november 10, 2015 learning community webinar€¦ · teeth. having missing teeth can affect...

November 10, 2015 Learning Community Webinar

Healthy Congregations Program Updates:

Requirement changes for certification 3 courses instead of 7 7 hours of course work Three courses: Health Ministry 101, Outcomes-Based

Planning, and Program Evaluation & Using Data

Upcoming HC Learning Community Webinars Special Grant Opportunities to consider

Healthy Congregations Upcoming Training Details:

Dates TBD for 2016 Will continue to offer in person training and online

training Entire course schedule and registration details will

be posted on: www.healthfund.org/hcctraining.php

Registration deadlines are available and must have enough people registered to hold the class

http://www.healthfund.org/hcctraining.php

Thinking Ahead… Additional Funding Opportunities for

2015-2016

Upcoming special grant opportunities available: • The Big Garden Community Gardens (up to

$2,700) • Summer Food Program (up to $2,000)

Save the Date: Healthy Congregations Retreat

Ideas and information you can take home and use right away in your church

Healthy Congregations Core training courses

Relaxing, natural setting of Rock Springs, Junction City, KS

April 22-23, 2016 No cost to participate Core Training Courses will

be on April 21, 2016 from 1pm- 9pm

Resource Link: www.healthfund.org/retreat

Judy Johnston, MS, RD/LD Research instructor

Department of Preventive Medicine & Public Health KU School of Medicine – Wichita

[email protected] 316-293-1861

mailto:[email protected]

Oral health needs and challenges through the life

cycle Oral health and overall health Challenges of low oral work force in Kansas and

what is being done to address that KMOM and GKAS: events for underserved

populations Suggestions for faith communities

What We Will Discuss

The most prevalent childhood disease Affects more than 25 percent of U.S. children aged 2-5

and half of those aged 12-15 28% of those 35 to 44 years of age have untreated tooth

decay 18 % of adults 65 and older have untreated tooth decay

Dental caries, the disease process that causes tooth decay (cavities):

Tooth decay (cavities) is one of the most common chronic

conditions of childhood in the United States. Tooth decay is preventable. Fluoride varnish, a high concentration fluoride coating that is

painted on teeth, can prevent about one-third (33%) of decay in the primary (baby) teeth.

Children living in communities with fluoridated tap water have fewer decayed teeth than children who live in areas where their tap water is not fluoridated.

Children who brush daily with fluoride toothpaste will have less tooth decay.

Children’s Oral Health: Cavities

1. Marinho VCC, Worthington HV, Walsh T, Clarkson JE. Fluoride varnishes for preventing dental caries in children and adolescents. Cochrane Database of Systematic Reviews. 2013; Issue 7. Art. No.: CD002279. DOI: 10.1002/14651858.CD002279.pub2

2. Community Preventive Services Task Force. Preventing Dental Caries: Community Water Fluoridation website. http://www.thecommunityguide.org/oral/fluoridation.html. Accessed October 29, 2015.

3. Marinho VCC, Higgins JPT, Logan S, Sheiham A. Fluoride toothpastes for preventing dental caries in children and adolescents. Cochrane Database of Systematic Reviews. 2003; Issue 1. Art. No.: CD002278. DOI: 10.1002/14651858.CD002278.

4. Ahovuo-Saloranta A, Forss H, Walsh T, Hiiri A, Nordblad A, Mäkelä M, Worthington HV. Sealants for preventing dental decay in the permanent teeth. Cochrane Database of Systematic Reviews. 2013; Issue 3. Art. No.: CD001830. DOI: 10.1002/14651858.CD001830.pub4.

http://www.thecommunityguide.org/oral/fluoridation.html

Tooth decay is preventable (cont.) Applying dental sealants to the chewing surfaces of the

back teeth is another way to prevent tooth decay. Both oral health care providers and primary care

physicians can do this Studies in children show that sealants reduce decay in the

permanent molars by 81% for 2 years after they are placed on the tooth and continue to be effective for 4 years after placement.


1. Marinho VCC, Worthington HV, Walsh T, Clarkson JE. Fluoride varnishes for preventing dental caries in children and adolescents. Cochrane Database of Systematic Reviews. 2013; Issue 7. Art. No.: CD002279. DOI: 10.1002/14651858.CD002279.pub2

2. Community Preventive Services Task Force. Preventing Dental Caries: Community Water Fluoridation website. http://www.thecommunityguide.org/oral/fluoridation.html. Accessed October 29, 2015.

3. Marinho VCC, Higgins JPT, Logan S, Sheiham A. Fluoride toothpastes for preventing dental caries in children and adolescents. Cochrane Database of Systematic Reviews. 2003; Issue 1. Art. No.: CD002278. DOI: 10.1002/14651858.CD002278.

