Oral Health Care for the Underserved: What Resources Are - PowerPoint PPT Presentation

Oral Health Care for the Underserved: What Resources Are Available? Mitsuko Ikeda Project Director National Network for Oral Health Access 2012 NATIONAL PRIMARY CARE CONFERENCE ON AGING 2012 HEALTH CARE FOR RESIDENTS OF PUBLIC HOUSING TRAINING CONFERENCE

What is NNOHA? • A nationwide network of safety-net oral health providers and their supporters • Established in 1991 by a group of Dental Directors from Federally Qualified Community Health Centers (FQHCs) who recognized the need for peer-to-peer networking, services, and collaboration to most effectively operate Health Center dental programs.

What is NNOHA? • Mission: “To improve the oral health of underserved populations and contribute to overall health through leadership, advocacy, and support to oral health providers in safety- net systems.” • Currently about 2,000 individual members

About Health Center Oral Health Programs • Health Centers are non-profit clinics that provide high-quality health care services to underserved, low-income individuals with little, or no insurance. • 828 Health Centers across the country offer dental services. • In 2010, Health Centers provided dental care to 3.75 million patients. At the same time, Health Centers provided medical care to about 16.8 million patients. • Age 65+: Approximately 7% or 1.76 million • Medical capacity exceeds dental capacity in Health Centers 2010 UDS : http://bphc.hrsa.gov/uds/view.aspx?year=2010

2010 National Public Housing Data • 172,731 total patients  66,545 patients under 19 (38.5%)  97,605 patients ages 19-64 (56.5%)  8,581 patients ages 65 and over (5%) • 38,988 dental patients • 36.1% of Patients best served in a language other than English 2010 National Public Housing Data: http://bphc.hrsa.gov/uds/view.aspx?prog=PH&year=2010

Seniors’ Oral Health • More older people are keeping their natural teeth than ever before. However, among those aged 65 years and over there are sharp differences by income , with those in poverty twice as likely as those with higher incomes to have lost all their teeth. • Many older Americans take medications for chronic conditions that have side effects detrimental to their oral health. These include antihistamines, diuretics, and antidepressants.

Seniors’ Oral Health • One-third of adults aged 65 years and over have untreated dental caries ; slightly over 40 percent have periodontal disease. • Only 22 percent of older persons are covered by dental insurance ; most elderly dental expenses are paid out-of- pocket. http://www.cdc.gov/nchs/pressroom/01facts/olderame.htm#ORAL HEALTH

Access Challenges for Adults & Elders • Transportation • Mobility • Language • System navigation • Lack of dental insurance

Insurance Challenges • Lack of Insurance Options  Medicare = Routine dental care for adults not covered  Medicaid = Most states do not cover routine dental care for adults

Insurance Challenges • Among older adults, approximately 46% age 65-74 and 39% age 75 and over had at least one dental visit. • While 60% of older adults from a high-income family had at least one dental visit during the year, less than 31% of older adults from a poor or low-income family had at least one dental visit during the year. • Approximately 70% of older adults did not have any dental coverage in 2004. 2007 MEPS data • Public housing residents were more than twice as likely as other city residents not to have had a preventive dental visit in the past 2 years. Use of a Population-Based Survey to Describe the Health of Boston Public Housing Residents (2008)

Challenges to Maintaining Oral Health • Medication Use  Affects oral health (e.g. Dry mouth) • Motor control issues • Diet  Current oral health status  Resources/food sufficiency  Access to variety

Access Solutions • Starting a dental program • Medical-Dental Integration  Expanding non-dental providers role in oral health access • Utilizing local / state resources • Workforce Innovation

Starting a Dental Program • How to Start a Dental Clinic:  http://www.nnoha.org/practicemanagement/star tclinic.html • Safety Net Dental Clinic Manual  http://www.dentalclinicmanual.com/

Other NNOHA Resources • Factsheet - "Characteristics of a Quality Oral Health/Dental Program" • Action Guide - "Oral Health and the Patient- Centered Health Home" • Operations Manual for Health Center Oral Health Programs

State & Local Resources • Health Centers • Other FQHC’s and look -alikes • Dental & Dental Hygiene Schools • State Programs  http://www.bphc.org/programs/cib/chronicdiseas e/oralhealth/sohp/Pages/Home.aspx

