Dental Public Health Activities & Practices

Transcription

1 Dental Public Health Activities & Practices Practice Number: Submitted By: Oral Health Section, North Carolina Department of Health & Human Services Submission Date: May 2002 Last Updated: January 2005 Name of the Practice: SECTION I: PRACTICE OVERVIEW Use of Epidemiological Studies and Surveillance to Direct State and Local Oral Health Programs Public Health Functions: Assessment Use of Data Assessment Acquiring Data HP 2010 Objectives: Increase the number of states with State-based surveillance system Reduce dental caries experience in children Reduce untreated dental decay in children and adults Increase sealants in 8 year-olds first molars and in 14-year-olds first and second molars. State: North Carolina Abstract: Region: South Region IV Key Words: Epidemiological study, oral health survey, needs assessment, surveillance, children oral health status The Oral Health Section, North Carolina Division of Public Health, determines the oral health of a community in three ways: (1) Dental assessments measuring specific oral conditions such as the average number of decayed, missing and filled teeth and proportion of children with dental sealants, (2) Dental screenings identifying children in need of dental care and referring them for care, and (3) Statewide epidemiological surveys scientifically measuring the quantity and types of oral disease in a population. Over 280,000 elementary school children participate in either assessments or screenings annually. The epidemiological surveys are conducted approximately every 15 years; the last survey was conducted in The North Carolina oral health program has been based on epidemiological studies beginning in the 1960 s with a household dental survey of people of all ages. Findings were used to guide the program planning through the 1970 s. The survey was repeated in 1976 to measure trends in oral health status and provided baseline information. In 1986, the Oral Health Section received funds for the North Carolina School Oral Health Survey (NCSOHS). The NCSOHS has been a valuable tool for the planning, evaluation and assessment of North Carolina's state and local dental public health programs. Recommendations based on the findings of the NCSOHS included major programmatic modifications in the North Carolina oral health program such as (1) targeting of screening to specific grades and high-risk groups, (2) greater emphasis on follow-up of children who are screened and need treatment, and (3) a change in program emphasis from restorative treatment services to preventive services, especially dental sealants. Contact Persons for Inquiries: Rebecca S. King, DDS, MPH, Section Chief, Oral Health Section, North Carolina Department of Health & Human Services, 2728 Capital Blvd., Raleigh, NC 27604, Phone: , Fax: , rebecca.king@ncmail.net Practice #36001 Use of Epidemiological Studies & Surveillance to Direct State & Local Oral Health Programs 1

2 SECTION II: PRACTICE DESCRIPTION History of the Practice: The first statewide evaluation of oral health in North Carolina was carried out in 1960, as a door-todoor survey. Findings were used to guide the program planning of the North Carolina Oral Health Section through the 1970 s. The 1960 survey was repeated in 1976 in order to measure trends in oral health status and provide baseline information for subsequent surveys. In 1986, the Section received funds from the Kate B. Reynolds Health Care Trust and the North Carolina General Assembly for the North Carolina School Oral Health Survey (NCSOHS) in order to follow up the previous studies. This series of statewide dental studies is unique in the United States. The North Carolina Department of Health & Human Services, Oral Health Section currently determines the overall oral health of a community through three ways: (1) Dental assessments - measure specific oral conditions such as tooth decay, (2) Dental screenings - search for tooth decay and other disease conditions in individuals and refer them for dental care, and (3) Epidemiological surveys - scientifically measure the quantity and types of oral disease in a population. Over 280,000 elementary school children participate in either the assessments or screenings annually. The epidemiological surveys are conducted approximately every 15 years because of the nature of dental diseases. The North Carolina School Oral Health Survey was the last survey conducted. Justification of the Practice: North Carolina has one of the country's premier state oral public health programs. The program has been based on epidemiological studies starting in the 1960s. The North Carolina School Oral Health Survey provided a "diagnosis" of the oral health of the state population of six million people, necessary before "prescribing" an effective and efficient public health preventive treatment program. The North Carolina School Oral Health Survey has been a valuable tool for the planning, evaluation and assessment of North Carolina's state and local dental public health programs. Future surveys will continue to help develop programs. The survey is crucial because of radical changes in oral health, dental technologies, demographics, dental manpower and financing of dental care. In an environment of rapid change, it is necessary to obtain up-to-date and accurate information to use for planning and carrying out an effective public health program. Administration, Operations, Services, Personnel, Expertise and Resources of the Practice: Survey Objectives and Sample: The North Carolina School Oral Health Survey objectives were grouped to study the following subjects: Current oral health status (including caries, periodontal disease and sealants) Treatment needs Risk factors The survey sample was stratified by the following groupings in order to allow targeted assessments and more accurate "treatments." The groupings were age, racial group, parent education, geographic region and degree of urbanism. More than 8,000 school children, in grades K-12 (age 5-17), were included in the survey sample. Survey Staff: A total of 17 dentists served as survey examiners. In addition, 17 recorders supported data collection. The examiners and recorders were primarily state staff but a few local public health dentists, dental hygienists and assistants also participated. Four dental equipment technicians and school personnel who helped with the oral health screening arrangements also provided staffing support for the survey. Practice #36001 Use of Epidemiological Studies & Surveillance to Direct State & Local Oral Health Programs 2

