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IPE: Current and emerging issues in dental public health

Terms in this set (76)

most prevalent chronic disease in children and adults?
dental caries (tooth decay) even though its preventable
Caries has significantly decreased for most Americans over the past ______________, disparities remain among some _________
4 decades
population groups
dental caries
multifactorial etiology
mostly occurs in molars in perm teeth
early childhood caries (ECC) is
the presence of 1 or more decayed (non-cavitated or cavitated lesions), missing (due to caries), or filled tooth surfaces in any primary tooth in a child 71 months of age or younger
severe ECC (S-ECC)
-In children younger than 3 years of age, any sign of smooth-surface caries
-From ages 3 through 5, 1 or more cavitated, missing (due to caries), or filled smooth surfaces in primary maxillary anterior teeth or a decayed,missing, or filled score of ≥4 (age 3), ≥5 (age 4), or ≥6 (age 5) surfaces
caries experience
-the presence of either untreated or treated (restored or filled) tooth decay.
-Proxy for caries prevention
untreated caries
Proxy for access to treatment/services
In spite of several milestones in dental innovations, presently, poor oral health continues to exist as a silent epidemic, where __________ disproportionately suffer from major and often preventable oral diseases, which results in __________
underserved populations
great societal costs
public health importance of oral diseases
-High prevalence
►High cost of treatment
►Considerable impact on individuals
►Affects quality of life
►Causes are know
►Easy and cheap to prevent
►Diagnosis is easy
Dental caries is the most common, chronic disease of childhood, and is usually established before age
2
Caries in primary teeth for preschool children increasing from _________between 1988 and 2004.
24% to 28%
Consequences of ECC include
a higher risk of new carious lesions in both the primary and permanent dentitions
untreated tooth decay ________ in young children
declined
since 1999-2004 the prevalence of _________ in primary teeth of children aged 2-5 years has dropped by __________
untreated tooth decay
half

(Mexican American and low-income children saw the greatest declines)
cost of ECC
-death
-hospital costs (morbidity associated with treatment like speech and nutrition)
-family associated morbidity (missed days from school/work for parents, childcare)
-costs associated with ECC
cost effectiveness early and routine preventative care
Children who had their first preventive dental visit by age 1 were more likely to have subsequent preventive visits but were not more likely to have subsequent restorative or emergency visits

The age at the first preventive dental visit had a significant positive effect on dentally related expenditures, with the average dentally related costs being less for children who received earlier preventive care
in 2015, ________ of Michigan medicaid beneficiaries below the age of 2 had at least 1 dental visit
6.3%
AGE ONE VISIT AND MICHIGAN DENTISTS
Managing behavior of young children was the biggest barrier to providing care.
_____ of dentists indicated they were not interested in treating young children
34%
providing dental care for infants and young children can reduce rates of
ECC
For the preventing and controlling the dental disease, strategies should -
-Stop/delay the onset of tooth decay in the primary teeth
-Identify and recognize early signs of tooth decay
-Treat tooth decay early
-Prevent new and recurrent tooth decay
For promoting systems of care, strategies should
1. Provide an adequate and competent workforce
2. Integrate oral health and coordinate dental care services with care systems supporting young children
dental caries in school aged children
The most common chronic disease among children 5 to 17 years -five times more common than asthma
-national estimates show that as much as _____ of all dental caries in schoolchildren occurs in pits and fissures
-what teeth are at highest risk for tooth decay?
90%
permanent 1st and 2nd molars
Sealants are clinically effective in .
preventing tooth decay as long as the sealant is retained on the tooth
Studies have shown that there is a ________drop in decay of molars for up to five years after a sealant is applied.
60%
about ____ of kids ages 6-11 years don't get dental sealants
about ______ of low income kids ages 6-9 don't get dental sealants
60%
75%
The 5-year tooth decay rate was lower for
sealed tooth surfaces with incipient caries compared to unsealed tooth surfaces (10.8 percent versus 51.8 percent).
a 10 year study showed that caries _______under a dental sealant placed over __________ that were no more than_________of the tooth
did not progress
cavitated lesions
halfway through the dentin
The most frequent cause of infant deaths in Michigan is
low birth weight /premature births
what is a critical aspect of prevention of tooth decay in young children?
Perinatal Oral Health (conception to first year of age)
evidence shows that oral health complications may be associated with
adverse pregnancy outcomes
why is perinatal oral health important for the mother???
-Periodontal disease _________ to affect pregnancy outcomes
-May reduce ________ deliveries. No conclusive evidence yet that treatment for periodontal disease will reduce the risk of ______
-may have the potential
-preterm and low birth weight, preterm birth
why is perinatal oral health important for the infant ???
--has the potential to decrease ______ and improve oral health for infant
-Promote mother's ______________ of oral health behaviors
-ECC
-positive role-modeling
maternal child transmission
-begins around
-depends on
-4-6 months
-direct transmission of saliva and frequent exposure with the bacteria by the mother
Evidence for this Maternal Child Transmission comes from several studies revealing that
the genetic makeup of the mutans streptococci in mothers and their babies are similar or identical

(Studies have also shown that if we can reduce the amount of mutans streptococci inmothers' mouths we can delay the onset of caries activity in their children's mouth)
the most cost-effective prevention for cavities begins with
pregnant women and children ages 0-5
preventative oral health services provided by nondental providers in medical settings were associated with ______________but were not associated with _______________________ Efforts to promote oral health in medical settings should continue. Strategies to promote physician-dentist collaborations are needed to improve continuity of care for children receiving dental services in medical settings

