Ohio Public Health Association Dental Care Access: A Public Health Issue April 17 th, 2014 Presented by: Audia Ellis, MSN, RN, FNP BC audiaellis@yahoo.com Objectives Evaluate the current state of dental care access in Ohio Identify disease processes that are associated with poor oral health Evaluate the impact that poor oral health and lack of access to dental care has on overall general health Identify the role and contribution that Public Health Nurses play in enhancing oral health Evaluate possible solutions that can improve dental care and access A Public Health Issue Lack of access to dental care for all ages remains a public health challenge The Reality: The current dental delivery system is broken and does not meet the needs of roughly a third of the country s inhabitants IOM, 2011 Importance of Oral & Dental Care Oral care is an essential part of patient care Vital for: Maintaining overall health Self Esteem Well being of individuals Current State on Oral Health & Dental Care: Facts Dental care remains Ohio s top unmet health need for children and adults with low income. Approximately 340, 000 children in Ohio have never been to a dentist 51% of children in Ohio have experienced tooth decay by the 3 rd grade Approximately 486,000 children in Ohio do not have dental insurance. Approximately 45% of all Ohio adults have had one or more permanent teeth removed due to tooth decay or gum disease and 7% have had all teeth removed. Poor oral health is attributed to various factors: Limited access to oral health care and lack of dental coverage Inadequate health literacy Lack of attention to oral health among health care providers Individual health behaviors: tobacco use, alcohol use and poor dietary choices Utilization of Emergency Departments There has been increasing reliance on use of the ED in the underserved population due to lack of access to other sources of medical and dental care. Between 2001 and 2008, there has been a 41% increase in ED visits for dental issues, when compared to the 13% increase in ED use for all other conditions Dental related ED visits cost millions of dollars each year in each state 1
OPHA 2012 Position Statement: Access to Health Care Background on Access to Care: 19% of Ohioans (age 18 64)were uninsured as of 2010 4.6% of children (<18 years) were uninsured as of 2010 Access to care is 1 of the 10 leading indicators in Healthy People 2020 Insurance is a strong predictor of access to care Policy Recommendations: Support state/national efforts (i.e. Affordable Care Act) Reduce access barriers (cost, language, lack of providers) Increase disease prevention and health promotion programs Health Inequalities: Facts Disproportionate burden of disease, injury, premature death and disability is more prevalent among minorities (African Americans and Hispanics) 17.6% of the total Ohio population is comprised of minorities African American adults were 70% more likely to suffer from stroke and 30% are more likely to have diabetes and hypertension Significant disparities in tooth loss exist depending on race, income and geography Tooth loss is more prevalent in black and multi racial adults than white adults 16% of indigent adults with income less than $15,000 have had all their teeth removed, when compared to only 2% among individuals with income greater than $50,000 Seniors experience the most tooth loss, especially the indigent Adults in Appalachian counties are more likely to have tooth loss when compared to other areas Health Inequalities: Facts Cont. Poor dental health and lack of access to dental care is most pronounced in the following population: 1. Uninsured 2. Minorities 3. Individuals between 18 44 years of age 4. Elderly OPHA Position Statement: Addressing Health Inequalities Support outreach and education to involve minority members of local communities Support all Healthy People 2020 initiatives that seek to establish health equity and the elimination of disparities Focus on social determinants of health (i.e. income, education, social/physical environment, support networks OPHA Believes: It is equally important to focus on these determinants of health, as it is to focus on access to health care, health care quality & health behaviors. APHA Support of the Surgeon General Report Framework for Action on Oral Health Report Recommendations: Accelerate the building of the science and evidence base Utilize research findings to improve oral health and guide practice Build and maintain an effective health infrastructure that meets oral health needs Integrate oral health into overall health Eliminate barriers to dental care and access Current Barriers to Dental Care & Access Limited access to dental services Lack of availability of dental services Lack of awareness of the need for care Cost Fear of dental procedures 2
