Dental Caries

• Science base
• Strep Mutans carbohydrates
• Disease starts in FIRST YEAR children need
  dental assessment by age 1
• Medical management early
• Demineralization - remineralization balance
• Fluoride works - but is not a vaccination

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Dental Caries

• Cost issues
• 20-30 of family child health expenditures
• Emergency and hospital services increase costs
• 2-3 for oral health in state Medicaid budgets
• Prevention is cost-effective

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Dental Caries

• Access issues
• Inspector Generals Report only 15 children on
  Medicaid received dental exam
• 2.6 times more children lack dental insurance
  than medical insurance

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Dental Caries

• Clinical picture
• white spots progressing to cavities
• facial cellulitis, abscess
• systemic spread possible
• failure to thrive (Acs)
• life long impact on teeth, underlying bone

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Barriers to Care

• Lack of dental insurance
• Current definitions of medical necessity
• Shortage of dental providers for children
• Low Medicaid reimbursement rates
• Lack of awareness by physicians and public
• Child poverty

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Dental Caries Solutions

• Definitions of medical necessity
• Educate primary care providers
• Prepare general dentists to see children
• Increase number of dental trainees
• Role of dental hygienists, PCPs?
• Strengthen public sector

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Dental Caries Solutions

• Fluoridation
• Creative strategies and partnerships
• Use of Head Start, schools, WIC
• Incentives to care for underserved
• Medicaid reimbursement issues
• Public awareness

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CSHCN

• Increased risk for oral health problems
• Craniofacial conditions
• Neurodevelopmental disorders, gastric tubes
• Heart disease, rhreumatologic conditions
• Medications, cancer treatments, transplants
• HIV-AIDS, immune conditions

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CSHCN needed research

• Science oral-systemic health linkages
• Epidemiologic extent of problems
• Health services
• cost-effectiveness of interdisciplinary team care
• barriers to care
• quality of life measures as outcomes

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References

• American Academy of Pediatric Dentistry Reference
  Manual. (Web site aapd.org)
• Nowak, Arthur J 1999 ed, The Handbook, 2nd ed.,
  AAPD, Chicago
• Milgrom P, Weinstein P. 1999. Early Childhood
  Caries A team approach to prevention. University
  of Washington School of Dentistry, Seattle (206
  543-5444)

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Maternal factors

• Prenatal influence on development
• Oral disease and risk for LBW
• Vertical transmission of cariogenic bacteria
• Behavior, nutrition, and health habits
• Access to health care for child and family

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Maternal factors what we dont do but should

• Ensure access to health care for all women during
  and beyond pregnancy
• Address oral health issues in prenatal care
• Partner with womens health care providers

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Conclusions

• The mouth is part of the body
• Molecules have no boundaries
• Youre not healthy without oral health
• C. Everett Koop, Former Surgeon General

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Conclusions

• Ethical issues access and health status
• Social determinants of health

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Recommendations

• Integration of oral health in
• clinical care
• health policy
• research
• training

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What we can do together

• Attend Surgeon Generals Conference on Children
  and Oral Health June 12-13, 2000 in Washington,
  DC
• Promote comprehensive health care for all
  children (including oral health!)

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Surgeon Generals Conference WEB SITE

• Call for abstracts and registrationwww.nidr.nih.
  gov/sgr/children/children.htm
• Abstracts due Dec 1

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Best Practices / New Initiatives

• Bright Futures
• Craniofacial Team standards of care
• HRSA-HCFA oral health initiative
• Surgeon Generals Report on Oral Health
• New multidisciplinary RFAs from NIH