pew children’s dental campaign
TRANSCRIPT
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Pew Children’s Dental Campaign
From the Community to the Clinic: Conversations About Fluoride
2014 National Primary Oral Health Conference
William Maas, DDS, MPH, MS, The Pew Charitable Trusts
Mary McNamara, The Pew Charitable Trusts
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26%
37%
50% 56%
58%
0%
10%
20%
30%
40%
50%
60%
70%
80%
% C
ari
es-
Fre
e
1971-73 1979-80 1986-87 1988-94 1999-2002Source: National Survey Findings
Ages 5-17 years Ages 6-19 years
Trends in Cavity-Free School Children (Permanent Teeth)
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• Wichita and Portland?
• Attempts to discontinue CWF in your community?
• Attempts to discontinue CWF in nearby communities (state or region)?
Rollbacks are highly leveraged by opponents of CWF.
Setbacks and “Rollbacks”
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Involvement of Community Health Professionals Makes a Difference
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www.cdhp.org
“Despite water fluoridation’s
being used for more than
one-half of a century to
prevent dental caries . . . a
considerable degree of
misunderstanding remains
about its purpose and
effects.”
The Concern:
(Source: M.L.R. Melbye & J.M. Armfield, Journal of the
American Dental Association, January 2013, Vol. 144, pp.
65-75)
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www.cdhp.org
“Misinformation and
unsubstantiated concerns
regarding water fluoridation
are critical public health
issues because the
introduction of fluoridation
frequently relies on the
outcome of community
consultation, or more
directly on a public
referendum …”
The Concern:
(Source: M.L.R. Melbye & J.M. Armfield, Journal of the
American Dental Association, January 2013, Vol. 144, pp.
65-75)
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www.cdhp.org
“Unfortunately,
researchers in several
studies have indicated
that the percentage of
people who obtain
information about water
fluoridation from dentists
is quite low. ”
Dentists’ Role:
(Source: M.L.R. Melbye & J.M. Armfield, Journal of the
American Dental Association, January 2013, Vol. 144, pp.
65-75)
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www.cdhp.org
Dentists have “a major
responsibility” to convey
the importance of water
fluoridation.
“Evidence suggests that, in
terms of the relative effect
on individual and
population oral health
outcomes, dentists tend to
overemphasize oral
hygiene compared with
use of fluorides.”
Dentists’ Role:
(Source: M.L.R. Melbye & J.M. Armfield, Journal of the
American Dental Association, January 2013, Vol. 144, pp.
65-75)
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www.cdhp.org
• Not seeing this topic as
an important public
health issue
• Needing preparation to
discuss the science
and/or perform an
advocacy role
• Concerns about negative
reactions from patients
Possible Barriers:
(Source: M.L.R. Melbye & J.M. Armfield, Journal of the
American Dental Association, January 2013, Vol. 144, pp.
65-75)
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What we’ll cover: • What CHC health professionals should know
about CWF?
• What the public knows?
• How the public gets their information?
• How the public perceives risk?
• Tips for effective communication
• Chairside “toolkit” for fluoride conversations – Common Questions
– Fluoride Safety
– Fluorosis Facts (parents and health professionals)
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U.S. Task Force on Community Preventive Services strongly recommends CWF
• Updated April 2013
Fluoridation Prevents Tooth Decay
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Fluoridation Works Throughout the Lifespan
11/5/2013
“Fluoridation is the single most effective public health measure to prevent tooth decay and improve oral health over a lifetime, for both children and adults.”
--David Satcher, MD, PhD Surgeon General (1998-2002)
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Fluoridation reduces tooth decay about 25%
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Fluoridation still works in the U.S. … even in communities where children brush with fluoridated
toothpaste and get fluoride treatments at the dentist.
National survey of 40,000 schoolchildren (1986-87):
– Almost all toothpaste had fluoride
– Twice annual fluoride treatments were common
Findings:
– Regional data demonstrated “halo effect”
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Fluoridation is Safe
• The Environmental Protection Agency (EPA) is responsible for regulating public drinking water and enforcing the Safe Drinking Water Act.
• The EPA does not have a position per se on the fluoridation, only on the level of fluoride in the drinking water.
• Fluoride occurs in U.S. water supplies at levels from 0.1 to 8.0 mg/L or parts per million (ppm).
• The EPA does not permit levels above 4.0 mg/L to be used for drinking water.
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National Research Council has Weighed and Debated all the Evidence • The EPA is guided by the National Research Council
NRC, for fluoride and other issues.
• No findings of the 2006 NRC report question the safety of fluoride at 0.7-1.2 mg/L.
• Know the four page Report in Brief.
• Future EPA action will address severe dental fluorosis, the well known adverse health effect of 2-4 mg/L, not the imagined health effects claimed by opponents.
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Does Fluoride Affect IQ?
