Oral Health in Oral Health in Massachusetts Massachusetts - - PDF document

Oral Health in Oral Health in Massachusetts Massachusetts

Catherine Hayes, DMD, Dr.Med.Sc. Catherine Hayes, DMD, Dr.Med.Sc. Professor and Chair Professor and Chair Department of Public Health and Department of Public Health and Community Service Community Service Tufts University School of Dental Medicine Tufts University School of Dental Medicine

Surgeon General's Report on Surgeon General's Report on Oral Health Oral Health – – May, 2000 May, 2000

Focused on the relationship between oral Focused on the relationship between oral health and overall good health throughout health and overall good health throughout life life Identified a "silent epidemic" of dental and Identified a "silent epidemic" of dental and

• ral diseases that burdens some population
• ral diseases that burdens some population

groups groups Significant disparity between racial and Significant disparity between racial and socioeconomic groups in regards to oral socioeconomic groups in regards to oral health and ensuing overall health issues health and ensuing overall health issues

Surgeon General Surgeon General’ ’s Report s Report

Lack of awareness of the importance of Lack of awareness of the importance of

• ral health among the public
• ral health among the public

The association between oral health The association between oral health problems and other health problems problems and other health problems Mouth as a mirror for general health Mouth as a mirror for general health and well and well-

• being

being

National Call for Action National Call for Action

The Surgeon General The Surgeon General called for called for action action to promote access to oral to promote access to oral health care for all Americans, health care for all Americans, especially the disadvantaged and especially the disadvantaged and minority children found to be at minority children found to be at greatest risk for severe medical greatest risk for severe medical complications resulting from complications resulting from minimal oral care and treatment minimal oral care and treatment

National Call for Action National Call for Action

Change Perceptions of Oral Health Change Perceptions of Oral Health Overcome Barriers by Replicating Overcome Barriers by Replicating Effective Programs Effective Programs Build Science Base and Accelerate Build Science Base and Accelerate Transfer Transfer Increase Oral Heath Workforce Diversity, Increase Oral Heath Workforce Diversity, Capacity and Flexibility Capacity and Flexibility Increase Collaborations Increase Collaborations

Massachusetts Oral Health Report Massachusetts Oral Health Report October 2006 October 2006

Many Massachusetts residents lack easy Many Massachusetts residents lack easy access to routine dental care access to routine dental care Profound impacts on overall health and Profound impacts on overall health and social functioning social functioning The greatest barriers to access to dental The greatest barriers to access to dental care are experienced by minorities, the care are experienced by minorities, the poor, the uninsured, and persons in poor, the uninsured, and persons in relatively poor health relatively poor health

Massachusetts Oral Health Report Massachusetts Oral Health Report -

• 2006

2006

Access to dental care may also be Access to dental care may also be powerfully impacted by powerfully impacted by

– – the availability of dentists the availability of dentists – – the geographic distribution of dentists the geographic distribution of dentists – – number and distribution of dentists who number and distribution of dentists who accept MassHealth(Medicaid) accept MassHealth(Medicaid)

Massachusetts Oral Health Report Massachusetts Oral Health Report -

• 2006

2006

Many rural areas of Massachusetts lack easy access Many rural areas of Massachusetts lack easy access to dental care providers. to dental care providers. 30% of cities/towns in Massachusetts don 30% of cities/towns in Massachusetts don’ ’t have t have enough dentists to care for the people who live enough dentists to care for the people who live there. there. 69 cities/towns in Massachusetts have NO dentist. 69 cities/towns in Massachusetts have NO dentist. 58% of cities/towns in Massachusetts have no dental 58% of cities/towns in Massachusetts have no dental specialists. specialists.

Massachusetts Oral Health Report Massachusetts Oral Health Report -

• 2006

2006

65% of cities/towns in Massachusetts have 65% of cities/towns in Massachusetts have no pediatric dentist. no pediatric dentist. More than 50% of cities/towns in More than 50% of cities/towns in Massachusetts have no dentist that accepts Massachusetts have no dentist that accepts MassHealth (Medicaid). MassHealth (Medicaid). The majority of MassHealth dentists in The majority of MassHealth dentists in Massachusetts are clustered in urban areas. Massachusetts are clustered in urban areas.

The Oral Health of The Oral Health of Massachusetts Children Massachusetts Children -

• 2008

2008

Overall we have made some progress in improving oral Overall we have made some progress in improving oral health, on average, by reducing caries experience, health, on average, by reducing caries experience, percent of children with untreated decay and the number percent of children with untreated decay and the number

• f children who have received dental sealants.
• f children who have received dental sealants.