Results from this study indicate that .... they express little belief in the __________ through application of fluoride varnish."" .... about the ________ who would care for the children identified by them to ______
-a reduction in caries experience in young children
-Improvement in subsequent use of treatment services in dental settings.
- ability of children's medical providers to screen for dental problems or prevent dental problems
-inability of medical providers in finding dentists
-be at risk for oral disease or in need of dental treatment
Michigan Initiative for Mother and Infant Oral Health
1 million grant program at Detroit Mercy Dental to improve oral health outcomes for at risk pregnant women and children
Data on the relationship between ___________with dental caries is well established. Therefore, regardless of the potential for improved oral health to improve pregnancy outcomes, public policies that support comprehensive dental services for vulnerable women of childbearing age should be expanded, so not only their own oral and general health is safeguarded but also so that their children's _______
-maternal and child experience

-risk of caries is reduced
interventions
Infants & Young Children (0-5 Yrs.) / ECC

School aged Children (6-8 Yrs. - 1st molar; 12-14Yrs. - 2nd molar)
Infants & Young Children (0-5 Yrs.) / ECC
-Stop/delay the onset of tooth decay in the primary teeth
-Age one visit
-Head Start Prevention programs (Fluoride varnish programs)
-Oral Health at Well Child Visits (Screening & referral for age one visits, Fluoride varnish application)
-CWF (community water fluoridation)
School aged Children (6-8 Yrs. - 1st molar; 12-14Yrs. - 2nd molar)
Application of dental sealants (School sealant programs, School linked/based dental clinics / mobile clinics)

CWF
dental caries cannot be ______ but it can be _____
treated away
prevented
prevalence of 2 or more 9 selected chronic conditions among adults aged 45 and over by age and sex
1. Hypertension
2. Heart disease
3. Diabetes
4. Cancer
5. Stroke
6. Chronic bronchitis
7. Emphysema
8. Asthma
9. Kidney disease
prescription drug use
oral health care status of 65+
-___ have visited a dentist or dental clinic in past year
-____ have lost all of their natural teeth due to tooth decay or gum disease
-________ have lost 6 or more teeth due to tooth decay or gum disease
46.3%
17.3%
36%
dental workforce competency
-comfort level treating vulnerable elderly patients
dental workforce competency
-areas of treatment where information is needed on vulnerable elderly patient care
community water fluoridation
-the controlled adjustment and monitoring of fluoride in community drinking water to reach optimal fluoride concentrations for caries prevention
Since 1962 the U.S. Public Health Service has recommended that community drinking waters contain ______ fluoride depending on the annual average maximum daily air temperature of the area.
0.7 to 1.2 ppm

new recommendation is 0.7 ppm
Water fluoridation benefits
all residents served by community water supplies regardless of socioeconomic status
Number of American served by public water systems that do not provide fluoridated drinking water
25.6% (or 72,706,665)
Number of American treated at hospital emergency rooms in 2009 for preventable dental problems
830,590
Estimated rate by which community water fluoridation reduces toothdecay throughout a person's lifetime
25%
Lifetime cost of treating one decayed molar
$6,105
Amount of money communities save for every dollar invested in water fluoridation
$1 spent = $38 saved
controversy of community water fluoridation
-Safety concerns - cancer, heart and kidney diseases
► Personal choice/freedom
► Communist plot
► Mass medication
► "Fluoridation discriminates against those with low incomes"
the dentist shortage
Dentists Nationally, increases in supply will not meet the increases in demand for dentists, which will exacerbate the existing shortage.
Assuming that the workforce participation patterns remain unchanged, the supply of dentists is expected to grow by 11,800 full- time equivalents (FTEs) - from 190,800 in 2012 to 202,600 in 2025 - a _______ increase nationally.

The national demand for dentists is projected to grow by 20,400 FTEs- from 197,800 in 2012 to 218,200 in 2025 - a _____ increase.
6 percent

10 percent
states with dentist shortage?
ALL 50 but greatest shortfalls in 2025 are California, Florida, and New York
dental workforce is
aging
In 2018, the average age of retirement age among dentists was ____ up from 66.5 in 2008.
69.4
As of 2019, there are _______ per 100,000 U.S. population.
61.1 dentists working in dentistry
As of 2019, about ______- reported that their practice, research, or administration area is an ADA- recognized specialty.
one in five professionally active dentists (21.0%)
oral health workforce diversity
Workforce diversity does not mirror US population

More white/asian dentists, less black/hispanic
female and under-represented minority (URM) first-year dental students as a % of enrollment
nearly doubled during 1980s

since 1990 % female students increased at a much slower pace and URM students have fluctuated

in 2018, female dental students outnumbered male students for the first time
dental health professional shortage areas as of January 1 2021
access to dental services stats
untreated caries by age
mainly 20-64

Caries rates are going down for all age groups but disparities exist.

In spite of the decrease, a large portion of the population has untreated caries
percent of population who visited a general dentist in the past 12 months by poverty level
much less when below poverty line
dentist participation in medicaid or CHIP
38% dentists
69% physicians

more female than male dentists and most in pediatric dentists and dentists 21-34
factors and impacts on IMPROVING ORAL HEALTH
what oral disease has significant public health implications
-periodontitis
-gingivitis
-dental caries
-oral cancers
-all of the above
dental caries
what are examples of current challenges in preventing caries
access to care
cost
insurance
compliance

etc (just a poll Q)
is community water fluoridation safe?
yes
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