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Medical-Dental Partnerships To Promote Oral Health

Medical-Dental Partnerships To Promote Oral Health. Wendy E. Mouradian, MS, MD Pediatrics, Pediatric Dentistry, Health Services (Public Health) Children’s Hospital Regional Medical Ctr University of Washington. Acknowledgements. Comprehensive Center for Oral Health Research (NIH - NIDCR)

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Medical-Dental Partnerships To Promote Oral Health

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  1. Medical-Dental Partnerships To Promote Oral Health Wendy E. Mouradian, MS, MDPediatrics, Pediatric Dentistry, Health Services (Public Health) Children’s Hospital Regional Medical Ctr University of Washington

  2. Acknowledgements • Comprehensive Center for Oral Health Research (NIH - NIDCR) • Maternal and Child Health Bureau, HRSA (Leadership Education in Pediatric Dentistry) • Bureau of Health Professions, HRSA (Interdisciplinary Children’s Oral Health Promotion)

  3. Summit Themes Whatcom County: • Engage community members • Present local data • Discuss “best practices” • Raise awareness of dental caries as an infectious disease • Problem solve: children, adults, elderly

  4. Surgeon General’s Report on Oral Health (2000) • Oral diseases are common and consequential • Linked to overall health and well-being • Profound disparities in oral health status • Disparities: SES, rural, minorities, vulnerable Preventive measures exist • Research / translation of science needed http://www.nidcr.nih.gov/sgr/sgr.htm

  5. Vulnerable Populations • Children • Elderly • Special Needs • Adult populations

  6. Medical-dental Educational Collaborations Journal of Dental Education –Aug 2003 Overview and commentary – children’s oral health • Washington State (family medicine residents) • Mouradian et al • North Carolina (pediatricians, family physicians) • Rozier et al

  7. Medical-dental Educational Collaborations Journal of Dental Education –Dec 2003 Overview and commentary – special pop. • Elderly populations • Pyle et al • Mental retardation, other special needs • Fenton et al

  8. Medical-dental Educational Collaborations Journal of Dental Education –Apr 2004 Overview and commentary -Public health approaches • Kids Get Care (case management model) • Hennessey et al • OPENWIDE (CT – Head Start) • Wolfe et al

  9. Children’s Oral Health • Dental care is most common unmet health need of children • More likely to lack dental insurance • Access to dental care limited u/ Medicaid • Disparities by SES, rural areas, special health needs/disabilities

  10. Impact on Children • Disease burden- 52 million school hours • Pain, infection, growth problems, ER visits • Hospitalizations and surgeries • Long term impact on economic, quality of life • Children with special needs: impact on general health

  11. Reach Children Early • Prevention works • Dental disease develops early <1-2 yrs • Disease transmitted from mother • Reach in primary care, child care, Head Start, educational, social systems

  12. Washington State Smiles Survey, 2000 • Disparities in oral health outcomes by race/ethnicity, SES • Many children lack access to dental care • Washington state data do not compare favorably with national data Kathy Phipps, MPH, DrPH, consulting epidemiologist

  13. Prevalence of ECC Washington 1-year-olds Washington 2-year-olds NHANES III 2-year-olds

  14. 60 54.6 50 46.0 40.7 40 Percent of Children 30 21.6 19.2 16.9 20 10 0 Sealants Untreated Decay 2000 Trends Over Time Caries Experience 1994

  15. Adult Oral Health • Periodontal disease is common • Maternal periodontal disease and LBW • Periodontal and cardiovascular disease • Pulmonary impact of oral disease • Mothers choose health care for families • Oral-systemic health: diabetes, others • Oral cancer: 8000 people die a year

  16. Older Adults • More periodontal disease • More oral-systemic health impacts • More oral cancer • Impact of medications • Long term care facilities • Complex social arrangements

  17. Mental Retardation and Special Needs • Lack of data on oral conditions • Impact of medications, conditions • Down syndrome and periodontal disease • Effect of anti-convulsants • Difficulty with self-care • Complex guardianship, living arrangements

  18. Key themes: Special populations • Importance of oral-systemic interactions: need for interdisciplinary collaboration • Diminished mental/ motor capacity need for special arrangements and emphasis upon prevention • Difficulty accessing care need for better training, other solutions • Complex social and cultural factors • Lack of good data