4. Ahovuo-Saloranta A, Forss H, Walsh T, Hiiri A, Nordblad A, Mäkelä M, Worthington HV. Sealants for preventing dental decay in the permanent teeth. Cochrane Database of Systematic Reviews. 2013; Issue 3. Art. No.: CD001830. DOI: 10.1002/14651858.CD001830.pub4.

http://www.thecommunityguide.org/oral/fluoridation.html

Untreated tooth decay can cause pain and infections that may

lead to problems with eating, speaking, playing, and learning.

About 1 of 5 (20%) children aged 5 to 11 years have at least one untreated decayed tooth.

1 of 7 (13%) adolescents aged 12 to 19 years have at least one untreated decayed tooth.

The percentage of children and adolescents aged 5 to 19 years with untreated tooth decay is twice as high for those from low-income families (25%) compared with children from higher-income households (11%).


1 Dye BA, Xianfen L, Beltrán-Aguilar ED. Selected Oral Health Indicators in the United States 2005–2008. NCHS Data Brief, no. 96. Hyattsville, MD: National Center for Health Statistics, Centers for Disease Control and Prevention; 2012.

More than 17,500 Kansans visit an emergency room each year with

dental pain

Nearly one-third of all adults in the United States have untreated tooth decay. > 40 % of poor adults (20 years and older) have at least one

untreated decayed tooth 16 % of non-poor adults have at least one untreated decayed tooth

Nearly a quarter of all adults have experienced some facial pain in

the past six months Toothaches are the most common pain of the mouth or face

reported by adults. Facial pain can interfere with eating, swallowing, and talking

Adult Oral Health

Periodontal (Gum )Disease Gum disease is mainly the result of infections and inflammation of

the gums and bone that surround and support the teeth 15% of adults aged 35 to 44 years have gum disease 47.2% of adults aged 30 years and older have some form of gum

disease. Severe gum disease affects about 14 % of adults aged 45 to 54 years Gum disease increases with age.

To help prevent or control gum diseases: Brush and floss every day to remove the bacteria that cause gum

disease. See a dentist at least once a year for checkups, or more frequently if

you have any of the warning signs or risk factors

Adult Oral Health (cont.)

Periodontal (Gum ) Disease Warning Signs Bad breath or bad taste that won't go away Red or swollen gums Tender or bleeding gums Painful chewing Loose teeth Sensitive teeth Gums that have pulled away from your teeth Any change in the way your teeth fit together when you

bite Any change in the fit of partial dentures


Periodontal (Gum ) Disease Risk Factors Smoking Diabetes Poor oral hygiene Stress Heredity Crooked teeth Underlying immuno-deficiencies—e.g., AIDS Fillings that have become defective Taking medications that cause dry mouth Bridges that no longer fit properly Female hormonal changes, such as with pregnancy or the use of

oral contraceptives


Employed adults lose more than 164 million hours of work each

year due to oral health problems or dental visits. Does having dental insurance matter? 40% of those without dental benefits report their last dental

checkup was over 1 year ago 77% of those with dental benefits report their last dental visit was

within the past year.

For every adult 19 years or older without medical insurance, there are three without dental insurance. KanCare/KS Medicaid now covers adult basic dental services

(cleaning, x-rays, annual dental screening, emergency extractions) Dental Insurance is an “add-on” under the Affordable Care Act Medicare was not designed to provide routine dental care.


More older people are keeping their natural teeth than

ever before. Adults aged >65 years who live in poverty are twice as

likely as those with higher incomes to have lost all their teeth. Having missing teeth can affect nutrition, since people

without teeth often prefer soft, easily chewed foods. Because dentures are not as efficient for chewing food as

natural teeth, denture wearers also may choose soft foods and avoid fresh fruits and vegetables

Oral Health – Older Adults

Vargas CM, Kramarow EA, Yellowitz JA. The Oral Health of Older Americans[PDF– 85K](http: //www.cdc.gov/nchs/data/ahcd/agingtrends/03oral.pdf) Aging Trends, No. 3. Hyattsville, MD: National Center for Health Statistics, 2001.

http://www.cdc.gov/nchs/data/ahcd/agingtrends/03oral.pdf



Many older Americans take medications for chronic conditions that

have side effects detrimental to their oral health.

Reduction of the flow of saliva increases the risk for oral disease, since saliva contains antimicrobial components as well as minerals that help rebuild tooth enamel attacked by decay-causing bacteria.

Individuals in long-term care facilities—about 5 % of the elderly—take an average of 8 drugs each day.

