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Medical-Dental Partnerships To Promote Oral Health

Medical-Dental Partnerships To Promote Oral Health

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Medical-Dental Partnerships To Promote Oral Health

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  1. Medical-Dental Partnerships To Promote Oral Health Wendy E. Mouradian, MS, MDPediatrics, Pediatric Dentistry, Health Services (Public Health) Children’s Hospital Regional Medical Ctr University of Washington

  2. Acknowledgements • Comprehensive Center for Oral Health Research (NIH - NIDCR) • Maternal and Child Health Bureau, HRSA (Leadership Education in Pediatric Dentistry) • Bureau of Health Professions, HRSA (Interdisciplinary Children’s Oral Health Promotion)

  3. Summit Themes Whatcom County: • Engage community members • Present local data • Discuss “best practices” • Raise awareness of dental caries as an infectious disease • Problem solve: children, adults, elderly

  4. Surgeon General’s Report on Oral Health (2000) • Oral diseases are common and consequential • Linked to overall health and well-being • Profound disparities in oral health status • Disparities: SES, rural, minorities, vulnerable Preventive measures exist • Research / translation of science needed http://www.nidcr.nih.gov/sgr/sgr.htm

  5. Vulnerable Populations • Children • Elderly • Special Needs • Adult populations

  6. Medical-dental Educational Collaborations Journal of Dental Education –Aug 2003 Overview and commentary – children’s oral health • Washington State (family medicine residents) • Mouradian et al • North Carolina (pediatricians, family physicians) • Rozier et al

  7. Medical-dental Educational Collaborations Journal of Dental Education –Dec 2003 Overview and commentary – special pop. • Elderly populations • Pyle et al • Mental retardation, other special needs • Fenton et al

  8. Medical-dental Educational Collaborations Journal of Dental Education –Apr 2004 Overview and commentary -Public health approaches • Kids Get Care (case management model) • Hennessey et al • OPENWIDE (CT – Head Start) • Wolfe et al

  9. Children’s Oral Health • Dental care is most common unmet health need of children • More likely to lack dental insurance • Access to dental care limited u/ Medicaid • Disparities by SES, rural areas, special health needs/disabilities

  10. Impact on Children • Disease burden- 52 million school hours • Pain, infection, growth problems, ER visits • Hospitalizations and surgeries • Long term impact on economic, quality of life • Children with special needs: impact on general health

  11. Reach Children Early • Prevention works • Dental disease develops early <1-2 yrs • Disease transmitted from mother • Reach in primary care, child care, Head Start, educational, social systems

  12. Washington State Smiles Survey, 2000 • Disparities in oral health outcomes by race/ethnicity, SES • Many children lack access to dental care • Washington state data do not compare favorably with national data Kathy Phipps, MPH, DrPH, consulting epidemiologist

  13. Prevalence of ECC Washington 1-year-olds Washington 2-year-olds NHANES III 2-year-olds

  14. 60 54.6 50 46.0 40.7 40 Percent of Children 30 21.6 19.2 16.9 20 10 0 Sealants Untreated Decay 2000 Trends Over Time Caries Experience 1994

  15. Adult Oral Health • Periodontal disease is common • Maternal periodontal disease and LBW • Periodontal and cardiovascular disease • Pulmonary impact of oral disease • Mothers choose health care for families • Oral-systemic health: diabetes, others • Oral cancer: 8000 people die a year

  16. Older Adults • More periodontal disease • More oral-systemic health impacts • More oral cancer • Impact of medications • Long term care facilities • Complex social arrangements

  17. Mental Retardation and Special Needs • Lack of data on oral conditions • Impact of medications, conditions • Down syndrome and periodontal disease • Effect of anti-convulsants • Difficulty with self-care • Complex guardianship, living arrangements

  18. Key themes: Special populations • Importance of oral-systemic interactions: need for interdisciplinary collaboration • Diminished mental/ motor capacity need for special arrangements and emphasis upon prevention • Difficulty accessing care need for better training, other solutions • Complex social and cultural factors • Lack of good data

