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A Model Dental Public Health Program : Alameda County California. Jared I. Fine, DDS, MPH. Percent of Children with Dental Decay at WIC ** compared to Healthy People 2010 Objective. *. *Includes white spot lesions ** 7/2009-3/2010.

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A model dental public health program alameda county california
A Model Dental Public Health Program :Alameda County California

Jared I. Fine, DDS, MPH


Percent of children with dental decay at wic compared to healthy people 2010 objective
Percent of Children with Dental Decay at WIC ** compared to Healthy People 2010 Objective

*

*Includes white spot lesions ** 7/2009-3/2010


Children from low income families suffer more untreated dental disease
Children from low income families suffer more untreated dental disease.

Percentage of School Children with Untreated Decay by School Poverty Status, Alameda County, 2002-2004


Impact of poor oral health
Impact of Poor Oral Health dental disease.

  • 1.6 million missed school days

  • Difficulty with learning

  • Failure to thrive

  • High cost of dental care

  • Lost self esteem



Percentage of women delivering in California who received no dental care during pregnancy, by income: MIHA 2002-2007


Main reason for not receiving dental care during pregnancy among women with dental problems, MIHA 2004-2007 (n=8,558)


Us surgeon general s report on oral health 2000
US Surgeon General’s Report on among women with dental problems, MIHA 2004-2007 (n=8,558) Oral Health 2000

  • “In spite of the safe and effective means of maintaining oral health that have benefited the majority of Americans over the past half century, many among us still experience needless pain and suffering, complications that devastate overall health and well-being, and financial and social costs that diminish the quality of life and burden American society”


Mission of Public Health: among women with dental problems, MIHA 2004-2007 (n=8,558)The fulfillment of society’s interest in assuring the conditions in which people can be healthy.

  • Core functions:

    • Assessment

    • Policy Development

    • Assurance


Essential services of public health
Essential Services of Public Health among women with dental problems, MIHA 2004-2007 (n=8,558)

  • Monitor health status

  • Diagnose and investigate

  • Inform, educate and empower

  • Mobilize community partnerships

  • Develop policies and plans

  • Enforce and laws and regulations

  • Link people to needed service/assure care

  • Assure a competent workforce

  • Evaluate health services

  • Research


Legal basis
Legal Basis among women with dental problems, MIHA 2004-2007 (n=8,558)

Federal Law EPSDT(CHDP) defined by the Social Security Act specifies that dental services are :

1) to be provided at intervals that meet standards…in consultation with recognized dental organizations;

2)provided at medically necessary intervals;

3) at minimum include relief of pain and infection, restoration of teeth and maintenance of dental health.


What do the professions say
What do the professions say? among women with dental problems, MIHA 2004-2007 (n=8,558)

“..every child should begin to receive oral health risk assessments by 6 months…”

  • American Academy of Pediatrics

    “…children should be seen by a dentist following eruption of 1st tooth but no later than 12 months of age..”

  • American Academy of Pediatric Dentistry


Maternal and child health oral health performance objective for the nation
Maternal and Child Health Oral Health Performance Objective for the nation:

  • By 2020- increase by 28% the number of 6-9 yr olds have had at least one dental sealant on a permanent first molar


What s the ideal
What’s the ideal? for the nation:

Capacity to :

  • Conduct surveillance and assessment

  • Conduct individual and group health education;

  • Mobilize community and organizational partnerships



Client support
Client Support for the nation:

  • Outreach

  • Case management

  • Insurance assistance


Clinical preventive services
Clinical Preventive Services for the nation:

  • Dental screening

  • Fluoride varnish application

  • Dental sealants


Restorative dental treatment
Restorative Dental Treatment for the nation:

  • Primary Dental Care

  • Specialty Care: e g

    Pediatric Dentistry or Oral Surgery

  • Sedation Hospital based services


Assessment
Assessment for the nation:

  • Professionally and client defined health needs

  • Causal factors

  • Manpower, facilities, services, programs and financing to address those needs


Dental disease is nearly 100 preventable yet
Dental disease is nearly 100% preventable yet… for the nation:

  • By kindergarten > 32% of all children have untreated tooth decay; in low income schools that proportion is 46%

  • By 3rd grade 69% of all students have had tooth decay

  • 8% of kindergarteners and 9% of 3rd graders had toothaches or dental abscesses at the time of examination

  • Children experience pain, difficulty chewing, learning, smiling, even failure to thrive.


Recent oral health and systemic disease studies
Recent Oral Health and for the nation: Systemic Disease Studies

  • Cardiovascular disease

  • Diabetes mellitus

  • Obesity

  • Osteoporosis

  • Respiratory diseases

  • Adverse pregnancy outcomes

  • Malnutrition and Iron Deficiency


Reduced cost by providing dental preventive services
Reduced Cost by Providing Dental Preventive Services for the nation:

Aetna- Columbia University 144,000 insured

Cigna, and Blue Cross Blue Shield of Michigan

Washington Dental Service,Costco,MetLife Inc.

Kellog Co.,Ford Motor Co.

Reduced Medical Cost

9%

16%

11%

History of

Diabetes

Coronary Artery Disease

Cerebrovascular Disease



Assurance
Assurance for the nation:

  • Provision of or guarantee of access to state of the art resources, services that are acceptable, accessible, of high quality, comprehensive and continuous; and

  • information with which people can make individual, family or community decisions.