Common drug categories that cause “dry mouth” Antihistamines Diuretics antidepressants.

Oral Health – Older Adults (cont.)












Adults aged >65 years: 1/3 have untreated dental caries - on the crowns of teeth

(coronal caries) and on tooth roots (because of gum recession; slightly over 40 % have periodontal (gum) disease; 23 % of 65- to 74-year-olds have severe gum disease.

Only 22 % of older persons are covered by dental insurance;

most elderly dental expenses are paid out-of-pocket.

Oral disorders can have a significant impact on the functional, social and psychological well-being of older adults

Oral Health – Older Adults (cont.)





Tooth decay disproportionately affects minorities and

low-income populations. The greatest racial and ethnic disparity among children

aged 2–4 years and aged 6–8 years is seen in Mexican American and black, non-Hispanic children.

Blacks, non-Hispanics, and Mexican Americans aged 35–44 years experience untreated tooth decay nearly twice as much as white, non-Hispanics.

Adults aged 35–44 years with less than a high school education experience untreated tooth decay nearly three times that of adults with at least some college education.

Disparities in Oral Health

Tooth decay disproportionately affects minorities and

low-income populations. Adults aged 35–44 years with less than a high school

education experience destructive periodontal (gum) disease nearly three times that of adults with a least some college education.

Periodontal (gum) Disease is higher in men than women, and greatest among Mexican Americans and Non-Hispanic blacks, and those with less than a high school education.


Numerous factors other than income and ethnicity can

impact oral health status: education level age language barriers cultural factors oral health literacy ability to perform daily oral health care insurance status geography


Skipping preventive dental visits Neglecting to brush Neglecting to floss Using tobacco Using alcohol

Unhealthy behaviors adversely affect oral health

Diabetes Cardiovascular disease Human papillomavirus (HPV) infection HIV/AIDS Osteoporosis Obesity Autoimmune disorders like rheumatoid arthritis.

Medical Conditions that may affect or be affected by poor oral health

According to the CDC, adults with diabetes are almost twice

as likely to have gum disease as non-diabetic patients of equivalent ages.

People with diabetes are at an increased risk for serious gum disease because they are generally more susceptible to bacterial infection, and have a decreased ability to fight bacteria that invade the gums

The relationship between serious gum disease and diabetes is two-way people with diabetes more susceptible to serious gum disease serious gum disease may have the potential to affect blood

glucose

Diabetes and Oral Health

People with developmental disabilities suffer from a

high occurrence of tooth decay and gum disease for a number of reasons: physical conditions like an inability to hold a toothbrush, lack of understanding of how to practice basic personal

oral hygiene, difficulty obtaining treatment.

Older adults (age >65) 70 % have periodontal disease; Medicare does not cover oral health care

Other Groups with Increased Risk of Poor Oral Health

In the individual and small-group markets, dental

coverage for children is an Essential Health Benefit—meaning that it must be available inside and outside of the state Marketplaces, either as part of a health plan or as a stand-alone dental plan. Kids’ parents are not required to buy oral care insurance. Insurers don’t have to offer adult dental coverage.

What about the Affordable Care Act and oral health services?

The “Dental Care Service Desert” is a designation that describes

geographic areas where there are no dental services and where the closest dental office is at least a half-hour drive from residents’ homes.

In 2009, at least 57,000 Kansans lived in Dental Care Service Deserts and that number is increasing.

Kansas has a shortage of primary care dentists and Extended Care Permit dental hygienists (ECPs) in certain rural areas of the state fewer people living in rural communities; limited access to all types of health care services; an aging dentist workforce; high costs necessary to run and maintain a viable dental practice

Oral Health Workforce in Kansas

Kimminau K, Wellever A. Mapping the Rural Kansas Dental Workforce: Implications for Population Oral Health 2011 http://www.kdheks.gov/ohi/download/Mapping_the_Rural_Kansas_Dental_Workforce.pdf

Can be mobile, responsive to community need, and promote oral

disease prevention and oral health care in many communities

Most are currently not working in very rural communities

Requirements must be experienced dental hygienist work under the supervision of a dentist deliver screening, oral prophylaxis (cleaning), and educational outreach

Settings where ECPs are allowed to practice nursing homes public health departments schools some other public settings

Oral Health Workforce in Kansas: Extended Care Permit hygienists

(ECPs)


People currently not served by the oral health system include

three major subpopulations: People who cannot easily travel for services (including the

elderly, people with disabilities, and those without means of transportation)

Those without dental insurance and those who cannot afford to pay out-of-pocket for care; and

Medicaid/HealthWave enrollees who cannot find a dental provider willing to accept patients that have public insurance as their only source of payment.