  19. Context Disparities may worsen: • Demographics:diversity;child poverty; survival those with special needs, elderly • Workforce gaps:not enough dentists; retiring;mostnot in Medicaid; physicians lack training • Policy gaps: lack of insurance; oral care not “medically necessary” (especially impacts special needs population)

  20. Partnership • Department of Pediatric Dentistry • Department of Family Medicine • UW Affiliated Family Practice Residency Network • Department of Medical Education and Bioinformatics

  21. ICOHP Goal 1: Training family medicine residents and faculty in oral health promotion Objectives: • Develop curricula in children’s oral health, 0-5 • Pilot, implement in WWAMI sites • Evaluate effect of training on knowledge, attitudes, behavior • Disseminate curricula

  22. Washington Montana Wyoming Alaska Idaho Family Practice Residency Affiliation Under Negotiation Rural Training Track UW FP Residency Network: Sites

  23. Geographical barriers

  24. Assumptions • Biggest obstacle will be buy-in • Tailor curriculum to physician needs • Integration with dental sector in community critical • Sustainability will require additional work

  25. Focus Groups: Faculty/ Residents, Staff Barriers • Oral health not on their radar screen; lack knowledge/self-efficacy • Providers busy: oral health not a priority • Concerned about the evidence base • Confusion about physician role • Lots of baggage about dentists

  26. Focus Groups: Faculty/ Residents, Staff Opportunities • Care about children in pain • Unable to answer parents’ questions • Prevention is a high priority • Already providing health education • Acutely aware of access issues • Committed to underserved communities

  27. Address Barriers and Opportunities • Increase motivation • Oral health important • Impact on children • Increase practitioner knowledge • Normal dental development • Caries process

  28. Address Barriers and Opportunities • Review evidence base (USPSTF; CDC Fluoride recommendations) • Frame in terms of primary care roles: • Anticipatory guidance • Nutrition/feeding • Injury prevention; emergency management • Special issues for CSHCN

  29. Address Barriers and Opportunities • Address resentment towards dentists: Work with dentists one-on-one: • partner with ABCD, community health clinics, pediatric dental trainees • Increase communication, lines of referral • Reinforce principles of family-centered, culturally competent care • already part of residency culture / training

  30. Modules:Frame to issues raised • Module 1: Public Health Overview; Oral Health Promotion and Practice • Module 2: Normal Dental Development/ Pathology • Module 3: Dental Caries; Collaborating with Dentists • Module 4: Dental Trauma and Emergencies • Module 5: Oral-systemic Health Interactions

  31. Respond to Requests for More Information • Module 6: Atraumatic Restorative Technique • Module 7: Maternal oral health • Module 8: Adolescent oral health • Module 0: Managing the change process

  32. Trainings to date • Seattle • Yakima • Spokane • Olympia • Boise • Anchorage • Pending: Valley, Vancouver

  33. Frame for Primary Care Providers PCP Roles: 1. Anticipatory guidance/ counseling 2. Risk assessment - oral screening, history (maternal history) 3. Applying fluoride varnish 4. Dental referral / collaboration 5. Monitor oral-systemic health interactions 6. Manage simple dental trauma 7. Maternal oral health counseling

  34. North Carolina • North Carolina: Statewide Medicaid program: pediatricians/family practitioners provide oral health education / screening exams / apply fluoride varnishes to young children 0-3 / dental referrals • Partnership: Supported by dental, pediatric, family practice societies

  35. Others to watch • MCH Oral Health training for non-dental providers • http://www.mchoralhealth.org/PediatricOH/index.htm • Minnesota training, fluoride varnishes • http://meded1.ahc.umn.edu/fluoridevarnish/xindex.htm • AAP –presentations for chapters – stay tuned

  36. Medical Mantra • Address medical training gaps • Change perceptions among medical professionals • Integrate oral health into systemsof care especially for vulnerable populations • Developmedical-dental collaborations • Leadership in policy/ education • Standard of practice that includes oral health

  37. Key Points • Disparities in oral disease /access to care • Impact on vulnerable populations • Workforce critical: not enough providers • Prevention is key - if started early • Integrate oral health into overall health • Partnerships are needed to make this happen

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