State of the State North Carolina Oral Health Section Division of Public Health NC DHHS - PowerPoint PPT Presentation

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State of the State North Carolina Oral Health Section Division of Public Health NC DHHS

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  1. State of the State North CarolinaOral Health SectionDivision of Public HealthNC DHHS Rebecca S King, DDS, MPH Chief, Oral Health Section UCSF DPH-175 Seminar November 13, 2012

  2. Objectives • Identify the origin of state DPH program • Infrastructure • Describe program components • Status of fluoridation in NC • Pre-school preventive activities • School-based preventive services

  3. Turn of the Last Century • 1910 -- Dr. RM Squires: The true function of both medicine and dentistry is to prevent the ills they are called upon to cure. • 1918 – NC Dental Society gets legislative funding • Reduce pain and infection • Educate on importance of oral health

  4. Oral Health Section, 2012 Focus: To promote conditions in which all North Carolinians can achieve oral health as part of overall health. To work towards eliminating disparities in oral health by using best practices. Motto: North Carolina children – cavity-free forever

  5. Oral Health Section Staff • 4 Public health dentists • 41 Public health dental hygienists • 2 Health education staff • 2 Equipment technicians • Support staff

  6. Oral Health Section Regions and Staff Assignments Central Region 7 State Hygienist positions 15 Counties Western Region 16 State Hygienist positions 1 Local Hygienist 39 Counties CAM- DEN ALLE- GHANY CURRITUCK GATES NORTH- AMPTON ASHE WARREN SURRY HERT- FORD STOKES ROCKING- HAM CASWELL VANCE PER- QUIMANS PERSON PASQUO- TANK GRAN- VILLE HALIFAX WATAUGA WILKES CHO- WAN YADKIN ORANGE BERTIE FORSYTH MITCHELL FRANKLIN GUILFORD AVERY YAN- CEY NASH ALEX- ANDER CALDWELL ALA- MANCE DURHAM EDGE- COMBE DAVIE MADISON WASH- INGTON IREDELL DAVID- SON DARE MARTIN TYRRELL WAKE BURKE WILSON BUN- COMBE CHATHAM RANDOLPH HAY- WOOD CATAWBA MCDOWELL BEAU- FORT PITT ROWAN SWAIN HYDE JOHNSTON LINCOLN GREENE RUTHER- FORD LEE GRAHAM HENDER- SON CABARRUS JACK- SON WAYNE HARNETT CLEVE- LAND MONT- GOMERY TRAN- SYLVANIA GASTON MOORE LENOIR STANLY POLK MACON CHEROKEE CRAVEN MECKLEN- BURG PAM- LICO CLAY CUMBER- LAND JONES SAMPSON RICH- MOND HOKE DUPLIN UNION ANSON SCOT- LAND CARTERET ONSLOW ROBESON BLADEN 34 State Hygienists 3 State Supervisors 5 Vacant RDH Positions 10 Local Preventive Dental Programs 1 Local Hygienists Under State Supervision 11 Counties With No Preventive Dental Program PENDER NEW HANOVER COLUMBUS BRUNSWICK Eastern Region 16 State Hygienist positions 46 Counties Revised 10/01/2012

  7. Budget Total ~ $5.38 M • Mostly state appropriations • ~25% Federal match (Medicaid “Federal Financial Participation” - FFP) • Salaries/fringes ~ $4.33 M • Non-salary ~ $1.12 M • $806,000 operating • Other federal grants ~ $309,500

  8. Program Components • Dental disease prevention • Oral health assessment • Dental health education and promotion • Access to dental care • Dental public health residency

  9. 1 Dental Disease Prevention • Water fluoridation • Pre-school & school-based dental preventive programs • Dental sealants • Fluoride mouthrinse

  10. Community Water Fluoridation Healthy People 2020 goal– 79.6% on community water systems NC surpassed - 87%

  11. Pre-school Dental Prevention Programs in North Carolina

  12. Motivating Assumptions • ECC is a serious public health problem • Its burden can be reduced through prevention targeted to very young, high risk children • Virtually all infants & toddlers obtain care at medical offices and it is a logical place to provide services

  13. Into The Mouths of Babes Statewide Medicaid Dental Prevention Program for Young Children

  14. Goals Enlist our Medical colleagues to help: • Increase access to preventive dental care for low-income children • Reduce the prevalence of ECC in low-income children • Reduce the burden of treatment needs on a dental care system already stretched beyond its capacity to serve young children

  15. Dental Prevention Service Package Medicaid children from tooth eruption to age 3 1/2 • Oral evaluation and risk assessment • Referral for dental care • Caregiver education • Fluoride • supplements • toothpaste • fluoride varnish

  16. Into the Mouths of Babes • >450 physician practices, residency programs, local heath departments trained and supported • OHS position for trainer • Originally funded by a series of federal grants (MCH, HRSA, CDC)

  17. # Annual IMB Preventive Dental Visits in NC Medical Offices

  18. Percent of Health Check Screenings Receiving IMB Services * *For years 2000-2006 includes 1-2 yr olds only, for 2007 on includes 1-3 year olds.

