Oral Health in Whatcom County

1. 1 Oral Health inWhatcom County Assessing our Community Here today to present info collected last summer about OH. Just a sample of the info that is out there – meant to provide a foundation for today’s work. So when identifying strategies to promote community health, assessment is a very important thing to do.Here today to present info collected last summer about OH. Just a sample of the info that is out there – meant to provide a foundation for today’s work. So when identifying strategies to promote community health, assessment is a very important thing to do.

2. 2 Healthy People in Healthy Communities The vision of public health is Healthy People in Healthy Communities. To reach this vision, the first step is assessment which is shown by this wheel to be one of the core functions of public health. Assessment is use to monitor health of a community and identify and describe problems (ie, what subgroups are experiencing the problems disproportionately) so that interventions we design are based on “truth” (or approximation) which increases the likelihood that interventions will work – appropriate and effective. So basically we use assessment to make sure we make informed decisions – this makes it very importantThe vision of public health is Healthy People in Healthy Communities. To reach this vision, the first step is assessment which is shown by this wheel to be one of the core functions of public health. Assessment is use to monitor health of a community and identify and describe problems (ie, what subgroups are experiencing the problems disproportionately) so that interventions we design are based on “truth” (or approximation) which increases the likelihood that interventions will work – appropriate and effective. So basically we use assessment to make sure we make informed decisions – this makes it very important

3. 3 Assessment Strategy Existing Data 2000 WA Smile Survey 2002 Whatcom BRFS 2002 MAA billing records Telephone Survey: 400 respondents Key Informant Interviews: 29 informants Dentist Survey: 65 respondents (75% return rate) Our oral health assessment strategy used multiple data sources to describe the picture of oral health in our community. First, we looked at OH information that was already collected via other assessments. The WA state smile survey, used statewide data to make estimates about our county. The BRFS which was a telephone survey done in Whatcom County 2002 (800 respondents) had OH section. MAA records – Medicaid utilization rates After that we conducted 3 assessments of our own: 1) telephone survey of 400 adults 2) key informant interviews: 29 community members work in oral health or interested in oral health (providers, social services professionals, government representatives) 3) In collaboration with Colleen White, RDH at Lummi, Mail survey to Dentists: sent to 86 dentists, 65 responded – 75% return rate. We recently received this data so today I’ll be presenting preliminary results. While we have a lot of information, many times assessment raises more questions than it answers. Frequently those questions are “why?” is this the case. So when those questions arise, I encourage you to write them down for consideration by the oral health coalition. Our oral health assessment strategy used multiple data sources to describe the picture of oral health in our community. First, we looked at OH information that was already collected via other assessments. The WA state smile survey, used statewide data to make estimates about our county. The BRFS which was a telephone survey done in Whatcom County 2002 (800 respondents) had OH section. MAA records – Medicaid utilization rates After that we conducted 3 assessments of our own: 1) telephone survey of 400 adults 2) key informant interviews: 29 community members work in oral health or interested in oral health (providers, social services professionals, government representatives) 3) In collaboration with Colleen White, RDH at Lummi, Mail survey to Dentists: sent to 86 dentists, 65 responded – 75% return rate. We recently received this data so today I’ll be presenting preliminary results. While we have a lot of information, many times assessment raises more questions than it answers. Frequently those questions are “why?” is this the case. So when those questions arise, I encourage you to write them down for consideration by the oral health coalition.

4. 4 Topic Areas Profile of our Dentists Access to Services For Medicaid-Insured Population Dental Health Status Prevention: Fluoride, Sealants, Education Summary of Concerns I will present these results in 5 main topic areas: First, is a profile of our dentists. Second, I will describe the provision of services to Medicaid-insured populations. Third, I will discuss how patients pay for care Fourth, I will describe what we know about he dental health status of Whatcom residents Finally, I’ll discuss 2 major methods of prevention: dental sealants and multiple uses of fluoride I’ll conclude with a summary of concerns identified by dentists and key informants for children, adults, and seniors in our communityI will present these results in 5 main topic areas: First, is a profile of our dentists. Second, I will describe the provision of services to Medicaid-insured populations. Third, I will discuss how patients pay for care Fourth, I will describe what we know about he dental health status of Whatcom residents Finally, I’ll discuss 2 major methods of prevention: dental sealants and multiple uses of fluoride I’ll conclude with a summary of concerns identified by dentists and key informants for children, adults, and seniors in our community

5. 5 Profile of Dentists Who are our dentists?Who are our dentists?