Wic oral health collaborative
WIC/Oral Health Collaborative for the nation:

To strengthen partnerships that enables WIC to be the “entry point” for dental care :

To increase the number of at risk one year olds who :

  • have access care;

  • receive preventive dental services;

  • have a dental home.


Wic oral health program
WIC Oral Health Program for the nation:

  • Internal promotion: flagging clients, signups, appointments, reminder calls, bookmarks;

  • Nutrition assistant conducted group oral health education;

  • Dental hygienist oral assessment, toothbrush cleaning, fluoride varnish, anticipatory guidance, goal setting;

  • Case manager insurance assistance and dental appointment making.


Services at wic july1 2008 december 31 2012
Services for the nation:at WICJuly1,2008-December 31. 2012


Impact of wic dental days
Impact of WIC Dental Days for the nation:

  • WIC dental days participants have 42% less restorative dental care needs compared to other Medi-Cal enrollees

  • Cost savings was estimated to be 54% of those who had not benefitted from WIC services


Comprehensive school oral health program

Pave way to tx for the nation:

Educate to self care

Limit lost school hours

Build partnerships

Minimize barriers eg geography, language.

Positive dental experience

Comprehensive School Oral Health Program

School BasedSchool Linked

Examinations Case management

Education for Dental Care

Dental sealants for Insurance

Fluoride treatments other services

Parent notification

Preventive &

Restorative Care


Financial sustainability
Financial Sustainability for the nation:

  • Dental hygienist: FFS Medi-Cal and private grant

  • Dental assistant: City grant and MCH federal/local (FFP)

  • Dentist: FQHC clinic partners

  • Case manager: CHDP federal/local (FFP) and local general funds;

  • Administrative staff: MCH federal/local (FFP)

  • Project manager: MCH federal/local (FFP)


Know where the money is go where the money is eg
Know Where the Money Is, for the nation: “Go Where the Money Is!” eg.

  • Federal Financial Participation (FFP)

    Title XIX Medicaid funding for MCH,CHDP

  • Federally Qualified Health Centers (FQHC)

  • Tobacco Tax Settlement funds

  • Private and Public Foundations

  • State, City and County General Funds

  • In kind support – volunteers and staff

  • First 5


Federal financial participation
Federal Financial Participation for the nation:

  • Skilled licensed professional personnel including dentists, dental hygienists can . . .

    For example:

  • Coordinate a sealant program

  • Plan a needs assessment

  • Establish an early childhood caries prevention program at WIC

  • Matching Sources: Local General, State General, Philanthropic or Private Funds donated to the County.


Policy development
Policy Development for the nation:

  • Means to create policies and programs via a participatory process that addresses the identified needs.


Access
ACCESS for the nation:

  • New paradigm -Federally Qualified Health Centers collaborating as the school based dental delivery system.

  • La Clinica de la Raza, Asian Health Services and Lifelong Medical

  • Oakland Unified School District


Education
EDUCATION for the nation:

  • Study of the impact of Sugar Sweetened Beverages on the economy and on health of Alameda County Residents i.e

    • Dental caries

    • Obesity

    • Diabetes

    • Heart disease

    • Stroke


Coordination and oversight
Coordination and Oversight for the nation:

  • Institutionalized Public Health Commission Dental Subcommittee

  • Provide Advocacy

  • Coordination

  • Aid in resource development


PREVENTION for the nation:

KNOWLEDGE


PREVENTION for the nation:

KNOWLEDGE

STRATEGIES


PREVENTION for the nation:

KNOWLEDGE

STRATEGIES

POLITICAL WILL


Office of dental health resources
Office of Dental Health Resources for the nation:

  • 1 Dental Director, Dental Hygienist Program Manager, Program Financial Specialist, Administrative Assistant.

  • 4 Community Health Outreach/Case managers

  • 1 Registered Dental Hygienist, 1 Registered Dental Assistant

  • 5 workgroups – School Based Implementation, Public Health Commission Dental Subcommittee, Sustainability, Perinatal Dental Care, Evaluation.


Building capacity for sustainability
Building Capacity for Sustainability for the nation:

  • Create Credible Need

  • Develop a Constituency of Advocates

  • Establish Broad Goals and Tangible Objectives


Create credible need
Create Credible Need for the nation:

  • Establish, package and promote

  • Define it, prepare it for specific audiences

  • Deliver it in language they understand

  • Make it relevant to them and their values


Build and nurture partnerships
Build and Nurture Partnerships for the nation:

  • Learn who your partners are and cultivate them

  • Policy Makers, universities, dental, medical, and nursing providers, school nurses, school advocates, child health, MCH, EPSDT, etc.

  • Internal and external, natural and unanticipated – e.g. insurance/finance

  • Build consensus on mutual goals

  • Develop memorandums of understanding


Establish broad goals and tangible objectives
Establish Broad Goals and Tangible Objectives for the nation:

  • Clarify shared values, perceived needs

  • Normative goals/vision

  • Short term achievable objectives

    “Advocacy without recommendations is no advocacy at all”


Be a win 3 opportunist
Be a Win for the nation:3 Opportunist

  • Network of schools, providers

  • Prevalence of dental problems = a contact opportunity for well child visits, immunizations, and insurance enrollment (Medicaid/SCHIP)

  • New research – periodontal disease and birth outcomes

  • New paradigms – S. mutans transmissible infection

    “It’s never ‘self serving’ if you are serving”


Success requires
Success Requires: for the nation:

  • Credibility

  • Accountability

  • Responsiveness

  • Follow through

  • Helping others look good

  • Maintaining your sense of humor!


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