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Medical-Dental Partnerships To Promote Oral Health

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... of dental caries as an infectious ... Caries process. Address Barriers ... Module 3: Dental Caries; Collaborating with Dentists. Module 4: Dental Trauma ... – PowerPoint PPT presentation

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Title: Medical-Dental Partnerships To Promote Oral Health


1
Medical-Dental Partnerships To Promote Oral
Health
  • Wendy E. Mouradian, MS, MD Pediatrics, Pediatric
    Dentistry, Health Services (Public Health)
  • Childrens Hospital Regional Medical Ctr
  • University of Washington

2
Acknowledgements
  • Comprehensive Center for Oral Health Research
    (NIH - NIDCR)
  • Maternal and Child Health Bureau, HRSA
    (Leadership Education in Pediatric Dentistry)
  • Bureau of Health Professions, HRSA
    (Interdisciplinary Childrens Oral Health
    Promotion)

3
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4
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5
Summit Themes
  • Whatcom County
  • Engage community members
  • Present local data
  • Discuss best practices
  • Raise awareness of dental caries as an infectious
    disease
  • Problem solve children, adults, elderly

6
Surgeon Generals Report on Oral Health (2000)
  • Oral diseases are common and consequential
  • Linked to overall health and well-being
  • Profound disparities in oral health status
  • Disparities SES, rural, minorities, vulnerable
    Preventive measures exist
  • Research / translation of science needed
  • http//www.nidcr.nih.gov/sgr/sgr.htm

7
Vulnerable Populations
  • Children
  • Elderly
  • Special Needs
  • Adult populations

8
Medical-dental Educational Collaborations
  • Journal of Dental Education Aug 2003
  • Overview and commentary childrens oral health
  • Washington State (family medicine residents)
  • Mouradian et al
  • North Carolina (pediatricians, family physicians)
  • Rozier et al

9
Medical-dental Educational Collaborations
  • Journal of Dental Education Dec 2003
  • Overview and commentary special pop.
  • Elderly populations
  • Pyle et al
  • Mental retardation, other special needs
  • Fenton et al

10
Medical-dental Educational Collaborations
  • Journal of Dental Education Apr 2004
  • Overview and commentary -Public health approaches
  • Kids Get Care (case management model)
  • Hennessey et al
  • OPENWIDE (CT Head Start)
  • Wolfe et al

11
Childrens Oral Health
  • Dental care is most common unmet health need of
    children
  • More likely to lack dental insurance
  • Access to dental care limited u/ Medicaid
  • Disparities by SES, rural areas, special health
    needs/disabilities

12
Impact on Children
  • Disease burden- 52 million school hours
  • Pain, infection, growth problems, ER visits
  • Hospitalizations and surgeries
  • Long term impact on economic, quality of life
  • Children with special needs impact on general
    health

13
Reach Children Early
  • Prevention works
  • Dental disease develops early lt1-2 yrs
  • Disease transmitted from mother
  • Reach in primary care, child care, Head Start,
    educational, social systems

14
Washington State Smiles Survey, 2000
  • Disparities in oral health outcomes by
    race/ethnicity, SES
  • Many children lack access to dental care
  • Washington state data do not compare favorably
    with national data
  • Kathy Phipps, MPH, DrPH, consulting
    epidemiologist

15
Prevalence of ECC
Washington 1-year-olds
Washington 2-year-olds
NHANES III 2-year-olds
16
Trends Over Time
Caries Experience
1994
17
Adult Oral Health
  • Periodontal disease is common
  • Maternal periodontal disease and LBW
  • Periodontal and cardiovascular disease
  • Pulmonary impact of oral disease
  • Mothers choose health care for families
  • Oral-systemic health diabetes, others
  • Oral cancer 8000 people die a year

18
Older Adults
  • More periodontal disease
  • More oral-systemic health impacts
  • More oral cancer
  • Impact of medications
  • Long term care facilities
  • Complex social arrangements

19
Mental Retardation and Special Needs
  • Lack of data on oral conditions
  • Impact of medications, conditions
  • Down syndrome and periodontal disease
  • Effect of anti-convulsants
  • Difficulty with self-care
  • Complex guardianship, living arrangements

20
Key themes Special populations
  • Importance of oral-systemic interactions
  • need for interdisciplinary collaboration
  • Diminished mental/ motor capacity
  • need for special arrangements and emphasis
    upon prevention
  • Difficulty accessing care
  • need for better training, other solutions
  • Complex social and cultural factors
  • Lack of good data