Ohio s Dental Professional Shortage There are 84 federally designated dental health professional shortage areas in Ohio. More than a million Ohioans live in these shortage areas. Diseases Associated with Poor Oral Health Coronary artery disease Pneumonia and other respiratory diseases Diabetes Stroke Osteoporosis Low birth weight babies Kidney disease Cancer The Effects of Poor Dental Health Poor dental health in childhood and adolescence is associated with cardiovascular disease later in life Cardiovascular disease may increase as much as 20% in the presence of periodontal disease Dental disease can exacerbate pre existing heart disease, such as infective endocarditis In pregnancy, studies have shown an association between maternal dental disease and pre term birth Dental disease can exacerbate diabetes and its associating long term complications Note: Dental disease and diabetes exacerbate each other Role of Public Health Nurses & Oral Health Poor health is predominant in the disadvantaged and vulnerable groups Majority of patients cared for and advocated for by public health nurses fall into theses categories Individuals in these groups are less likely to seek dental care Through thorough oral assessment, they can be provided with the appropriate resources Implement adequate effective preventative strategies in children prior to the eruption of teeth. Key Period: The first 2 years of life Inform and educate parents on children's oral care and oral health promotion strategies: A. Brushing with fluoride toothpaste B. Daily flossing Role of Public Health Nurses & Oral Health Cont. Hold a pivotal role in assessing oral health in children as part of general health surveillance Dental neglect in children can be a marker of broader of neglect Public health nurses have extensive contact with children and play a key role in child protection Studies have shown there is rarely a link made between dental caries and child neglect Understanding the importance of oral hygiene is imperative due to it effects on individuals quality of life Role of Public Health Nurses & Oral Health Cont. Parental education should consist of: Every child should have the 1 st dental visit by their first birthday or by the time the first tooth erupts Always brush child s teeth with a fluoridated dentifrice (toothpaste) Children < 3 years old: Smear or size of a grain of rice Children >3 to 6 years old: No more than a pea size Brush teeth twice daily Supervise children to ensure that they are using the correct amount of toothpaste and to minimize swallowing of toothpaste 3
Option #1: Community Interventions Assessment of currently established fluoridation programs Cornerstone of ALL dental caries prevention is water fluoridation followed by fluoride varnish application by the eruption of the first tooth Promote use of Head Start and Early Child Development programs. Works with each family to establish an ongoing source of preventative and primary oral health care with diagnostic testing, examination, and treatment. Educate and promote utilization of school based or linked oral health programs Promote interventions to reduce tooth decay A. School based sealant programs B. Fluoride use Option #1: Community Interventions Cont. Promote use of Mobile/Portable Dental Programs Identify and encourage utilization of community based services that provide assistance with transportation for appointments Very few counties have more than 1 safety net clinic Mobile dental programs are limited Option #2: Registered Dental Practitioner A Registered Dental Practitioner (RDP) is a dental professional who has obtained intensive education in a limited scope of practice and works under the supervision of a licensed dentist Some are also able to practice remotely from a licensed dentists Care provided includes: Routine preventative care Placement of fillings Non complicated extractions. Nurse practitioners have immensely assisted in addressing the medical workforce shortage and RDPs are capable of doing the same for the dental work force Approximately 52 countries have expanded their dental team through utilization of RDPs They include: New Zealand Great Britain Canada The Netherlands Australia Recently in the U.S. (Alaska and Minnesota) Option #3: System wide Interventions Ensure that managed care programs (insurance programs) are educating their members on available resources and benefits Increase Medicaid reimbursement Recruit dental students and hygienists from shortage areas Increase the number of community health centers that provide oral health Increase the capacity of state dental health programs Evaluate and improve methods of monitoring oral diseases Increase the number of fluoridation programs in more communities Option 3: System Wide Interventions Cont. Award grants to train school based health care providers and nurses A. Conduct oral assessment B. Utilize risk assessment instruments C. Apply fluoride varnish for kids high risk for dental caries Expand the grants awarded to more communities in more states for the integration of oral health into school based health centers. States awarded previously: California, Colorado, Minnesota and New York Total: $2.3 million 4
For her to grow with a healthy smile, we need TEAMWORK! Team Members: Public Health Nurses and providers Dental providers Policy makers Consumers Universal Health Care Action Network of Ohio (UHCAN Ohio) A statewide consumer organization working for high quality and affordable health care for all Ohioans Mission: To improve the oral health of children and adults Project: Dental Access Now Working to reduce the dental health care shortage in Ohio by expanding the health care team Care will be more accessible to those who currently need it most. Hospital EDs can reduce costs The safety net will be strengthened. There will be a decrease in the occurrence of the diseases associated with dental disease Potential Outcomes. Take Away Points Dental hygiene and health has a significant impact on general health Lack of access to dental care is a serious public health issue Public health nurses play a vital role in enhancing dental care and access There are options available that can be utilized to improve this dire issue Dental care is in FACT a part of overall general health care This is not just a dental issue.this is a PUBLIC HEALTH issue References 5
References Cont. 6