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California Childrens Oral Health: Opportunities

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Title: California Childrens Oral Health: Opportunities


1
California Childrens Oral Health Opportunities
Hal Slavkin, Dean, School of Dentistry,
University of Southern California, Los Angeles,
California
5th Annual Community Forum on the Conditions of
Children in Orange County November 15th, 2006
2
Todays Program
  • The Changing Landscape of Oral Health in America
  • Surgeon Generals Report Oral Health in
    America (2000)
  • Healthy People 2010 (2000)
  • Californias The Silent Epidemic (2000-2006)
  • HRSA Report on Oral Health
  • Improving the Oral Health in California
  • A Call to Action
  • Community-based programs (e.g. WomenAndCommunity)
  • Fast Food Services vs Community Wellness
    Strategies

3
A Changing Environment
  • Changing patterns of morbidity/mortality
  • Changing demographics
  • Changing management of health care
  • Changing paradigms for health and disease
  • Golden era of biomedical research
  • Changing societal expectations and quality of
    life
  • Global information technology

4
General Background
  • Demographics
  • 1980- - - 235.1 million people
  • 2000- - - 277.8 million people
  • 2006- - - 300.0 million people
  • 2020 - - -332 million people
  • Expenditures For Dental Services
  • 1980 - - - 13 billion (30 dental insurance)
  • 2000 - - - 60 billion (50 dental insurance)
  • 2006 - - 109 billion
  • Demand For Oral Health Services
  • Demand increasing for prevention, periodontics,
    endodontics, orthodontics, implants, esthetic
    dentistry
  • 110 million Americans do not have dental
    insurance (access issue)
  • Oral Health Workforce
  • 180,000 dentists in 140,000 dental practices
  • 6,000 dentists retire each year and 4,200
    DDS/DMD graduate each year
  • 5,000 dental hygienist graduate per year
  • 4,900 dental assistant graduates per year
  • 490 dental technician graduates per year
  • Expanded Work Force

5
A Case Study California
  • The Neglected Epidemic (1993-1994)
  • Halting A Neglected Epidemic (2000, 2006)
  • HRSA Oral Health Survey, (2001-2006)
  • USC Southern California Center Health (2001)
  • California in the New Millennium, Mark Baldassare
    (2000)

6
California in 2006
  • Approximately 224 languages/dialects spoken
  • The under-18 population grew gt20 from 1990-2000
  • State Asian-Americans grew by 38 versus 35 for
    Latinos (1990-2000)
  • Fifth largest economy in the world
  • Major issues include education, health, energy,
    water air quality, transportation
  • State population of 37.5 million project 50
    million by 2028
  • Southern California 8 Counties (Santa Barbara,
    Ventura, Los Angeles, Orange, Riverside, San
    Bernardino, San Diego Imperial) 24.4 million
  • Largest ethnic group is Latinos gt58 of State
    youth are Latino
  • States growth primarily driven by immigration

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8
Californias Children
  • Only 30 of Californians receive the benefits of
    fluoridated drinking water
  • More than 20 of children are overweight
  • More than 25 of preschool children without
    dental insurance
  • More than 40 of high school students without
    dental insurance
  • Between 50 and 75 of minority high school
    students need dental care
  • Californias children have twice as much
    untreated tooth decay (dental caries) as the
    national average
  • Children living in poverty have increased in
    number with attendant increases in disease
    especially minority children.
  • The under-18 population increased gt20 across
    Southern California from 1990-2000

9
Southern California Region
  • 9 counties (Santa Barbara to San Diego)
  • 24.4 million people
  • 55 of all births in the state
  • Nearly 10,000 cases of structural birth defects
    annually
  • 32 speak Spanish at home
  • 13 earn less than 15,000 annually

10
Los Angeles County
  • 11.5 million people
  • 4,000 square miles
  • 88 cities
  • 23 are non-citizens
  • 36.3 foreign-born
  • Increases by 300,000 people per year
  • 1/3 of all births in the State of California

11

Language Spoken at Home Los Angeles County
12
America and Poor Children
  • By 2030, non-White children will constitute a
    majority
  • From 1969-1997 the number of poor children grew
    by 46 (more than 4 million)
  • In 2000, a child is born into poverty every 40
    seconds
  • A child is reported abused or neglected every 11
    seconds
  • A child runs away from home every 24 seconds
  • A child bears a child every minute
  • In 2000, gt30 of high school females smoked
    cigarettes (Surgeon Generals Report Women and
    Smoking, March 26, 2001) tobacco linked with
    chronic diseases and disorders
  • 1 Chronic disease of children is tooth decay
  • 1 Reason for school absenteeism is tooth decay