Oral Health Workforce in Kansas


Kansas Mission of Mercy (KMOM) Sponsored by the Kansas Dental Charitable Foundation Primary goal: to relieve pain due to untreated dental needs 2016 – Topeka, January 29-30

Give Kids a Smile (GKAS) Sponsored by the American Dental association Foundation Primary goal: provide dental care for children who don’t receive

it for whatever reason; establish a dental home for these children

Nationally, dental practices offer free care on set schedule GKAS in Sedgwick County sponsored by the Wichita Sedgwick

County Oral Health Coalition 1-day event serves uninsured children aged 0-12 years of age

Community-Driven Dental Care for Underserved Populations: Events

“The dental health crisis is caused by a failure to prevent disease.

We cannot drill, fill and extract our way out of this crisis without a

fundamentally different approach: one that accentuates disease prevention.”

2013 Prevention Summit: Advancing America’s Oral Health November 18–20, 2013 • Chicago, IL

Extracting teeth, filling cavities, or performing root canal

therapy are comparatively costly approaches to treating dental disease, when compared with preventive measures.

While emergency and restorative interventions like fillings and root canal therapy can stop disease, they cannot restore the natural tooth and gum tissue lost because of it.

The most cost-effective way to ensure optimal dental health in both children and adults is through prevention, education and behavioral modifications.

Maintaining Oral Health through Prevention

Topical fluoride application: $31.70 (child), $32.59

(adult) Periodic examination by a general dentist: $44.10 Prophylaxis (cleaning): $61.14 (child), $82.08 (adult) Sealant application per tooth: $44.12

National Average Costs of Common Preventive Services

Amalgam filling, two-surface, in permanent tooth:

$146.61 Resin-based composite filling, rear tooth: $197.09 Root canal on a molar (excluding final crown):

$918.88 Porcelain Crown: $1,026.30 Extraction of an erupted tooth or root visible above

the gumline: $147.32

National Average Costs of Common Restorative Services

Individual Level - Children Use fluoride toothpaste. If your child is younger than age 6, watch your child brush their

teeth. Make sure your child only uses a pea-sized amount of toothpaste and always spits it out rather than swallows it.

If your child is younger than age 2, do not use fluoride toothpaste unless your doctor or dentist tells you to.

Model toothbrushing for your children/grandchildren

Talk to your pediatrician, family doctor, nurse, or dentist about putting topical fluoride/fluoride varnish on your child’s teeth as soon as the first tooth appears in the mouth.

What Is Included in Prevention?

Individual Level - Children If your drinking water is not fluoridated, ask your dentist,

family doctor, or pediatrician if your child needs oral fluoride supplements

Talk to your child's dentist about dental sealants. Sealants protect teeth from decay.

Have your child visit a dentist for a first checkup by age 1


Individual Level – Adults Drink fluoridated water and use a fluoride toothpaste.

Fluoride's protection against tooth decay works at all ages.

Take care of your teeth and gums. Thorough tooth brushing and flossing to reduce dental plaque can prevent gingivitis—the mildest form of gum disease.

Avoid tobacco. In addition to the general health risks posed by tobacco, smokers have 4 times the risk of developing gum disease compared to non-smokers. Tobacco use in any form—cigarette, pipes, and smokeless (spit) tobacco—increases the risk for gum disease, oral and throat cancers, and oral fungal infection (candidiasis). Spit tobacco containing sugar increases the risk of tooth decay.


Individual Level – Adults Limit alcohol. Heavy use of alcohol is also a risk factor for

oral and throat cancers. When used alone, alcohol and tobacco are risk factors for oral cancers, but when used in combination the effects of alcohol and tobacco are even greater.

Eat wisely. Limit snacks. Eat fruits and vegetables to stimulate salivary flow to aid remineralization of tooth surfaces with early stages of tooth decay.

Visit the dentist regularly. Professional tooth cleaning (prophylaxis) is important for preventing oral problems, especially when self-care is difficult.


Individual Level – Adults (cont.) Diabetic patients: maintain control of the disease to

prevent complications, including an increased risk of gum disease.

If medications produce a dry mouth, ask your doctor if there are other drugs that can be substituted. If dry mouth cannot be avoided, drink plenty of water, chew sugarless gum, and avoid tobacco and alcohol.

Have an oral health check-up before beginning cancer treatment. Treating existing oral health problems before cancer therapy may help prevent or limit oral complications or tissue damage.


