Improving Oral Health: Challenges and Progress in North Carolina

1. 2020 Oral Health Objectives:Much progress but More to be Done Rebecca S King, DDS, MPH Section Chief, NC Oral Health Section

2. Introduction • Background • 2010 Healthy Carolinian Objectives • 2020 Healthy Carolinian Objectives

3. We’ve come a long way baby!! But we still have a ways to go!! Why?

4. Major Factors • Sociodemographic • Dental workforce • Need for prevention and education

5. Social and Demographic Trends“New Majority” • … South is the only region… where low income children = majority of public school students – 54%. • % low income children in schools doubled since 1989 • 2000-07: pop. <5 year olds grew by 20% • 2001-05: Hispanics = 50% of growth in public schools Poverty, poor education, and inequality lead to poor dental health! Southern Educational Association, 2007

6. Dentist Workforce Trends • 4 counties have no dentist • 10 counties have 1 or fewer dentists/ 10,000 population • NC Supply lags behind US supply Slight increase over the last 10 years • Future: expanding dental school graduates

7. GAO Report 2008 • Millions of poor American children have untreated tooth decay • 6.5 million children enrolled in Medicaid had untreated tooth decay (2005) • some could not find a dentist willing to treat them • only 1 in 3 received any dental care in a year • Report was ordered after young boy died in 2007 http://www.cnn.com/2008/US/09/23/dentalcare.medicaid/ind

9. Early Treatment is Essential

10. Dental Care Safety Net Clinics Prior to 1996* * NC Oral Health Section

11. Dental Care Safety Net Clinics March 2010* * NC Oral Health Section

12. Need for Prevention and Education We’ve never cured a disease through a treatment program.

13. Tooth Decay: Most Common Chronic Childhood Disease • Mortality: can be fatal, usually not • Morbidity: quality of life • 6X more common than asthma • Advocacy groups rate high • Largely preventable • Once diseased, have to repair • Able to track because it leaves a record

14. Quality of Life* Impacts† on Child and Family by Race, Grades K-3 Pain Difficulty Eating Missed School Financial Difficulties †Occasionally, often or very often in lifetime Percent *2003-2004 NC OHS Statewide Dental Survey

15. Disparities in Disease Trends in Tooth Decay in 12-17-Year-Old Children* Mean DMFT 7.6 3.1 1.4 *NC OHS Statewide Dental Survey Data

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

17. Disparities in Access % Children with Dental Insurance by Type and Race** Percent White Black Hisp White Black Hisp White Black Hisp Private Public None *2003-2004 NC OHS Statewide Dental Survey

18. Costs of Dental Treatment 2006 MEPS data • Expenditures 7.4% of total health care • Mean/person $607 • 42% had an expenditure • 43% paid by private insurance • 49% out of pocket http://www.meps.ahrq.gov/data_files/publications/st263/stat263.pdf

19. Cost-Effective Preventive Measures • CDC recommends as most beneficial preventive measures • Water Fluoridation • Benefits children and adults • 50 cents - $1/person/year • Lifetime costs less than cost of one filling • Dental Sealants • Fluoride varnish

20. Early Stage Decay and Obvious Cavities in Permanent Teeth* Obvious cavities only Early stage decay only 10% Both 24% 65% Children *2003-2004 NC OHS Statewide Dental Survey

21. Why Education? • “You can’t be healthy without good oral health” • Dr. C. Everett Koop • Value placed on oral health

22. 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

23. Update on Healthy Carolinians 2010 Oral Health Objectives

24. HC-2010 Oral Health Objective 1. Reduce tooth decay in preschool children. Target: 1.3 average # decayed, missing and filled primary teeth (dmft). Baseline, 1999: 1.45 average # decayed, missing and filled primary teeth (dmft).

25. Tooth Decay in Kindergarten Children (primary teeth)* Baseline 1.45 Target 1.3 *NC OHS annual assessment data

26. HC-2010 Oral Health Objective 2. Increase the proportion of 5th graders whose permanent teeth are free of decay. Target: 87% Baseline, 1999: 79% fifth grade children have never had a cavity in a permanent tooth.

27. Fifth Grade Children with Permanent teeth Free from Decay* Target 87% Baseline 79% ? *NC OHS annual assessment data

28. Fifth Grade Children: Avg. # Decayed Permanent Teeth* *NC OHS annual assessment data

29. HC-2010 Oral Health Objective 3. Increase the proportion of children < age 19 at or below 200% Federal poverty level who received any dental preventive service during the last year. Developmental Objective, baseline data to be collected and analyzed by 2001.

30. Access to Care for Medicaid Children* *NC Div. of Medical Assistance

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

32. Dental Prevention Service Package Medicaid children from tooth eruption to age 3 ½ • Provided in a medical setting • Oral evaluation and risk assessment • Referral for dental care • Caregiver education • Fluoride varnish

33. HC-2010 Oral Health Objective 4. Increase the proportion of adults who visited a dentist within the past year. Target: 73.9% Baseline, 1999: 67.2% of adults 18 years and older visited a dentist during the past year.

34. How many visited dentist, clinic for any reason in last year?* Target Baseline 73.9 74 72 70 69.4 Percent ? 68 67.6 67.5 67.2 67.2 66 65.2 64 62 60 1999 2001 2002 2004 2006 2008 2010 Year *BRFSS

35. HC-2010 Oral Health Objective 5. Decrease the proportion of adults, ages 45 – 65 years, who lost 5+ teeth due to tooth decay or gum disease. Target: 20% Baseline, 1999: 22.3% of adults, ages 45-64, had a tooth removed due to decay or gum disease.

36. Proportion of adults, ages 45-64, who lost 5+ teeth due to tooth decay or gum disease* Target ?? % People Who Lost 6+ Teeth Year *NC State Center for Health Statistics

37. Healthy Carolina 2020 Draft Oral Health Objectives

38. HC-2020 Oral Health Objective 1 Draft Increase the % of children enrolled in Medicaid ages 1-5 who received any dental service during the previous 12 months. • Target: 56.4% • Baseline: 46.9% (2008) • Method: 90th percentile for NC counties

39. % Medicaid children receiving dental services, last 12 months Baseline Target Percentage Year

40. HC-2020 Oral Health Objective 2 Draft Decrease the average number of decayed, missing, or filled teeth (dmft) among kindergartners. Target: 1.06 average # decayed, missing and filled primary teeth (dmft). Baseline, 2008-09: 1.5 average # decayed, missing and filled primary teeth (dmft). Method: Best 10th percentile of NC counties.

41. 2. Tooth Decay in Kindergarten Children (primary teeth)* Baseline 1.5 Target 1.06 *NC OHS annual assessment data

42. HC-2020 Oral Health Objective 3 Draft Decrease the percent of people (ages 18+) who have had permanent teeth removed due to tooth decay or gum disease* • # teeth removed due to tooth decay or gum disease? Don’t include teeth lost for other reasons, such as injury or orthodontics. • Target: 35.8% • Baseline: 54.3% (2001) • Method: NC Pace applied out to 2020. *BRFSS data

43. 3. Percent of adults who had a permanent tooth removed due to tooth decay or gum disease* Target Percentage Year *BRFSS data

44. Questions Later