Oral Health in Maine: Facts & Figures, August 2005

1. Judith A. Feinstein, MSPH Director, Maine Oral Health Program ME Center for Disease Control & Prevention (Bureau of Health) Maine Department of Health & Human Services Oral Health in Maine: Facts & Figures, August 2005

2. “…Oral health is integral to general health. You cannot be healthy without oral health.” Oral Health in America: A Report of the Surgeon General, 2000

3. 1999 Maine Smile Survey: 20% of children in grades K & 3 needed treatment. 47% of 3rd graders had at least one sealant, and 56.8% needed at least one more. About 31% of grade K and 45% of grade 3 had a history of decay. Oral Health in Maine

4. 2002 Maine Child Health Survey Kindergarten – 18.4%: untreated caries. 2003 Youth Risk Behavior Survey: 77% of middle school students reported a dental visit in past year – compared to 87% in 2001. Oral Health in Maine

5. Of the children screened, 15% of kindergarten and 17% of the 3rd graders had untreated dental decay. Of the kindergarten children screened, 11% hadn’t had a dental visit. Of the 3rd graders screened, 57% had at least one dental sealant, but 50% of them needed at least one more. 15% of the kindergarten children and 41% of the 3rd graders who were screened have decay experience (fillings and/or decay). In 1999, 38% of lower income children had sealants; in 2004, 53% of the lower income children screened have them – a level similar to higher income children. Oral Health in Maine2004 Maine Child Health Survey, Preliminary Data

6. ~ half of women who had a baby that year visited a dental office or clinic during their pregnancy. Women 35 or older were more likely, and women 25 or younger less likely to have had a dental visit. Oral Health in Maine PRAMS – 2000 Survey

7. Nearly 25% of new moms said they needed a dental visit during pregnancy; but of these, 35% did not go. The women who did not obtain needed care were more likely to be 20-24 years old, enrolled in WIC, or have annual incomes of less than $16,000. Oral Health in Maine PRAMS – 2000 Survey

8. Oral Health in Maine • BRFSS data for 1995-97 indicated that for people age 65 and over, Maine was the 5th most edentulous (toothless) state in the country (1999) • 2002: 30.4% of adults aged 65 and older reported loss of all their natural teeth and 43.8% reported retention of most of their natural teeth. • 2002: 4.8% of the 25-34 age group and 11.8% of those aged 35-44 had lost six or more teeth. • 2004: Of Maine adults, 12.7% had lost six or more teeth; 2.1% of those aged 35-44 and 24.3% of those 65 and older had lost all of their teeth.

9. Exposure to optimally fluoridated water can reduce dental decay by 20 to 40%. Close to half of Maine’s cities & towns do not have public water supplies. Of communities with public water supplies, 84% of the population has fluoridated drinking water; but for the state as a whole, about 38%. Water Fluoridation

10. Oral Health Infrastructure in Maine • Most dental care in Maine is delivered via small, independently operating private practices. • Maine’s oral health safety net: • One municipal children’s clinic (Bangor) • 12 Federally Qualified Health Centers • 4 private non-profit children’s clinics • Three private non-profits with dental centers in 7 locations • State clinics: Portland, Augusta, Bangor

11. Infrastructure • Volunteer and voucher programs • Dental Hygiene Schools – Preventive services • Preventive Dental Hygiene Programs & Agencies • Mobile Programs: Miles for Smiles and The Tooth Ferry

12. Federally Designated Medically Underserved Areas and Populations (Jan. 2005)

13. Federally Designated Primary Care Health Professional Shortage Areas (Jan. 2005)

14. Federally Designated Dental Health Professional Shortage Areas (Jan. 2005)

15. Workforce concerns: numbers, age and distribution of dentists (2002) 589 dentists, net gain of 8 since 1998 (actively practicing vs. 630 licensees) 465 (~80%) were general practice dentists. Dentist to population ratio was one per 2,165, compared to national ratio of one per 1,656. Maine was 28th in the 50 states. Only 30% of Maine dentists were 45 or younger; average age was 50.5. Issues for Oral Health in Maine

16. Issues in Maine Workforce concerns: numbers, age and distribution of dental hygienists (2004) • 739 hygienists, compared to 715 in 1999 (actively practicing); 90% employed in private dental offices. • Hygienist to population ratio is one RDH per 1,752 residents. Cumberland County’s ratio was significantly lower (better) than the state’s ratio; Washington & Somerset were significantly worse. • About 64% of Maine’s hygienists are 45 or younger (compared to 75% in 1999).

17. MaineCare • In 2002, 57% of both general practice dentists and specialist dentists treated MaineCare patients in their practices. • When asked if they were accepting new MaineCare patients, more than 60% of specialists reported that they were, compared to 23% of general practitioners.

18. MaineCare • MaineCare reimbursement is well below market rate – estimated at 40% of “usual & customary.” Current payment levels fall below the 10th percentile of fees charged by general dentists in New England. • About 45-48% of Maine dentists were paid by MaineCare in 2004, and about 65,000 clients received at least one service. Total paid: over $20 million (compared to $13 million 2 years earlier).