Colorado Children’s Oral Health

Cavity Free Colorado

Colorado Childrens Oral Health

Katya Mauritson, DMDOral Health Unit DirectorColorado Department of Public Health and EnvironmentThank you to Oral Health Colorado and Cavity-Free at Three for hosting this conference and gathering so many of our oral health champions in one room!Im the director of the OHU at the health department.Some backgroundGeneral dentist; A couple of years ago, after almost 10 years of practice, I started taking PH classes. I knew I wanted a change but didnt know what.The position for dental director showed up; I wasnt going to apply; a good friend of mine was much more qualified and I told her about it on Tuesday.By Friday, I wanted the job but didnt want to turn on her and compete. But she told me, at 4 PM the day the application was due that she didnt want to work 40 hours a week again (or sometimes a little more)1

Stole this slide from Urbinas presentation Added a few of our great national partnersEveryone supporting the work of the unit, we all support each others workI am so thankful for the open communications and collaborative efforts that are happening.And all the support of our partners.This is an amazing environment to work in and as we all move forward, collaborating on projects, sharing resources and efforts, we will continue make great strides and improving oral health in Colorado.Not everyone is listed on this page, but you all are the reason oral health is a winnable battle2Percent of Colorado parents reporting that their child (age 1 through 5) first went to the dentist by 12 months of age,2006-2010Source: Colorado Child Health Survey, Health Statistics Section, CDPHEPercentGoal: 4.6% by 2016We are changing this WB data point b/c we know it was a whimpy goal, especially with all your efforts but more than 10% change in a few years, but not really aspirational or energizing. weve already seen improvements so we probably wouldve had to increase the goal, but also b/c the CDC changed how cell phone surveys were weighted in the data since more minorities use cell phones. So the CHS, BRFSS and other phone surveys all have been changed. Calling more cell phonesWe wont have trend data again for a few years: kind of shock therapy; the old data was the best we had at the time but now that we know the change in cell phone usage has to be adjusted for now.Nowe have very small gain, but our partners efforts should blow past that goal quickly once they get up and running3Percent of 3rd grade children in Colorado with sealants, Oral Health Basic Screening Survey

PercentSource: Oral Health Program, Colorado Department of Public Health and EnvironmentSealants = Percentage of 3rd Grade Students with dental sealants on at least one permanent molar toothGoal: 39% by 2016Were going to look at this 39% goal in a couple of minutesThis will be changing in a couple of different waysBy 2016, 75 percent or more of the population served by community water systems receives optimally fluoridated water;4

Our 2016 WB goal is 75%Now at 72.7%HP 2020 goal 79.6%Shelly Gehshan Dr. Bill Moss from Pews CDHP, talk about this access being an equity issue

OConnels 2005 study in 2003 dollars, $1 invested saves up to $61 in dental procedures: get one cavity as a child, turns into new filling, crown, RCT, ext, implant or partial

For the cost of one filling, you can get a lifetime of protective water fluoridation

Even with additional sources, CWF prevents 25-50% cavities5

Toolkit for Promoting Maternal and Child Oral Health in Colorado Communities

http://www.oralhealthcolorado.org/new-toolkit-for-promoting-oral-health-in-colorado-communitiesHow many people have seen this toolkit?Funded by Colorado Trust initiativeDental home interacting with a health home to promote overall well being, optimally fluoridated CW, OH ed in health care, child care, schools, workplace, enough dental provider, everyone receives evidence-based interventions, OH needs are identified and addressed

Disparities in access to care are actively monitored and the community is engaged in promoting health equity. HE in state plan as one of the main focus areas; WB refocus on HE to target resources and efforts so we make big progress in areas that need it the mostWIC flip charts about oral health which show the WIC providers how to educate their customers AAPOther CO: podcasts to overcome barriers in MA submission; CF3 and OHCO will help spread that informationWorking with CF3 as they enroll more dentists in MedicaidTrain home visitation nurses in CF3: motivational interviewing, behavioral change is preventionCommunity Standards: CWF!!!Used in MCH oral health priority of preventing cavities in 0-5 year olds9 counties are planning to work on this priority and first stop is this toolkitChaffee, Garfield, Gilpin, Jefferson, Mineral, Montezuma, NWVNA, Ouray, Teller.