  19. Rates

  20. IMB Program Contributed to: • Increase in access to preventive dental services • Reduction in treatment services, particularly in early life • Increase in dental use through referral, which attenuated treatment reductions observed in dental claims because of disease treatment • Reduction in hospitalization • 50% chance of breakeven for costs

  21. Early Head Start • Surveys and focus groups to find needs • Teachers • Parents • Developing and piloting training materials • Expand the concept that baby teeth are important • Urge parents to seek early preventive care

  22. Carolina Dental Home • HRSA Access to Dental Care Grant • ~$115,000/year for three years • Brought providers together to pilot test how to best get more dental referrals for very young high-risk children, develop risk assessment tool • Collaborators: Local dentists and Pediatric Dentist, Family Physicians, Pediatricians, Medicaid, NC Dental Society, Oral Health Section, UNC Schools of Dentistry and Public Health, community leaders, others

  23. PORRT • Targeted State Maternal and Child Oral Health Service System Grant • $160,000/year for 4 years • Evidenced-based review of risk factors • Priority Oral Risk Assessment and Referral Tool • Expand pilot statewide and evaluate tool • Latest modification: develop curriculum for CHIPRA QI staff to train using video

  24. ZOE • Zero Out Early Childhood Tooth decay • Children in Early Head Start (EHS), birth – age three • UNC School of PH, OHS, Head Start • 5 year NIDCR, NIH grant • Improve access to improve prevention – improve oral health • Evaluate effectiveness of interventions

  25. ZOE Components • Train EHS staff • preventive services in the classroom • parent education • how to encourage parents to care for children's teeth at home (Motivational Interviewing) • Link EHS children with IMB medical providers • Incentivize parents whose children get ZOE age 3 dental exam

  26. School-based Dental Prevention Programs in North Carolina

  27. Dental Sealants • Statewide goal is 50% - a top OHS priority • OHS target population • K-3 high-risk children • 5,700 sealants placed per year • Fifth graders with sealants increased from 28% (1996) to 44% (2010)

  28. Fluoride Mouthrinse • School-based program from mid-1970s to 2002 • Increasingly targeted in early 1990s • Discontinued due to budget cuts and lack of recent data

  29. Effect of Fluoride Mouthrinse* FRL Fluoride Mean Mouthrinse dfs No No 3.09 Yes 1.38 Yes No 5.36 Yes 3.55 P<.001 *2004-2007 NC OHS Statewide Dental Survey

  30. Fluoride Mouthrinse Resurgence • Survey data showed decreased disparities • Obtained expansion budget funding in 2006 • Targeting schools with highest decay rates who promise compliance, grades 1 – 5. • Began in January 2007 • Increase in budget 2008 • Serving ~ 52,000 children

  31. Effectiveness School-Based FMR* • Each ‘FMR year’ associated with weak overall caries-preventive effect • Trend towards higher caries prevention in high-risk schools • Children in high-risk schools who participated for 3+ years demonstrated a sizable ‘FMR Effect’ • Children in high risk schools can experience substantial caries-preventive benefits from long term FMR participation, reducing disparities * Divaris et al, http://jdr.sagepub.com/content/early/2011/12/21/0022034511433505

  32. 2 Oral HealthAssessment • Statewide dental surveys • Oral health surveillance

  33. Statewide Dental Surveys Provide evidence base for program: • Early 1960s • 1976-1977 • 1986-1987 • 2003-2004

  34. 2003-2004 Statewide Dental Survey • Sample: 8000 children K-12 • Study how well NC decay prevention programs are reducing decay • Measure • Disparities • Parents’ knowledge and opinions • How dental health affects quality of life • Results used for Section strategic planning

  35. Trends in Tooth Decay (DMFT) in 12-17-Year-Old Children* Mean DMFT 7.6 3.1 1.4 *NC OHS Statewide Dental Survey Data

  36. Trends in Untreated Decay in Permanent Teeth* Percent Year *NC OHS Statewide Dental Survey Data

  37. % Permanent Teeth with Untreated Decay, by Race Percent White Black Other *2003-2004 NC OHS Statewide Dental Survey

  38. Percent of Children with Dental Insurance by Type and Race* Percent White Black Hisp White Black Hisp White Black Other Private Public None *2003-2004 NC OHS Statewide Dental Survey

  39. Percent of Children with Any Decay (>0 DMFS)* Percent 1986-87 2003-04 *NC OHS Statewide Dental Surveys

  40. Percent of Children With Caries Experience* Primary Permanent *2003-2004 NC OHS Statewide Dental Survey

  41. Trends in Mean dfs(primary teeth) by Education Level* dfs <HS WHITES • Increases in all races • Increases in all educational levels • Particularly severe in those families with low education HS >HS 86-87 03-04 dfs OTHER RACES <HS Key: Less than High School Ed. High School Ed. Greater than High School Ed. HS >HS 86-87 03-04 *2003-2004 NC OHS Statewide Dental Survey

  42. Trends in Untreated Cavities by Education Level* %d/dfs WHITES • Increased treatment in lower income families • Middle and upper income families show little change <HS HS >HS 86-87 03-04 %d/dfs OTHER RACES <HS HS Key: Less than High School Ed. High School Ed. Greater than High School Ed. >HS 86-87 03-04 *2003-2004 NC OHS Statewide Dental Survey

  43. Trends in Dental SealantsChildren with >1 Sealant* Percent 6-11 yrs 12-17 yrs *NC OHS Statewide Dental Surveys

  44. Prevalence of Non-Cavitated and Cavitated Lesions in Permanent Teeth Cavitated only Non-Cavitated only Non-Cavitated & Cavitated 10% 24% 65% Children *2003-2004 NC OHS Statewide Dental Survey

  45. Value Placed on Oral Health* Baby teeth do not need to be filled because they are going to fall out anyway! “% of parents who agree” Percent White Black Hispanic *2003-2004 NC OHS Statewide Dental Survey

  46. Oral Health Surveillance Calibrated dental assessments 2011-2012 • By PH RDHs • Grades K and 5 • School oral health status data • Referral for treatment needs