One-Time Events • Mission of Mercy  Launched by Virginia Dental Association Foundation in 2000  Currently in over 20 states  http://www.adcfmom.org/ • Remote Area Medical (RAM):  http://www.ramusa.org/services/dental. htm

ADA Resources • OralLongevity DVD/Brochure  Educational DVD/Brochure (English/ Spanish) available upon request  www.orallongevity.ada.org • National Coalition Conference: Oral Health of Vulnerable Older Adults and Persons with Disabilities (November 18, 2010)  http://www.ada.org/nccc • Overcoming Obstacles to Oral Health training material  www.adacatalog.org (item P030)

Other Resources • ASTDD Basic Screening Survey for Older Adults Planning and Implementation Packet  http://www.astdd.org/basic-screening-survey-tool/#adults • Smiles for Life  Chapters on geriatric oral health, screening etc  http://www.smilesforlifeoralhealth.org/ • Oral Health America “Wisdom Tooth Project”  http://oralhealthamerica.org/programs/wisdom-tooth- project/ (Work in progress)

Workforce Innovation • RDH Direct-Access States  http://www.adha.org/governmental_affairs/dow nloads/direct_access.pdf • RDH-AP in SNIF • Teledentistry

Contact Us! Mitsuko Ikeda | Project Director mitsuko@nnoha.org National Network for Oral Health Access PMB: 329 3700 Quebec Street, Unit 100 Denver , CO 80207-1639 Phone: (303) 957-0635 Fax: (866) 316-4995

Dan Watt, DDS Dental Director Terry Reilly Health Services, Nampa, Idaho dwatt@trhs.org

Dan Watt, DDS Dental Director, Terry Reilly Health Services, Nampa, ID dwatt@trhs.org

 Oral pathogens found in defective cardiac lesions, aortic aneurisms, carotid artery plaque  Raises C reactive protein and TNC  At this point research not sure if it is a cause or an added effect  Some theories consider anatomic anomalies as cause for oral pathogens to stick to endothelium

 Bacteremia from oral disease cause increases in blood proteins which adversely affects insulin  The rise in blood sugar adversely affects the gingival tissues so periodontal diseases are more rampant (AGE/RAGE)  This symbiotic relationship can lead to a downward spiral in overall health. 

 The biofilm associated with periodontal disease is a reservoir for Diplococcus pneumonii, Helicobactor pylori, Cytomegalo virus, Human papilloma virus and other putative pathogens.  Given the exposure to other possible infective organisms, it is a possible portal of entry for other disease-related microorganisms  Studies show 1 in 10 pneumonia deaths in nursing homes could have been prevented with improve oral hygiene.

 ADA Oral Longevity Initiative (2004-2008) – a collaborative between ADA, ADAF, GlaxoSmith Kline (GSK) to enhance and preserve oral health of older Americans  2005 GSK pledges $1M over three years to ADAF to address the needs of older adults.  2007 Distributed ORAL LONGEVITY BROCHURES, and DVD’s to 155,000 dentists  2008 Focused consumer attention in AARP  Initiated SENIOR SMILES program

120,000 100,000 80,000 (Millions of Dollars) 60,000 40,000 20,000 0 Cancer Heart conditions Dental Diabetes mellitus Normal birth Source: Medical Expenditure Panel Survey 2007, AHRQ, US Dept of Health and Human Services

 CRISIS IN ORAL HEALTH

 47 m have difficulty accessing dental care  17 children received no dental care in 2009  Over ¼ adults age 65+ have no teeth  830,000 visits to E.R for dental conditions in 2009, up 16% since 2006  60% of kids have caries  Dentists per capita are declining especially those treating low income

3% needed urgent care 17% retained root tips 28% untreated caries 28% soft tissue problems 63% had dentures – 59% unsatisfactory

 Change perceptions – Oral Health Matters  Overcome barriers..and replicate effective programs  Build science base- accelerate science transfer  Increase workforce diversity, capacity, & flexibility  Increase collaborations with extant aging networks  Up to professions, policymakers, and the public to determine next steps  So what has happened??

• 50 % of elderly (65+) perceive their dental health as poor • 33% of the elderly have untreated cavities, but this is a low estimate as 43% visit the dentist • Low income elderly suffer more severe tooth loss than their wealthier counterparts • Gum disease in 41% of the elderly