6. Dentist Survey 6 Our Dentists Gender: 80% males, 20% females Our survey of dentists showed 80% of our dentists are male, 20% female. Most are in their 40’s and 50’sOur survey of dentists showed 80% of our dentists are male, 20% female. Most are in their 40’s and 50’s

7. Dentist Survey 7 Graduated From a Variety of Dental Schools Creighton U Georgetown Indiana Loma Linda Louisville, KY Marquette Medical College of Virginia Northwestern Ohio State St. Louis U U of Colorado Dentists in our community graduated from a wide variety of dental schools, with almost half graduating from the UWDentists in our community graduated from a wide variety of dental schools, with almost half graduating from the UW

8. Dentist Survey 8 Range of Years in Practice There is a wide range of the number of years our dentists have been in practice. From 18% being practice for less than 5 years to 6% practicing for over 36 years.There is a wide range of the number of years our dentists have been in practice. From 18% being practice for less than 5 years to 6% practicing for over 36 years.

9. Dentist Survey 9 Assessing Dental Capacity ¾ work less than 40 hours/week (avg=35) For assessing dental capacity, we know that currently ¾ dentists work less than full time. And almost 50% say they will retire in the next 20 years. Additionally, the average age of those who did not respond to this question was 51 (a little higher than overall average of 48), so it is likely that the percent that will retire in the next 20 years is actually higher than 50%. Raises the question: will we have a shortage of dentists in our community? DOH is currently using the dentist survey data to conduct a dental Health Personnel Shortage Area assessment to answer this question. The OH coalition and local dental society may want to explore this issue further.For assessing dental capacity, we know that currently ¾ dentists work less than full time. And almost 50% say they will retire in the next 20 years. Additionally, the average age of those who did not respond to this question was 51 (a little higher than overall average of 48), so it is likely that the percent that will retire in the next 20 years is actually higher than 50%. Raises the question: will we have a shortage of dentists in our community? DOH is currently using the dentist survey data to conduct a dental Health Personnel Shortage Area assessment to answer this question. The OH coalition and local dental society may want to explore this issue further.

10. 10 Access to Services

11. BRFS 11 Most Children Are Insured 80% of adults with children 5-12 say they have some kind of dental insurance (including Medicaid) that covers their children Limitation of phone survey is that it represents a best case scenario – poorest (those without telephones) cannot participate. But using these numbers, it looks like lack of dental insurance doesn’t seem to be the problem for most kids – however 17% do not have insurance.Limitation of phone survey is that it represents a best case scenario – poorest (those without telephones) cannot participate. But using these numbers, it looks like lack of dental insurance doesn’t seem to be the problem for most kids – however 17% do not have insurance.

12. BRFS 12 Some Children Are Unable to Get Care 1 in 4 parents with incomes <$20K say they were unable to get care for their child within last 2 years When we break it down by income, we see that 25% of lowest income children could not get care in the last 2 years. So: ¼ of low-income kids wanted dental care and could not get it. This demonstrates an access problem for low-income kids.When we break it down by income, we see that 25% of lowest income children could not get care in the last 2 years. So: ¼ of low-income kids wanted dental care and could not get it. This demonstrates an access problem for low-income kids.