Dental disease continues to be a significant health issue Dental disease continues to be a significant health issue for many children at an unacceptable level for such a for many children at an unacceptable level for such a preventable disease. preventable disease. Significant disparities also exist along race and ethnicity, Significant disparities also exist along race and ethnicity, income status, and where children live. income status, and where children live.

28% 41% 34% 15% 17% 11%

0% 10% 20% 30% 40% 50% Kindergarten 3rd Grade 6th Grade History of cavities Untreated cavities

Dental Disease is a Serious Health Dental Disease is a Serious Health Issue for Massachusetts Children Issue for Massachusetts Children

Percent (and number) of children 19,130 29,114 24,575 9,942 12,375 7,949

Significant Disparities in Disease Experience Significant Disparities in Disease Experience Among Racial and Ethnic Minority Among Racial and Ethnic Minority Children

Children

Percent of children with one or more teeth with untreated cavities or with a dental filling

28% 41% 34%

MA Average

Significant Disparities In Untreated Cavities Significant Disparities In Untreated Cavities Among Racial and Ethnic Minority Children Among Racial and Ethnic Minority Children

Percent of children with untreated cavities

15% 17% 11%

MA Average

2.3 1.9 1.8 3.0 2.1 3.0 2.2 2.7 2.1 2.9 2.6 1.8

1 2 3 4 Kindergarten 3rd Grade 6th Grade Non-Hispanic White Non-Hispanic Black Non-Hispanic Other Hispanic

More Untreated Decay More Untreated Decay Among Racial and Ethnic Minority Children Among Racial and Ethnic Minority Children

Mean number of teeth with untreated decay among children with untreated decay

1.9

MA Average

2.5 2.2

One in Ten Racial and Ethnic Minority One in Ten Racial and Ethnic Minority Children Suffer Oral Pain Children Suffer Oral Pain

Percent of children whose parents reported child was currently having pain in teeth or mouth

5% 4% 5%

MA Average

Percent of children with one or more dental sealants

Fewer Racial and Ethnic Minority Children Fewer Racial and Ethnic Minority Children Receive Preventive Treatment (Sealants) Receive Preventive Treatment (Sealants)

46% 52%

MA Average

Key Findings Key Findings

Dental disease is a significant health issue for Dental disease is a significant health issue for children in Massachusetts children in Massachusetts

– – Most common chronic childhood disease Most common chronic childhood disease – – Affects many children before kindergarten Affects many children before kindergarten – – Many school children are in pain Many school children are in pain

Significant oral health disparities Significant oral health disparities

– – Racial and ethnic minority children Racial and ethnic minority children – – Children from low Children from low-

• income families

income families – – Across counties Across counties

For more information on the For more information on the Massachusetts Oral Health Survey: Massachusetts Oral Health Survey: www.catalystinstitute.org www.catalystinstitute.org

MassHealth Program MassHealth Program

Percent of MassHealth Children Percent of MassHealth Children Who Received a Clinical Dental Examination Who Received a Clinical Dental Examination

2 4 . % 1 5 . 8 % 3 9 . 8 % 2 7 . 7 % 1 7 . 7 % 4 5 . 4 % 3 . % 1 9 . 4 % 4 9 . 4 %

0% 10% 20% 30% 40% 50% 60%

Periodic oral examination Comprenhensive oral evaluation Total number of exams FY2006 FY2007 FY2008

Percent of MassHealth Children Percent of MassHealth Children Who Received a Clinical Dental Examination Who Received a Clinical Dental Examination

24.0% 15.8% 39.8% 27.7% 17.7% 45.4% 30.0% 19.4% 49.4%

0% 10% 20% 30% 40% 50% 60%

Periodic oral examination Comprenhensive oral evaluation Total number of exams FY2006 FY2007 FY2008 10.6% 28.2% 38.8% 36.6% 11.2% 30.6% 41.8% 39.5% 12.1% 32.7% 44.8% 42.5%

0% 10% 20% 30% 40% 50%

Prophylaxis (14 - 21 y.o.) Prophylaxis (<14 y.o.) Total number of prophylaxis Topical application of fluoride (prophy not incl) FY2006 FY2007 FY2008

Percent of MassHealth Children Who Percent of MassHealth Children Who Received Prophy or Fluoride Received Prophy or Fluoride

Percent of MassHealth Children Who Percent of MassHealth Children Who Received Dental Sealants Received Dental Sealants