6School Basic Screening Survey

One of the big projects that took 19 hygienists, thousands of miles driven and flown, more than 6000 tongue depressors used(960 schools and 62,660 students with more than 10 kids in 3rd gradeTo measure3-5 years; about 60 schools; quartiles of F/RL proxy for SES: national standardTakes just 1 minute per child but a long time to arrangeLocal choice; school districts require different things; parents decide with active consentDont get as much data as wed likeThen principal & nurse must agree; some schools have volunteers to help coordinateFlown people thereSchools 58 k; 57 3rd55k got BMI, 54 3rd7Measures the oral health status:

Current, untreated decayHistory of decayECC for kindergartnersSealants on permanent molars on 3rd graders

Urgency of dental needs

Referral linksECC in kindergartenWorry is find something but cant treatDelta Dental foundationWithout data, we cannot improve our childrens oral health, ask for funding, paint the pictureLike Shelly has said, its often better to get an F b/c then the story is how much our kids are suffering and we have to do something about it.Data collected provides a possible avenue for funding projects.

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High Five Break!!!Next, this will be finally released in the next 2 weeks9

Results of dental screening among children in kindergarten.Colorado Childrens Oral Health Screening, 20032004, 20062007, and 20112012Colorado Department of Public Health and EnvironmentDecrease in overall decay in kindergartners not statistically significant, but fewer kindergarteners have untreated cavities, and fewer have urgent needs. This may mean not only increased access to dental providers who are fixing the cavities, but it is possible that the cavities are not as severe (painful). Could point to access, prevention, education, many factors. Fewer kids sitting in classroom in pain.10Results of dental screening among children in 3rd grade.Colorado Childrens Oral Health Screening, 20032004, 20062007, and 20112012 Colorado Department of Public Health and Environment

Decrease in overall decay in 3rd graders not statistically significant, but fewer 3rd graders have untreated cavities, and fewer have urgent needs. Overall increase in 3rd graders with sealants.11

Results of dental screening among children in kindergarten by percent of students in the school who are eligible for free or reduced price meal program (FRL).Colorado Childrens Oral Health Screening, 20032004, 20062007, and 20112012 Colorado Department of Public Health and Environment Only statistically significant changes in number of kindergartners experiencing caries since 2003-04 is in children in schools with 75% FRL eligible kids. No significant change overall.Same with untreated cavities. Children in schools with 75% FRL eligible kids have more than half as many kids with untreated cavities compared with results in 2003-04.

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Results of dental screening among children in third grade by percent of students in the school who are eligible for free or reduced price meal program (FRL).Colorado Childrens Oral Health Screening, 20032004, 20062007, and 20112012 Colorado Department of Public Health and Environment No statistically significant changes in 3rd graders caries experience since 2003-04.Schools with 75% FRL eligible kids have about half as many kids with untreated cavities compared with schools surveyed in 2003-04. Twice as many children in schools with >75% FRL eligible kids had sealants in 2011-2012 compared with children screened in 2003-04.

But, only 40% of kids in high risk schools (>50% FRL) got sealants, so still need a lot of work targeting those high risk schools.13

SEALANTS proven method for preventing decay

Third Graders: already beat WB target of 39% (45%)

But the evidence base is in 50% F/RL Dental sealants (%)Really, our goal should be 100% have sealants; aspirational but also attainable when we see these results(95% CI) 47.4 (40.354.6)/49.3 (41.657.1)/36.8 (31.641.9)/43.7 (37.050.3)Those schools need to reach 100% first, then everyone else because we will still miss a lot of kidsSealants protect those 6 year molars that are most likely to get cavities as they erupt/grow into place.Just by painting on a protective coating at the right time, children can avoid that first cavity in a permanent tooth at a young age and that tooth will be healthier for a lifetime14ResourcesOral Health Colorado

Mobile and Portable Dental Services in Preschool and School Settings: Complex Issues

School-Based or School-Linked Mobile or Portable Dental Services Policy Statement

Memorandum of Understanding

There are many different resources that can help navigate the sometimes complicated process of getting sealants to the kids who need them the mostThe state is supporting OHCOs work and around school sealant programsThere are resources to use and we have copies hereSealants are one of three WB metrics because they are evidence-based; they really work and many kids really need them15Colorado and Fluoride