3 Survey Results: Dental disease is increasingly affecting a smaller segment of the population. Over 80 percent of tooth decay is now found in approximately 25 percent of the children. This population with severe decay is, in general, of lower socioeconomic status and lives primarily in the rural mountain region of the state. Primary Teeth: In primary teeth, minority (nonwhite) children have a higher incidence of cavities than white children, and more of this decay has been left untreated. Other factors associated with both higher cavity and higher unmet needs in primary teeth are lower parent education, living in a non-urban area, and living in the Coastal or Mountain regions of North Carolina. Permanent Teeth: Overall, DMFT scores indicate a high level of treatment for the decay that has occurred, and that very few teeth are lost due to decay in children. Variations in DMFT scores were associated primarily with parent education, and to a lesser degree, with urbanism and geographic region. Whites and nonwhites were found to have similar levels of cavities experience, but the level of untreated decay is higher in nonwhites. Overall, 47 percent of all 5- to 17-year olds have had cavities in their permanent teeth. By age 17, over 83 percent have had some decay, with an average of 8.44 DMFS per child. Most decay occurs on the chewing surfaces of the teeth, with pit and fissure decay measured at over 81 percent of the total. National data collected by the National Institute of Dental Research and DMFS scores for North Carolina are virtually identical. Dental Sealants: The overall prevalence of children with sealants was 12 percent, with minority (nonwhite) children at about half this level. Geographic region and parent education were also associated with sealant prevalence. For every tooth surface sealed, approximately three were decayed or filled. Minority children had about twice as many decayed or filled surfaces for every sealant as white children. Sealants are severely underutilized in the entire survey population, especially among minorities. Periodontal Disease: The prevalence and severity of periodontal disease among North Carolina's children were very low. Seventy-two percent were assessed as healthy, and another 27 percent had very mild conditions that could be treated by cleaning and oral hygiene instruction. Only one percent requires more involved dental treatment for their periodontal condition. Dental Health Trends: DMFT (decayed, missing, and filled teeth) scores over the course of the 26 years encompassed by the three statewide surveys show large reductions in tooth decay and point to a significant pattern of reduction in the disparity between whites and nonwhite populations. Scores for white children dropped 26 percent between 1960 and 1976, while scores for minority children changed very little. However, between 1976 and 1986 scores for whites dropped another 42 percent while scores for minorities plunged to the same level as that for whites, so that both measured at 0.6 DMFT in Over this same time period, the percentage of decay that was treated increased, but minority populations still received significantly less treatment for their dental disease than white populations. Examples of Ways Data Have Been Used: Findings of the North Carolina School Oral Health Survey were published in a special Monograph "North Carolina School Oral Health Survey." Recommendations based on the findings of this Survey included major programmatic modifications in the North Carolina dental public health program. Organizational changes included: Changes in staff distribution. A team approach to providing preventive services was initiated to encourage staff to collaborate with other field staff in order to provide services previously unavailable. One unexpected benefit of the 1986 survey was the "management model" that validated this new way for staff to work together. Improved data collection concerning services provided, in order to determine service mix in a timely and accurate manner. A validation of the public/private partnership in providing public health dental services. The Section provides the research and informational, technical, and promotional inducements; and the private dental sector furnishes the actual dental services. Practice #36001 Use of Epidemiological Studies & Surveillance to Direct State & Local Oral Health Programs 3