21
Context
  • Disparities may worsen
  • Demographics diversity child poverty survival
    those with special needs, elderly
  • Workforce gaps not enough dentists retiring
    most not in Medicaid physicians lack training
  • Policy gaps lack of insurance oral care not
    medically necessary (especially impacts special
    needs population)

22
Partnership
  • Department of Pediatric Dentistry
  • Department of Family Medicine
  • UW Affiliated Family Practice Residency Network
  • Department of Medical Education and
    Bioinformatics

23
ICOHP
  • Goal 1 Training family medicine residents and
    faculty in oral health promotion
  • Objectives
  • Develop curricula in childrens oral health, 0-5
  • Pilot, implement in WWAMI sites
  • Evaluate effect of training on knowledge,
    attitudes, behavior
  • Disseminate curricula

24
UW FP Residency Network Sites
25
Geographical barriers
26
Assumptions
  • Biggest obstacle will be buy-in
  • Tailor curriculum to physician needs
  • Integration with dental sector in community
    critical
  • Sustainability will require additional work

27
Focus Groups Faculty/ Residents, Staff
  • Barriers
  • Oral health not on their radar screen lack
    knowledge/self-efficacy
  • Providers busy oral health not a priority
  • Concerned about the evidence base
  • Confusion about physician role
  • Lots of baggage about dentists

28
Focus Groups Faculty/ Residents, Staff
  • Opportunities
  • Care about children in pain
  • Unable to answer parents questions
  • Prevention is a high priority
  • Already providing health education
  • Acutely aware of access issues
  • Committed to underserved communities

29
Address Barriers and Opportunities
  • Increase motivation
  • Oral health important
  • Impact on children
  • Increase practitioner knowledge
  • Normal dental development
  • Caries process

30
Address Barriers and Opportunities
  • Review evidence base (USPSTF CDC Fluoride
    recommendations)
  • Frame in terms of primary care roles
  • Anticipatory guidance
  • Nutrition/feeding
  • Injury prevention emergency management
  • Special issues for CSHCN

31
Address Barriers and Opportunities
  • Address resentment towards dentists
  • Work with dentists one-on-one
  • partner with ABCD, community health clinics,
    pediatric dental trainees
  • Increase communication, lines of referral
  • Reinforce principles of family-centered,
    culturally competent care
  • already part of residency culture / training

32
Modules Frame to issues raised
  • Module 1 Public Health Overview Oral Health
    Promotion and Practice
  • Module 2 Normal Dental Development/ Pathology
  • Module 3 Dental Caries Collaborating with
    Dentists
  • Module 4 Dental Trauma and Emergencies
  • Module 5 Oral-systemic Health Interactions

33
Respond to Requests for More Information
  • Module 6 Atraumatic Restorative Technique
  • Module 7 Maternal oral health
  • Module 8 Adolescent oral health
  • Module 0 Managing the change process

34
Trainings to date
  • Seattle
  • Yakima
  • Spokane
  • Olympia
  • Boise
  • Anchorage
  • Pending Valley, Vancouver

35
Frame for Primary Care Providers
  • PCP Roles
  • 1. Anticipatory guidance/ counseling
  • 2. Risk assessment - oral screening, history
    (maternal history)
  • 3. Applying fluoride varnish
  • 4. Dental referral / collaboration
  • 5. Monitor oral-systemic health interactions
  • 6. Manage simple dental trauma
  • 7. Maternal oral health counseling

36
North Carolina
  • North Carolina Statewide Medicaid program
    pediatricians/family practitioners provide oral
    health education / screening exams / apply
    fluoride varnishes to young children 0-3 / dental
    referrals
  • Partnership Supported by dental, pediatric,
    family practice societies

37
Others to watch
  • MCH Oral Health training for non-dental providers
  • http//www.mchoralhealth.org/PediatricOH/index.htm
  • Minnesota training, fluoride varnishes
  • http//meded1.ahc.umn.edu/fluoridevarnish/xindex.h
    tm
  • AAP presentations for chapters stay tuned

38
Medical Mantra
  • Address medical training gaps
  • Change perceptions among medical professionals
  • Integrate oral health into systems of care
    especially for vulnerable populations
  • Develop medical-dental collaborations
  • Leadership in policy/ education
  • Standard of practice that includes oral health

39
Key Points
  • Disparities in oral disease /access to care
  • Impact on vulnerable populations
  • Workforce critical not enough providers
  • Prevention is key - if started early
  • Integrate oral health into overall health
  • Partnerships are needed to make this happen

40
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