13
California Opportunities
  • Improve oral health and well-being in California
  • Translate scientific and technology results into
    oral health promotion, disease prevention,
    standards of care, diagnosis treatments,
    clinical management of diseases and disorders,
    health services, health outcomes and health
    professional education
  • Recruit retain cultural diversity in the oral
    health professions workforce
  • Increase multi-center, multidisciplinary
    prospective and randomized clinical trials by
    linking 5 dental schools
  • Create a coalition between five dental schools,
    organized dentistry, dental insurance sector,
    key medical programs such as pediatrics and
    primary care, and other public and private
    partners
  • Promote student- and patient-centered,
    evidence-based, problem-based learning in dental
    education
  • Create state-wide oral health coalition with
    communities, dentistry, medicine, nursing,
    pharmacy, industry, government and non-profit
    foundations--- Emphasize Health Promotion!

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Competencies for Oral Health Professionals
  • Cultural competencies
  • Clinical competencies skills required for
    primary care oral health/dentistry
  • Health administration management
  • Epidemiology
  • Biostatistics
  • Human behavior
  • Cultural anthropology
  • Nutrition
  • Conflict resolution and mediation skills
  • Critical thinking and life-long learner
  • Communications
  • Public health education
  • Behavioral modifications
  • Skills of fluoridation, dental sealants, oral
    hygiene, infection control
  • Human genetics counseling
  • Manage oral infections systemic diseases
  • Information technology

16
Oral Health in America A Report of the Surgeon
General (2000)
Department of Health and Human Service
17
The Charge
Define, describe, and evaluate the interaction
between oral health and health and well-being
(quality of life), through the life span in the
context of changes in society. Secretary Donna
Shalala, 1996
18
The SG Report Project Team
  • Caswell A. Evans
  • Asst Director, Los Angeles County Department of
    Health Services
  • Dushanka V. Kleinman
  • Deputy Director, NIDCR, NIH
  • William R. Maas
  • Chief Dental Officer, USPHS and Director,
    Division of Oral Health, CDC
  • Harold C. Slavkin
  • Director, NIDCR, NIH

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21
Organization of the SG Report
  • What is Oral Health?
  • What is the Status of Oral Health in America?
  • What is the Relationship Between Oral Health and
    General Health and Well-Being?
  • How is Oral Health Promoted and Maintained and
    How are Oral Diseases Prevented?
  • What are the Needs and Opportunities to Enhance
    Oral Health?

22
Surgeon Generals Report Oral Health in America
  • Oral diseases affect health and well being
    throughout lifespan
  • Safe and effective preventive measures do exist
  • Lifestyle behaviors that affect general health
    such as tobacco alcohol use, and poor dietary
    choices, also affect oral health
  • Major oral health disparities
  • The mouth reflects general health and well being

23
SG ORAL HEALTH MESSAGES
  • Over 4.2 million live births each year
  • A major complication is low birth weight,
    premature babies
  • Most common birth defects being craniofacial,
    oral and dental deformities
  • The most common chronic disease in children is
    dental caries
  • Over 70 million children in US (26 US
    population)

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25
Tooth Decay The Most Common Chronic Disease of
Children
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28
Oral Health Disparities - Children
  • Dental caries are caused by transmissible
    bacterial infections from caregiver to infant
  • Inhibition of oral bacterial colonization into
    biofilms is a major target for caries prevention
    (antibodies? chemicals?)
  • Dental sealants are proven to be 100 effective
    in preventing dental caries on chewing surfaces
    of teeth
  • Fluoride varnish is an effective tool
  • Fluoridation of community drinking water appears
    to be the major factor responsible for the
    decline of dental caries in the US
  • More than 52 million school hours are lost due to
    dental pain and suffering in children

29
Oral Infection Associated With Low Birth Weight
Premature Babies and Congenital Craniofacial
Birth Defects
30
Craniosynostosis
31
Cleft Lip Cleft Palate
  • One of the most common birth defects
  • Prevalence is one per hour in the United States
    1 per 500 live births in California
  • Direct health costs are approximately 110,000
    per child

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36
Dental Caries is a Transmissible Bacterial
Infectious Disease
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38
SG ORAL HEALTH MESSAGES
  • Unintentional injuries to head and neck in
    children is a major health issue
  • Oral cancer is the sixth most common cancer
  • One American dies every hour of oral cancer
  • Periodontal diseases found in gt60 of adults
  • Tobacco linked with all major chronic diseases
    in 2000, 30 of high school females smoked
    cigarettes
  • Oral infections associated with systemic diseases
  • Systemic diseases have oral complications