13. Telephone Survey 13 Most Adults Pay Out-of-pocket Over 2/3 of adults pay all or some dental care costs out-of-pocket This is combining the 32% that pay all of their costs out of pocket, with the 36% that pay some of their costs out of pocket. So: there seems to be inadequate dental insurance coverage which makes it a financial burden to go to the dentist or receive dental care. This is combining the 32% that pay all of their costs out of pocket, with the 36% that pay some of their costs out of pocket. So: there seems to be inadequate dental insurance coverage which makes it a financial burden to go to the dentist or receive dental care.

14. Telephone Survey 14 Some Adults Are Unable to Get Care 73% of adults report a dental visit within last year Uninsured and seniors are less likely to have a recent visit 21% of adults say they or a household member could not receive dental care in the last 12 months because of cost Women, low-income, and uninsured are more likely to report cost as a barrier to care Further indicates an access problem for adults Women: 27% males: 15% Low-income: 42% Uninsured: 30%, insured: 8%Further indicates an access problem for adults Women: 27% males: 15% Low-income: 42% Uninsured: 30%, insured: 8%

15. Dentist Survey 15 Most Dentists Offer Payment Plans 78% of dentists offer payment plans Average 3-5 months for payment For most practices that accept payment plans, < 30% patients use them So, recognizing that cost is a barrier to care, some dentists are working on accommodating this barrier through offering payment plans. Meaning they allow their patients that are paying out of pocket to spread their payments over time. Average amount of time they will allow for the complete payment to be received is 3-5 months. Of dentists that allow payment plans, most say less than 30% of their patients use themSo, recognizing that cost is a barrier to care, some dentists are working on accommodating this barrier through offering payment plans. Meaning they allow their patients that are paying out of pocket to spread their payments over time. Average amount of time they will allow for the complete payment to be received is 3-5 months. Of dentists that allow payment plans, most say less than 30% of their patients use them

16. Dentist Survey 16 Some Dentists OfferSliding Fee Scale 20% offer sliding fee scale Of those that allow the sliding fee scale, most (64%) say less than 5% of their patients utilize it So, a small percentage of patients are receiving reduced fee services from private practice dentists but not many.So, a small percentage of patients are receiving reduced fee services from private practice dentists but not many.

17. St. Joseph Hospital 17 Use of Emergency Dept. For Dental Care Is Rising The number of visits to ED at St. Joseph Hospital for dental care increased 39% from 2001 to 2003 An indicator that there is an access problem for dental services is that the use… And they are taking up a larger percentage of ED visits (3% to 3.7%) Director of Emergency Services (Dr. Allen Buehler) attributed this increase to: 1) poor dental hygiene 2) lack of fluoridation in drinking water 3) lack of access to care 4) people’s unwillingness to goto dentist for financial and fear reasons 5) people who use dental pain as a means for getting drugs So, more patients are seeking care at ED – which is the most expensive treatment site.An indicator that there is an access problem for dental services is that the use… And they are taking up a larger percentage of ED visits (3% to 3.7%) Director of Emergency Services (Dr. Allen Buehler) attributed this increase to: 1) poor dental hygiene 2) lack of fluoridation in drinking water 3) lack of access to care 4) people’s unwillingness to goto dentist for financial and fear reasons 5) people who use dental pain as a means for getting drugs So, more patients are seeking care at ED – which is the most expensive treatment site.

18. 18 Access to Services For Medicaid-Insured Population

19. 19 Significant % of Residents Have Medicaid Insurance In Whatcom County: 58% Children under 5 46% Children under 18 ~12% of Adults have Medicaid Insurance 58% Children under 5 in Whatcom County are on Medicaid 46% Children under 18 ~12% of Adults 20+ 58% Children under 5 in Whatcom County are on Medicaid 46% Children under 18 ~12% of Adults 20+