Our other big evidence-based intervention is water fluoridation.Dr. McKay (r) persuaded the Colorado State Dental Association to invite Dr. Green Vardiman Black (l), one of the nation's most eminent dental researchers, to attend 1909 convention where McKay's findings were to be presented. The two men began joint research and discovered other areas of the country where brown staining of teeth occurred. a couple of decades later, discovered that fluoride provided protection from cavities without any harmful affects 16

Unfounded fear about Fluorosis: In optimal range, prevent 25-40% of cavities. IN ALL AGES: CDC hasnt messaged it well but is trying nowWith the help of Pew, speaking in plain language to get the science across in a simple messageThat is preventing a kid from his or her first cavity and first shot of local anestheticPrevents the possibility of a sensitive filling; prevents parents from worrying about their kid, from missing work, from paying out of pocket and feelingGuilty because this is preventable.All for the cost of a filling, a lifetime of protection from 25-40%Why dont we provide everyone we can this benefit?

Very mild, noticeable pretty much only in a dental chair, in 17

Or they talk about enamel fluorosis but really imply thisThat our children wont be able to stand up straight and will walk around tied up like pretzelsFear mongering and unfortunately it worksWe need clear messages on a local level to get to the science18Mass Medication?The American Public Health Association notes:It has been the position of the American courts that a significant government interest in the health and welfare of the public generally overrides individual objections to public health regulation.

U.S. Courts have consistently ruled that water fluoridation is not a form of compulsory mass medication or socialized medicine

The courts have ruled that: Fluoride is a nutrient, not a medicationNo one is forced to drink fluoridated water

Pew talks about choiceIs it fair that people dont get this inexpensive, easy to access intervention?This first statement can be noted in the American Public Health Policy statement about water fluoridation.The courts have ruled that:Fluoride is a nutrient, not a medication, and is present naturally in the environment, especially in Colorado.No one is forced to drink fluoridated water as alternative sources are available

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When we see how many adults dont have insurance then look at who also doesnt have protection from cavities.20

Certain parts of the state get double whamees. Actually triple whamees b/c they also dont have also may not have access to dental provider

For the cost of one filling, you can get a lifetime of protective fluoridation

Even with additional sources, CWF prevents 25-50% cavities21Resources State Oral Health UnitHealth DepartmentCDCs My Waters FluoridePews ILikeMyTeeth.org

One of the great public health achievements of the 20th century.

If everyone in this room was willing to champion fluoridation in their communities with the resources we have, wed be a big step closerPew has a Fluoridation Toolkit of slide presentations and educational materials to accessCDPHE is working on a local toolkit which you can access parts of now by contacting us: Let the water operators who often read something online and decide to stop fluoridating without telling anyone. Let them know how much fluoridation is supposed to be saving their community in averted cavities and cost. Town of Palisades, after more than 60 years of optimal fluoridation, stopped b/c one person read an antifluoridationist website and decided to stop, now more cavities, more pain, more procedures and pretty soon tens of thousands of dollars more in cost to the community for dental work that could have been averted.The decision to fluoridate is local and the implementation often comes down to one person.So we need all the champions we can get.22

One thing the state is doing is well train all recipients of dental loan repayment through the health service corps on water fluoridation so they understand the benefits and can also become champions.And they will now all get Cavity Free at Three training and be trained in seeing very young children and pregnant womenThis will help establish a dental home at age one in our safety net clinics where our loan repayment dentists and hygienists usually workAnd as CF3 goes office to office enrolling more Medicaid providers, the state is going to help with FTE from a new HRSA grant we got to help develop more oral health infrastructure in local public health agencies. We hope to help fund 4 new regional oral health specialists who will become CF3 trainers to expand activities across ColoradoTheyll also work with OHCO to ensure children in our lowest income schools get access to sealants, support data collection pieces and technical support for schools23

Surveillance with referral/follow-upWork at school district levelEducate and involve families: CDPHE FMLI to involve in your local coaltions/groupsSchool sealantsEquitable access to water fluoridationVt has share hygieneOHCOs work for school based workHRSA grant for ROHS35-50% utilization in MACounties want local data

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I know that the sky is the limit with everyone in this room working togetherThank you so much for your time and all that you do!25