4 Programmatic changes included: The targeting of screening to specific grades and high-risk groups. Greater emphasis on follow-up of children who are screened and need treatment, to address the phenomenon of the relatively small proportion of children bearing a disproportionate disease burden. A change in emphasis of the clinical component of the program from restorative treatment services to preventive services, especially dental sealants. The Oral Health Section discontinued the restorative clinical program and placed their emphasis on prevention and education/promotion programs with a focus on dental sealants. Additional Research: As conditions affecting dental health continue to change, the Oral Health Section will continue to gather dental health data. This will ensure that the Section's programs will remain up-to-date, effective and efficient. Additional research will include: Annual surveillance of sealant prevalence and dental decay in kindergarten and 5th grade children. This surveillance will be performed by trained, calibrated public health dental hygienists. The data gathered will enable comparisons of dental health between schools and counties, and in the same school or county over time. Current assessment (school year ) for North Carolina children in grades K-5 showed that that 37% of children entering kindergarten have already experienced tooth decay, 23% of children entering kindergarten have active decay in their primary teeth, and 20% of children in the 5 th grade have active decay in their permanent teeth. Furthermore, in , 37% of 5 th graders have a dental sealant on one or more teeth compared to 12% in Efforts will be made to seek resources for future statewide epidemiological surveys approximately every 15 years. Budget Estimates and Formulas of the Practice: An estimated overall cost of the North Carolina School Oral Health Survey was $320,000. The survey had two funding sources. Kate B. Reynolds Health Care Trust provided a grant totaling $220,000 and the Oral Health Section contributed $100,000 of state funds. Lessons Learned and Plans for Improvement: In today s dollars, a statewide epidemiological survey in North Carolina has been estimated to cost between $325,000 to $350,000. To support a large-scale survey, several funding sources would need to be identified to ensure successful implementation. In addition, few states currently have the resources or willingness to spend the state dollars for needed evaluative studies. To gain political support in conducting a survey, start the education and advocacy process early. Available Resources Models, Tools and Guidelines Relevant to the Practice: A monograph "North Carolina School Oral Health Survey" provides the findings of the North Carolina School Oral Health Survey For national research information, see the National Institute of Dental Research web site at Practice #36001 Use of Epidemiological Studies & Surveillance to Direct State & Local Oral Health Programs 4

5 SECTION III: PRACTICE EVALUATION INFORMATION Impact/Effectiveness Does the practice demonstrate impact, applicability, and benefits to the oral health care and wellbeing of certain populations or communities (i.e., reference scientific evidence and outcomes of the practice)? Recommendations based on the findings of the North Carolina School Oral Health Survey included major programmatic modifications in the North Carolina dental public health program. Organizational and programmatic changes included: (1) Changes in staff distribution. A team approach to providing preventive services was initiated to encourage staff to collaborate with other field staff in order to provide services previously unavailable and a "management model" validated this new way for staff to work together. (2) Improved data collection concerning services. (3) A validation of the public/private partnership in providing public health dental services. The Oral Health Section provides the research and informational, technical, and promotional inducements; and the private dental sector furnishes the actual dental services. (4) The targeting of screening to specific grades and high-risk groups. (5) Greater emphasis on follow-up of children who are screened and need treatment to address that a relatively small proportion of children bear a disproportionate level of disease. (6) A change in emphasis of the clinical component of the program from restorative treatment services to preventive services. The Oral Health Section discontinued the restorative clinical program and placed their emphasis on prevention and education/promotion programs with a focus on dental sealants. Efficiency Does the practice demonstrate cost and resource efficiency where expenses are appropriate to benefits? Are staffing and time requirements realistic and reasonable? A grant provided approximately two-thirds of the funding for the North Carolina School Oral Health Survey. Many partners provided generous donation of in-kind time, resources and services to support the operation of the survey. The time and resource committed to survey were worthwhile investments in assessing oral health needs and guiding organizational/programmatic changes. However, given the current resources and governmental support, it would be a challenge to find funding for repeating such a large-scale survey. Demonstrated Sustainability Does the practice show sustainable benefits and/or is the practice sustainable within populations/communities and between states/territories? The first statewide evaluation of oral health in North Carolina was carried out in The next major survey was the North Carolina School Oral Health Survey. The Oral Health Section will continue to seek resources for future epidemiological studies at approximately 15-year intervals. Annual surveillance of sealant and tooth decay prevalence in kindergarten and 5 th grade children is ongoing. The surveys have served as a valuable tool for the planning, evaluation and assessment of North Carolina's state and local dental public health programs over the years. Collaboration/Integration Does the practice build effective partnerships/coalitions among various organizations and integrate oral health with other health projects and issues? The implementation of the North Carolina School Oral Health Survey demonstrated a private-public partnership with Kate B. Reynolds Health Care Trust providing a $220,000 grant and Practice #36001 Use of Epidemiological Studies & Surveillance to Direct State & Local Oral Health Programs 5

6 the Oral Health Section, North Carolina Department of Health & Human Services contributing $100,000 of state funds to cover the cost of the survey. Objectives/Rationale Does the practice address HP 2010 objectives, the Surgeon General s Report on Oral Health, and/or build basic infrastructure and capacity for state/territorial oral health programs? The North Carolina School Oral Health Surveys monitored progress made towards achieving Healthy People objectives that related to increasing the number of states with State-based surveillance system, reducing dental caries experience in children, reducing untreated dental decay in children and adults, and increasing sealants among children. Extent of Use Among States Is the practice or aspects of the practice used in other states? The extent and approaches of how other states use oral health survey findings to direct and develop their state and local health programs are not yet determined. However, the Synopses of State and Territorial Dental Public Health Programs showed that in 2004 and 2005, 38 states reported having programs for needs assessment/oral health surveys. Practice #36001 Use of Epidemiological Studies & Surveillance to Direct State & Local Oral Health Programs 6