20. MAA billing data 20 33% of Medicaid-Insured Patients Receive Dental Care More Children Receive Services In Whatcom 43% in Whatcom 38% in WA State Fewer Adults Receive Services In Whatcom 17% in Whatcom 22% in WA State Fewer Seniors Receive Services In Whatcom 19% in Whatcom 21% in WA State Fewer Hispanics and more Native Americans receive services in Whatcom 33% of Medicaid-insured in Whatcom county received atleast one dental service (could just be a screening) in 2002. While this is similar to the statewide average of 34% it means that 2/3 did not receive services . When we break it down by age we see differences from the state So: we’re lagging behind the state in serving Adults, Seniors, and Hispanic population. Also, less than half of the children are receiving care. Adults 19-59 Hispanics: 34% Whatcom, 40% WA Native Americans: 34% Whatcom, 29% WA33% of Medicaid-insured in Whatcom county received atleast one dental service (could just be a screening) in 2002. While this is similar to the statewide average of 34% it means that 2/3 did not receive services . When we break it down by age we see differences from the state So: we’re lagging behind the state in serving Adults, Seniors, and Hispanic population. Also, less than half of the children are receiving care. Adults 19-59 Hispanics: 34% Whatcom, 40% WA Native Americans: 34% Whatcom, 29% WA

21. MAA billing data 21 Community Health Centers are Primary Service Site More so than in the state as a whole: We have 2 community health centers they are Interfaith community health center and Sea Mar community health center. 44% of patients with Medicaid insurance that received services, went to health centers, compared with 23% that went to health centers across the state. Conversly, 41% of patients with Medicaid insurance that received services in Whatcom went to private practice dentists, compared to 67% went to private practice dentists across the state. So in Whatcom county, Medicaid insured patients rely more on community health centers and less on private dentists – the opposite is true for the state as a whole. Brings up the question: is this system working for our community?We have 2 community health centers they are Interfaith community health center and Sea Mar community health center. 44% of patients with Medicaid insurance that received services, went to health centers, compared with 23% that went to health centers across the state. Conversly, 41% of patients with Medicaid insurance that received services in Whatcom went to private practice dentists, compared to 67% went to private practice dentists across the state. So in Whatcom county, Medicaid insured patients rely more on community health centers and less on private dentists – the opposite is true for the state as a whole. Brings up the question: is this system working for our community?

22. Dentist Survey 22 Many Private Practice Dentists Serve Medicaid-Insured 59% of private dentists serve some patients with Medicaid insurance Of dentists that serve Medicaid-insured patients, most (69%) say that Medicaid-insured patients account for less than 10% of their caseload. And not all of these dentists are accepting new patients with Medicaid insurance. So, many dentists are interacting with Medicaid reimbursement system, but are not serving a substantial proportion of this population. Of dentists that serve Medicaid-insured patients, most (69%) say that Medicaid-insured patients account for less than 10% of their caseload. And not all of these dentists are accepting new patients with Medicaid insurance. So, many dentists are interacting with Medicaid reimbursement system, but are not serving a substantial proportion of this population.

23. Dentist Survey 23 Low Reimbursement Rates Are Top Problem Dentists were asked to state the top 2 problems with providing dental services to Medicaid-insured patients. Overwhelming number one response was low reimbursement rates. Followed by no-shows. Some dentists stated they would prefer to volunteer their time, or provide services for free than deal with Medicaid reimbursement hassles Question: is there anything we can do to ameliorate these top complaints?Dentists were asked to state the top 2 problems with providing dental services to Medicaid-insured patients. Overwhelming number one response was low reimbursement rates. Followed by no-shows. Some dentists stated they would prefer to volunteer their time, or provide services for free than deal with Medicaid reimbursement hassles Question: is there anything we can do to ameliorate these top complaints?

24. MAA billing data 24 Increase in Service to Young Children w/ Medicaid Children under 2 years of age that were seen jumped from 10% to 18% Between 2000 and 2002, the number of children under 6 that were seen by private practice dentists more than doubled A positive sign: Doubled: ~600 in 2000 to ~1400 in 2002. This coincides with our Access to Baby and Child Dentistry program: ABCD coordinator connects children from infancy thru 5 who have Medicaid insurance to private practice dentists. Participating dentists receive an enhanced reimbursement from DSHS for serving children enrolled in ABCD program. Something is working. Can we build on this success? A positive sign: Doubled: ~600 in 2000 to ~1400 in 2002. This coincides with our Access to Baby and Child Dentistry program: ABCD coordinator connects children from infancy thru 5 who have Medicaid insurance to private practice dentists. Participating dentists receive an enhanced reimbursement from DSHS for serving children enrolled in ABCD program. Something is working. Can we build on this success?