0% 5% 10% 15% 20% 25% 30% 35% 40% 45% < 1 y.o. 1 - 2 y.o. 3 - 5 y.o. 6 - 9 y.o. 10 - 14 y.o. 15 - 18 y.o. 19 - 20 y.o. Age group (years) Percent of total num ber of unduplicated m em bers who received procedure FY2006 FY2007 FY2008 *

Percent of MassHealth Children Who Percent of MassHealth Children Who Received a Restorative Procedure Received a Restorative Procedure

13.4% 15.6% 2.3% 11.5% 16.1% 2.6% 11.8% 17.3% 3.1% 0% 4% 8% 12% 16% 20% Total number of amalgam restorations Total number of composite restorations Total number of other restorations FY2006 FY2007 FY2008

Dental Providers by County Dental Providers by County

COUNTY FY2007 FY2008 Barnstable 13 19 Berkshire 23 28 Bristol 84 110 Dukes and Nantucket 1 Essex 129 163 Franklin 18 20 Hampden 84 110 Hampshire 11 15 Middlesex 235 311 Norfolk 91 107 Plymouth 80 119 Suffolk 187 210 Worcester 87 143 Total 1,042 1,356

MassHealth Members (<21) by County MassHealth Members (<21) by County

COUNTY NUMBER OF MEMBERS (0-20 YEARS OLD) ENROLLED* FY 2007 FY 2008 Barnstable 12,669 13,888 Berkshire 11,033 11,964 Bristol 46,916 50,103 Dukes /Nantucket 1,457 1,749 Essex 60,913 65,165 Franklin 5,475 5,743 Hampden 61,437 64,965 Hampshire 7,130 7,643 Middlesex 70,392 76,175 Norfolk 26,067 28,286 Plymouth 31,239 34,202 Suffolk 80,363 84,182 Worcester 58,307 62,725 N/A 4,402 3,115 Total number of members 477,800 509,905

Fluoride Varnish Program Fluoride Varnish Program

As of October, 2008, physicians and other As of October, 2008, physicians and other non non-

• dental health providers may bill for

dental health providers may bill for fluoride varnish application fluoride varnish application Goal: to decrease Early Childhood Caries Goal: to decrease Early Childhood Caries thus decreasing need for TX in Operating thus decreasing need for TX in Operating room and Emergency room. room and Emergency room.

School Based Programs School Based Programs

DPH and MassHealth piloted a school based DPH and MassHealth piloted a school based program in Springfield in academic year 08 program in Springfield in academic year 08-

• 09

09 Twenty one schools in year 1 (13 are schools Twenty one schools in year 1 (13 are schools with SBHC) with SBHC) 9 elementary, 3 middle and 9 high schools. 9 elementary, 3 middle and 9 high schools. Total number of students with consent: 1,684. Total number of students with consent: 1,684. (31% also are enrolled in SBHC programs, 68% (31% also are enrolled in SBHC programs, 68% MassHealth children). MassHealth children).

School Based Programs School Based Programs

4,829 sealants placed (19 schools 4,829 sealants placed (19 schools reporting) with average of 5 sealants per reporting) with average of 5 sealants per student student Cost $42/child Cost $42/child 25.1% required restorative treatment 25.1% required restorative treatment 25.1%. (Range 14% to 45%). 25.1%. (Range 14% to 45%).

– – Of these 3.4% needed urgent or immediate Of these 3.4% needed urgent or immediate care care

Race/Ethnicity of Students Race/Ethnicity of Students Participating in Pilot Program Participating in Pilot Program

Race % of participants American Indian 0.2 Asian 5.8 Black 30.8 Hispanic 46.9 White 15.4 Other 0.9

Plans for Expansion of DPH Plans for Expansion of DPH School Based Programs School Based Programs

DPH, Office of Oral Health, will be DPH, Office of Oral Health, will be responsible for replicating effective school responsible for replicating effective school prevention/sealant programs already prevention/sealant programs already implemented in the state, expanding the implemented in the state, expanding the dental workforce for these portable dental workforce for these portable programs and building collaborations and programs and building collaborations and partnerships to ensure support and partnerships to ensure support and sustainability. sustainability.

Plans for FY 10 Plans for FY 10-

• 11

11

Coordinate expansion of School based Coordinate expansion of School based programs with other public/private programs with other public/private providers providers Coordinate referral network for school Coordinate referral network for school based programs with private practitioners based programs with private practitioners and safety net providers and safety net providers Increase dental provider network Increase dental provider network