  19. Context Disparities may worsen: • Demographics:diversity;child poverty; survival those with special needs, elderly • Workforce gaps:not enough dentists; retiring;mostnot in Medicaid; physicians lack training • Policy gaps: lack of insurance; oral care not “medically necessary” (especially impacts special needs population)

  20. Partnership • Department of Pediatric Dentistry • Department of Family Medicine • UW Affiliated Family Practice Residency Network • Department of Medical Education and Bioinformatics

  21. ICOHP Goal 1: Training family medicine residents and faculty in oral health promotion Objectives: • Develop curricula in children’s oral health, 0-5 • Pilot, implement in WWAMI sites • Evaluate effect of training on knowledge, attitudes, behavior • Disseminate curricula

  22. Washington Montana Wyoming Alaska Idaho Family Practice Residency Affiliation Under Negotiation Rural Training Track UW FP Residency Network: Sites

  23. Geographical barriers

  24. Assumptions • Biggest obstacle will be buy-in • Tailor curriculum to physician needs • Integration with dental sector in community critical • Sustainability will require additional work

  25. Focus Groups: Faculty/ Residents, Staff Barriers • Oral health not on their radar screen; lack knowledge/self-efficacy • Providers busy: oral health not a priority • Concerned about the evidence base • Confusion about physician role • Lots of baggage about dentists

  26. Focus Groups: Faculty/ Residents, Staff Opportunities • Care about children in pain • Unable to answer parents’ questions • Prevention is a high priority • Already providing health education • Acutely aware of access issues • Committed to underserved communities

  27. Address Barriers and Opportunities • Increase motivation • Oral health important • Impact on children • Increase practitioner knowledge • Normal dental development • Caries process

  28. Address Barriers and Opportunities • Review evidence base (USPSTF; CDC Fluoride recommendations) • Frame in terms of primary care roles: • Anticipatory guidance • Nutrition/feeding • Injury prevention; emergency management • Special issues for CSHCN

  29. Address Barriers and Opportunities • Address resentment towards dentists: Work with dentists one-on-one: • partner with ABCD, community health clinics, pediatric dental trainees • Increase communication, lines of referral • Reinforce principles of family-centered, culturally competent care • already part of residency culture / training

  30. Modules:Frame to issues raised • Module 1: Public Health Overview; Oral Health Promotion and Practice • Module 2: Normal Dental Development/ Pathology • Module 3: Dental Caries; Collaborating with Dentists • Module 4: Dental Trauma and Emergencies • Module 5: Oral-systemic Health Interactions

  31. Respond to Requests for More Information • Module 6: Atraumatic Restorative Technique • Module 7: Maternal oral health • Module 8: Adolescent oral health • Module 0: Managing the change process

  32. Trainings to date • Seattle • Yakima • Spokane • Olympia • Boise • Anchorage • Pending: Valley, Vancouver

  33. Frame for Primary Care Providers PCP Roles: 1. Anticipatory guidance/ counseling 2. Risk assessment - oral screening, history (maternal history) 3. Applying fluoride varnish 4. Dental referral / collaboration 5. Monitor oral-systemic health interactions 6. Manage simple dental trauma 7. Maternal oral health counseling

  34. North Carolina • North Carolina: Statewide Medicaid program: pediatricians/family practitioners provide oral health education / screening exams / apply fluoride varnishes to young children 0-3 / dental referrals • Partnership: Supported by dental, pediatric, family practice societies

  35. Others to watch • MCH Oral Health training for non-dental providers • http://www.mchoralhealth.org/PediatricOH/index.htm • Minnesota training, fluoride varnishes • http://meded1.ahc.umn.edu/fluoridevarnish/xindex.htm • AAP –presentations for chapters – stay tuned

  36. Medical Mantra • Address medical training gaps • Change perceptions among medical professionals • Integrate oral health into systemsof care especially for vulnerable populations • Developmedical-dental collaborations • Leadership in policy/ education • Standard of practice that includes oral health

  37. Key Points • Disparities in oral disease /access to care • Impact on vulnerable populations • Workforce critical: not enough providers • Prevention is key - if started early • Integrate oral health into overall health • Partnerships are needed to make this happen