25. 25 Dental Health Status What are the possible effects of this situation?What are the possible effects of this situation?

26. BRFS 26 Low-Income Report Poorer Dental Health 78% adults say good or very good 20% adults say fair or poor Low-income more likely to say fair or poor: When we break it down by income, we see a trend that higher incomes more often report good/very good dental health and low incomes more often report fair or poor oral health. Self-reported health status has been shown to be a good predictor of disease. When researchers have compared detailed clinical data collected by dentists with self-reports, those who say their oral health is “fair or poor” really do have “fair or poor” oral health. So, dental health status is related to incomeWhen we break it down by income, we see a trend that higher incomes more often report good/very good dental health and low incomes more often report fair or poor oral health. Self-reported health status has been shown to be a good predictor of disease. When researchers have compared detailed clinical data collected by dentists with self-reports, those who say their oral health is “fair or poor” really do have “fair or poor” oral health. So, dental health status is related to income

27. BRFS 27 More Cavities When Cost is a Barrier to Care 56% of adults with child over 2 say child has had a cavity Children have more cavities when cost is a barrier to care. Overall, 56% of adults …But when parents report cost to be a barrier to care for the family, this rate rises to 85%. Only 15% of children are cavity free in families where cost is a barrier to care. Nat’l stats: 5-9: 52% 17: 78% 18+: 85%Children have more cavities when cost is a barrier to care. Overall, 56% of adults …But when parents report cost to be a barrier to care for the family, this rate rises to 85%. Only 15% of children are cavity free in families where cost is a barrier to care. Nat’l stats: 5-9: 52% 17: 78% 18+: 85%

28. BRFS 28 Low-Income More Likely to Have Teeth Removed 38% adults have had at least one tooth removed due to disease Overall, 38% of adults… We see a trend that lower incomes are more likely to have lost teeth due to decay. Nat’l By 17: 7% have atleast 1 tooth removedOverall, 38% of adults… We see a trend that lower incomes are more likely to have lost teeth due to decay. Nat’l By 17: 7% have atleast 1 tooth removed

29. Telephone Survey 29 When Cost is a Problem, Treatment is Not Received 27% of adults whose dental providers recommended treatment received NONE. And, even if they get a visit, needed treatment may not be received. When cost is a problem, treatment is not received. Overall, 27% of adults whose dental providers recommended treatment received NONE. In families where cost is a barrier to care, this rate jumps to 39% compared to 19% in families where cost is not a barrier to care.And, even if they get a visit, needed treatment may not be received. When cost is a problem, treatment is not received. Overall, 27% of adults whose dental providers recommended treatment received NONE. In families where cost is a barrier to care, this rate jumps to 39% compared to 19% in families where cost is not a barrier to care.

30. 30 Key informants represented: dental care providers, healthcare providers, social services, and government. provided qualitative description of why dental health status is poor for some segments of our community: Missing or rotting teeth communicate low social status, children may miss school, adults may have trouble getting a job, health of seniors compromised by not being able to eat well. Due to limited access, small problems are left untreated until they require emergency care. Frequently, care they receive is “rudimentary” primarily pulling of the problematic teeth. Poverty and crisis are linked. Preventive care visits, eating balanced meals, bushing teeth can be low priority compared to ensuring basic survival. This can lead to missed dental appointments and being less connected to a specific health care provider. Lack of information, bureaucratic obstacles, and logistical matters such as transportation may be barriers for low income to access services. Low reimbursement rates So, there is expertise in this community that understands the complex issue of dental care in low-income. Panelist may shed more light on this.Key informants represented: dental care providers, healthcare providers, social services, and government. provided qualitative description of why dental health status is poor for some segments of our community: Missing or rotting teeth communicate low social status, children may miss school, adults may have trouble getting a job, health of seniors compromised by not being able to eat well. Due to limited access, small problems are left untreated until they require emergency care. Frequently, care they receive is “rudimentary” primarily pulling of the problematic teeth. Poverty and crisis are linked. Preventive care visits, eating balanced meals, bushing teeth can be low priority compared to ensuring basic survival. This can lead to missed dental appointments and being less connected to a specific health care provider. Lack of information, bureaucratic obstacles, and logistical matters such as transportation may be barriers for low income to access services. Low reimbursement rates So, there is expertise in this community that understands the complex issue of dental care in low-income. Panelist may shed more light on this.