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Fluoridation is Equitable
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Every $1 invested in water fluoridation
Saves $38 in unnecessary dental costs
Fluoridation is Cost-effective
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“Fluoridation is the single most important commitment a community can make to the oral health of its children and to future generations.” Dr. C. Everett Koop Surgeon General, 1982-1989
Fluoridation is Cost-effective
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Dental Fluorosis (severe) Dental Fluorosis (mild)
Fluorosis: Old Issue, Better Understanding
Our better understanding enables us to make sound policy decisions,
IF we can overcome the strategies and tactics of fluoridation opponents.
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2014 National Primary Oral Health Conference
Mary McNamara, The Pew Charitable Trusts
Conversations about Fluoride:
In the Clinic or in the Community
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Well informedof fluoridation
Just somewhatinformed or notat all informed
20%
80%
Public Knowledge of Community Water Fluoridation
(Source: Survey commissioned by the Pew Charitable Trusts survey, conducted in October 2010 by SalterMitchell LLC of 1,000 U.S. adults)
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How do people hear about fluoride?
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Groups most likely to oppose:
• under age 34
• men
• Hispanics
• Asians
• those who don’t currently have CWF
• those who describe themselves as conservative or liberal
(as distinct from middle of the road)
• those who report being more knowledgeable of CWF
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Age Gap
Attitude
Toward
CWF
Total
Sample
(n=1503)
Age 18-34
(n=416)
Age 35+
(n=1807)
Favor 44% 27% 50%
Neutral 34% 40% 32%
Oppose 23% 33% 19%
• Respondents under the age of 35 were significantly more likely to be
neutral or opposed to fluoridation compared to older respondents.
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Tested Messages
Statement (% saying makes them much
more supportive of CWF)
Total
(n=1503)
Initially in
Favor of
CWF
Initially
Neutral
Initially
Opposed
to CWF
Oral health is an important part of overall
health
44% 65% 35% 18%
Proven public health measure supported by
major medical organizations.
43 66 32 14
CWF helps prevent cavities in kids 40 63 29 14
60 years ago Americans routinely lost all their
teeth after age 65.
40 62 27 15
23 million American kids don’t have dental
insurance
38 59 25 14
Benefits all by lowering healthcare costs 36 55 26 14
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State
Mandate
Credibility on Issues of Low Concern
All other factors 15-20% Competence/Expertise
80-85%
Believe you if you are an expert
When you have not heard the
anti arguments.
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All other factors
15-20%
Honesty/openness 15-20%
Listening/caring 50%
Competence/expertise 15-20%
Credibility on Issues of High Concern
Science
Emotion
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Hazard (real risk) Versus Outrage (perceived risk)
August 28, 2014
According to the World Health Organization, shark attacks typically kill 10
people a year, mosquitos kill 750-thousand people a year.
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Perception of risk
• Voluntary versus Imposed
• Natural versus Manmade
• Familiar versus exotic
• Generated by a trusted source versus Generated by an
untrusted source
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A Primer on Health Risk Communication Principles and Practices. U.S. Department of Health and Human
Services, Public Health Service, Agency for Toxic
Substances and Disease Registry. 1994.
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Fluoride refusal and vaccination
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• Both prevent diseases
• Refusal of preventive care can lead to treatments
that place additional strain on the health care
system.
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Fluoride refusal and vaccination
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• 36.2% who refused immunizations also refused topical
fluoride,
• Fluoride and vaccination refusal most prevalent
35 and younger
White
4 years of college or more
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Effective Messaging
• Empathy frame: Acknowledging people may have fears and
concerns about fluoride helped to ease both. People get
confused when they hear conflicting information, and
discounting their concerns makes people defensive.
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• Importance of authority: People are pleased to learn that
recognizable organizations not only support fluoride, but have
researched it.
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What Public Health Can Learn from “Parks & Rec”
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"All I have on my side is facts and science...and people hate facts
and science".
-Leslie Knope
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What Public Health Can Learn from “Parks & Rec”
• Science, facts, and reason are not always enough to
change public attitudes and behaviors.
• Language matters
• Keep trying
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Introducing the
Chairside Fluoride “Toolkit”
Joint project of NNOHA and the American Academy
of Pediatrics
Available for download at ILikeMyTeeth.org
• Common Questions about Fluoride
• Fluoride Safety: Guide for Health Professionals
• Fluorosis Facts: Guide for Health Professionals
• Fluorosis Facts: Guide for Parents/Caregivers
• Say This, Not That
AAP Clinical Report, Fluoride Use in Caries Prevention
in Primary Care Settings, will be released August 25.
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Chairside Tools
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Chairside Tools
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Chairside Tools
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Keep informed…
…of these and other oral health issues by receiving Pew's monthly
e-newsletter – Dental News & Views.
Send an email to [email protected] with the words “Sign
me up“ in the subject line.
August 28, 2014