Professional Level Dentists and PCPs Use of fluoride varnish and dental sealants for all pediatric patients Participate in school screening efforts Participate in KanCare or pro-bono care for underserved populations Discuss tobacco use avoidance with all patients for all health reasons,

including oral health

Primary Care Physicians and Pediatricians – Encourage parents to take child to dentist as soon as first tooth erupts Conduct a visual examination of mouth at each visit and encourage

dentist follow-up if any concerns are noted Apply fluoride varnish Become aware of oral health resources in the community Discuss tobacco use avoidance with all patients for all health reasons,

including oral health


Community Level Community Water Fluoridation Community Dental Sealant Programs Tobacco prevention & cessation programs to prevent gum

disease and oral and pharyngeal cancers Participation in community care events for underserved

population (KMOM & GKAS) Education & oral health literacy


Fluoridated water has fluoride at a level that is effective for preventing

cavities; this can occur naturally or by adding fluoride. More than 70 years of scientific research has consistently shown that an

optimal level of fluoride in community water is safe and effective in preventing tooth decay by at least 25% in both children and adults.

The Centers for Disease control and Prevention (CDC) named community water fluoridation one of 10 great public health achievements of the 20th century.

Fluoridation has decreased tooth decay in America by 30% to 50%. The per-capita cost of water fluoridation over a person’s lifetime equals

the cost of a single dental filling. In the United States, fluoridated water saves more than $4.6 billion

annually in dental costs.

Community Water Fluoridation: Weighing the Costs Against the

Benefits

American Dental Association http://www.ada.org/en/public-programs/advocating-for-the-public/fluoride-and-fluoridation CDC Report, “Oral Health: Preventing Cavities, Gum Disease, and Oral Cancers,” 2004. Delta Dental Children’s Oral Health Survey, 2009. CDC MMWR Populations Receiving Optimally Fluoridated Drinking Water, 2008. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5727aı.htm

Goal: promote sealant use among private practitioners

and through community-based programs. Conduct promotional/education activities to consumers,

community leaders, and third-party payers

Provide sealants directly to vulnerable populations who are less likely to receive private dental care

Community Dental Sealant Programs

1. Develop and enforce a school policy on tobacco use.

2. Provide instruction about the short- and long-term negative physiologic and social consequences of tobacco use, social influences on tobacco use, peer norms regarding tobacco use, and refusal skills. 3. Provide tobacco-use-prevention education in kindergarten through 12th grade; this instruction should be especially intensive in junior high or middle school and reinforced in high school. 4. Provide program-specific training for teachers. 5. Involve parents or families in support of school-based programs to prevent tobacco use. 6. Support cessation efforts among students and all school staff who use tobacco. 7. Assess the tobacco-use-prevention program at regular intervals.

School-Based Tobacco Prevention

Programs prevent gum disease and oral and pharyngeal cancers Kansas Tobacco Quitline 1-800-QUIT-NOW (1-800-784-8669)

Confidential, personalized support Readiness quiz Cost savings calculator Telephone assistance in English or Spanish and

translation for more then 150 other languages Quit Guide – workbook Quit Coach – one-on-one support Web Coach – online access to highly trained coaches by

live chat or e-mail Text2Quit – connects you with coach from cell phone Mobile Application

Tobacco Prevention & Cessation

http://www.kdheks.gov/tobacco/download/Quitline_Fact_Sheet.pdf

A social movement has two compelling

requirements: A hot cause that rouses emotion, and a cool solution that is unconventional, collective, easy to

adopt, and not cognitively burdensome.

“Oral health requires a social movement.” Hayagreeva Rao, Ph.D.

Atholl McBean Professor of Organizational Behavior and Human Resources, Stanford University

Educate Model healthy eating, drinking and good oral care at all

events Include oral health messages in church bulletins Volunteer to support school-based screenings Utilize congregation’s transportation to take people to dental

appointments Facilitate expansion of Give Kids a Smile in your community Work on increasing oral health literacy in the community* Advocate for tobacco policies, community water fluoridation,

and Medicaid expansion

Opportunities for Faith Communities

Oral health literacy is the “degree to which individuals have

the capacity to obtain, process and understand basic oral health information and services needed to make appropriate health decisions’, a definition consistent with that of general health literacy.

Limited oral health literacy is associated with inaccurate knowledge about preventive measures such as water fluoridation, dental care visits, and oral health-related quality of life.

Oral health literacy skills are critical to empowering

individuals' ability to improve their own oral health and that of family members.

Oral Health Literacy*

** Healthy People 2010. Available at: http://www.healthypeople.gov

Good oral health is a significant part of our overall health and

quality of life.

What will you do to improve your oral health and that of your community?

november 10, 2015 learning community webinar€¦ · teeth. having missing teeth can affect...

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