31. 31 Prevention: Fluoride, Sealants and Education 2 major ways of preventing dental decay are sealants and use of fluoride2 major ways of preventing dental decay are sealants and use of fluoride

32. Telephone Survey 32 Lack of Information About Water Fluoridation Many residents either don’t know if they receive optimally fluoridated water or incorrectly believe that they do. Many residents either don’t know … Our phone survey asked residents who are on community or city water systems, “Does… 39% don’t know Interestingly 28% said YES, when the actual percentage of residents receiving fluoridated water from community or city systems is 6% (Lynden and Lummi reservation) So, do we need to do some education? Lynden accounted for ~9% of respondentsMany residents either don’t know … Our phone survey asked residents who are on community or city water systems, “Does… 39% don’t know Interestingly 28% said YES, when the actual percentage of residents receiving fluoridated water from community or city systems is 6% (Lynden and Lummi reservation) So, do we need to do some education? Lynden accounted for ~9% of respondents

33. 33 Community Water Fluoridation City of Lynden and Lummi Reservation water systems adjust concentration of fluoride to optimal level Optimal level: 1.1 mg/L Wells: 1990-2000, 5% in optimal level, 2% over optimal level.Optimal level: 1.1 mg/L Wells: 1990-2000, 5% in optimal level, 2% over optimal level.

34. Telephone Survey 34 Many Residents Favor Water Fluoridation More than twice as many adults feel that the water should be fluoridated than don’t And about ¼ are not certain – many stating they don’t have enough information. So do we need to provide more information to the community?And about ¼ are not certain – many stating they don’t have enough information. So do we need to provide more information to the community?

35. Telephone Survey 35 Fluoridated Toothpaste 75% of adults use toothpaste that contains fluoride Seniors (60+) are the age group least likely to use fluoridated toothpaste (61%) Fluoride controlled by the patient, and received frequently in small amounts is very powerful in preventing tooth decay. This can be especially important in seniors who may have recession exposing the tooth roots which are not covered by hard enamel and are very susceptible to decay. Why are seniors less likely to use fluoridated toothpaste? (because of dentures?) Why don’t other 25% use fluoridated toothpaste?Fluoride controlled by the patient, and received frequently in small amounts is very powerful in preventing tooth decay. This can be especially important in seniors who may have recession exposing the tooth roots which are not covered by hard enamel and are very susceptible to decay. Why are seniors less likely to use fluoridated toothpaste? (because of dentures?) Why don’t other 25% use fluoridated toothpaste?

36. 36 Fluoride Supplements and Varnish 41% of adults with children say their child currently takes fluoride supplements 64% of dentists routinely provide fluoride varnish to children under 5 46% of dentists routinely provide fluoride varnish to children 5-18 41% is really high, even for unfluoridated area. This may be due to self-report (concept misunderstood). Also, some studies have shown that few fluoride prescriptions are filled more than once. Is this the appropriate % for our community considering lack of community water fluoridation and wells? Varnish: many children are receiving varnish in community clinics, school-based services, and in medical setting. Are enough children receiving fluoride varnish in our community?41% is really high, even for unfluoridated area. This may be due to self-report (concept misunderstood). Also, some studies have shown that few fluoride prescriptions are filled more than once. Is this the appropriate % for our community considering lack of community water fluoridation and wells? Varnish: many children are receiving varnish in community clinics, school-based services, and in medical setting. Are enough children receiving fluoride varnish in our community?