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In a recent survey of adults 40 yrs older, only
14 of respondents said they had ever been
examined for oral cancer
  • Regular oral self-examination to inspect lips,
    gums, inside of cheeks, tongue, back of throat,
    and floor and roof of mouth
  • Annual oral health professional examination

44
Towards understanding oral neoplastic biological
processes
  • Inherited and acquired gene mutations
  • Multiple and sequential gene mutations
  • Multiple gene-gene and gene-environment
    interactions
  • Significant candidate gene mutations associated
    with transcription controls, mitosis, and
    apoptosis

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48
Genetic Factors in Oral Microbial Infections
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50
Oral Infection and Systemic Diseases
  • Low birth weight, premature babies
  • Cardiovascular disease
  • Cerebrovascular disease
  • Pulmonary diseases
  • Osteoarthritis
  • Diabetes complications with oral infection
  • Cancer therapy (radiation, surgery, chemotherapy)
    and oral complications (e.g. dry mouth and
    rampant tooth decay)

51
from your mouth to your heart?
  • Cardiovascular plaques (atherosclerosis) are
    contaminated with oral bacterial pathogens
  • In addition, cytomegalovirus and Chlamydia
    pneumoniae found in plaques
  • Four different antibodies directed to oral
    pathogens cross-react with blood
  • In animal studies, oral pathogens injected into
    blood are recovered in atherosclerotic plaques
  • Oral infection also associated with diabetes,
    chronic respiratory disease, stroke and low birth
    weight, premature births
  • Approximately 33 of adults over thirty years
    present periodontal diseases

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53
SG ORAL HEALTH MESSAGES
  • 34 million adults report severe chronic facial
    pain (migraine, tension headaches, fibromyalgia,
    myofascial pain, TMD, trigeminal neuralgia,
    Bells palsy, atypical facial pain, phantom limb,
    postherpetic neuralgia)
  • Unrelieved pain in 75 advanced cancer, 30-80
    HIV, 40 terminally ill, and 47 during cancer
    therapy
  • Osteoarthritis, osteoporosis, diabetes and cancer
    therapy have significant oral complications
  • Tooth loss, tooth pain, swallowing and facial
    pain are major complaints of poor elderly
  • The fastest growing subpopulation in US are
    people over 80 years of age (15 over 65 years of
    age by 2020)

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57
The SG Report A Framework For Action
  • Change perceptions regarding oral health and
    disease so that oral health becomes an accepted
    component of general health ( e.g. public
    perceptions, policymakers perceptions health
    providers perceptions)
  • Accelerate the building of the science-base to
    improve oral health
  • Build infrastructure that provides comprehensive
    oral health care for all Americans
  • Remove known barriers between people and oral
    health care services
  • Utilize public-private partnerships to improve
    the oral health of those who suffer
    disproportionately from oral diseases and
    disorders

58
A CALL TO ACTION
  • Integrate health promotion disease prevention
    in preschool K-12 education, social
    behavioral sciences education
  • Promote prenatal care with diet, exercise,
    multivitamin supplements
  • Integrate oral health- - -dentistry, medicine,
    nursing, pharmacy, speech therapy, physical
    therapy, social services
  • California campaign for tobacco cessation,
    alcohol reduction, healthy food choices,
    exercise, fluoridation, calcium for child and
    adolescents
  • Immunizations, oral hygiene, diet, sleep, exercise

59
A CALL TO ACTION
  • Preschool programs to include oral health
  • All school-based programs should provide
    caregivers and children with tools to optimize
    health and well being and to reduce burdens of
    disease
  • California standards for health promotion and
    disease prevention
  • Clinical and cultural competencies for all health
    professionals
  • Cross-disciplinary training programs between
    medicine, dentistry, dental hygiene, pharmacy,
    nursing, speech therapy, and social services

60
A CALL TO ACTION
  • Public/private coalitions to promote health and
    well being, risk assessment and disease
    prevention
  • Increase outcomes and health services research
  • Increase collaborations of health professions
    from prenatal through elderly stages of life
  • Achieve student debt forgiveness as incentive to
    address oral health disparities
  • Health needs of the California population,
    especially special needs and developmental
    disabilities, must be addressed by a continuum of
    biomedical,behavioral and health services
    research, and community-based prevention
    strategies

61
The Future of Oral Health For All Californians?
  • the future can be very bright if we seize the
    opportunities.

62
Knowing is not enough we must apply. Willing is
not enough we must do. Goethe
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