37. 37 Are Enough Kids Receiving Sealants? Estimate from state data that 47% of 6-10 year olds have sealants In Bellingham S.D., 43% of high risk children 5-11 had sealants in 2002 75% of adults with a child between 8 and 14 say the child has had dental sealants placed on teeth A dental sealant is a plastic coating applied to the chewing surfaces (the pits and fissures) of back molar teeth to prevent cavities. For Whatcom county, we have estimates from the state smile survey which show that 47% of 6-10 year olds have sealants but minority children are less likely. And self-report data from our phone survey that shows that 75%.…Research has shown that parents do reasonably well estimating past decay and current untreated decay but not so well with dental sealants. So, are enough children in Whatcom county receiving dental sealants?A dental sealant is a plastic coating applied to the chewing surfaces (the pits and fissures) of back molar teeth to prevent cavities. For Whatcom county, we have estimates from the state smile survey which show that 47% of 6-10 year olds have sealants but minority children are less likely. And self-report data from our phone survey that shows that 75%.…Research has shown that parents do reasonably well estimating past decay and current untreated decay but not so well with dental sealants. So, are enough children in Whatcom county receiving dental sealants?

38. Telephone Survey 38 Dental Health Education 91% of adults say they have enough oral health information 33% of Low-income adults have heard of Baby Bottle Tooth Decay (early childhood caries) compared to 50% of total population Most adults say they have enough oral health information. Information can be used to shape strategies. So oral health fair may not be best choice. However, a targeted educational intervention regarding BBTD may be appropriate. However, only 33% of low income adults have heard of Baby Bottle Tooth Decay compared to 50% of the total population So, what is the most appropriate intervention? Educational intervention targeting low-income parents? Most adults say they have enough oral health information. Information can be used to shape strategies. So oral health fair may not be best choice. However, a targeted educational intervention regarding BBTD may be appropriate. However, only 33% of low income adults have heard of Baby Bottle Tooth Decay compared to 50% of the total population So, what is the most appropriate intervention? Educational intervention targeting low-income parents?

39. 39 Main Concerns I’ve provided information that hopefully stimulated questions, thoughts and ideas for the direction you think we should go as a community. I’ve provided information that hopefully stimulated questions, thoughts and ideas for the direction you think we should go as a community.

40. 40 Dentists’ Top Concerns Children Lack of water fluoridation Dental caries (cavities) High sugar diets

41. 41 Dentists’ Top Concerns Adults Lack of access to dental care Dental caries and periodontal disease Seniors Dental caries and periodontal disease Lack of access to dental care Dentists concerns for adults and seniors were similar.Dentists concerns for adults and seniors were similar.

42. 42 Key Informants’ Concerns Children Decay from poor dental hygiene Lack of preventive care Lack of fluoridated drinking water or regular fluoride supplements Adults Lack of access to care (especially preventive) for uninsured and low-income

43. 43 Key Informants’ Concerns Seniors Access to care for those on fixed income Lack of transportation or home-visits for dental services Poor oral health can exacerbate other health problems

44. 44 Take Home Messages Cavities identified as concern for all age groups Dentists and key informants agreed that lack of access to care and lack of water fluoridation are primary concerns

45. 45 Take Home Messages People with low incomes are at highest risk for dental problems, but are least likely to receive care There is substantial interest and energy to address these issues in our community Don’t want to get stuck in data collection stage – no reason to collect information unless we’re going to use it. Don’t want to get stuck in data collection stage – no reason to collect information unless we’re going to use it.

46. 46 Thank You Dr. Curt Smith, DDS Dr. Monica King, DDS Shelly Zylstra Chris Phillips Dr. Mark Brooks, DDS Colleen White, RDH Felecia Caldwell Janet Davis