The National Vision for Oral Health

1. The National Vision for Oral Health William Bailey, DDS, MPH RADM, USPHS Chief Dental Officer Acting Director, CDC Division of Oral Health wdb9@cdc.gov

2. This presentation has not been cleared for dissemination and does not represent the opinion of the Centers for Disease Control and Prevention or the Department of Health and Human Services.

3. What may influence our vision? • National Backdrop • Debt, Health Reform, Strategic Plans, Reviews, Data Issues • Competing priorities • Infrastructure and capacity • Workforce challenges, succession planning, new models • Partnerships • Communication

4. How far out can we see? HHS Strategic Plan – 5 years HHS Oral Health Initiative – 5 years Healthy People 2020 – 10 years

11. Goal 2: Transform Health Care Through its Departmental Oral Health Initiative, HHS is promoting the incorporation of oral healthcare services and oral disease prevention into primary healthcare delivery sites. HHS will promote policies to integrate oral health into primary care, including prevention and improved health literacy. Improved availability of oral health services, including disease prevention, treatment, and health promotion and education should be promoted for poor and underserved populations as well as for the population at large.

12. Goal 2: Transform Health Care • Increase access to primary oral healthcare services and to oral disease preventive services by expanding access to: • health centers, school-based health centers, and Indian Health Service funded health programs that have comprehensive primary oral healthcare services, and • State and community-based programs that improve oral health, especially for children and pregnant women.

13. Goal 3: Advance Scientific Knowledge and Innovation Strengthen oral health research Use evidence-based oral health promotion and disease prevention Clarify the interrelationships between oral disease and other medical diseases

14. Goal 5: Strengthen the Nation’s Health and Human Service Infrastructure and Workforce • Expand the primary oral healthcare team • Promote models, where appropriate, that: • incorporate new providers, • expand scope of existing providers, and • utilize medical providers to provide evidence-based oral health preventive services

16. Structure - Oral Health Coordinating Committee • National Institutes of Health • Centers for Disease Control and Prevention • National Center for Health Statistics • Health Resources and Services Administration • Centers for Medicare and Medicaid Services • Administration for Families/Office of Head Start • Indian Health Service • Office on Disability • Food and Drug Administration • Agency for Healthcare Research and Quality • Administration on Aging • Office of Public Health and Science • US Coast Guard • Federal Bureau of Prisons

17. “Promoting and Enhancing the Oral Health of the Public”

18. National Oral Health Surveillance PlanProgress Report NIDCR and CDC met with nationally-recognized experts Themes emerged from the meeting: Oral health data must serve a multiplicity of need — for research and for public health/practice and policy. Strengthening communications with advocates and stakeholders will help define goal-directed data-capture methods and data analyses. The granularity and frequency of oral health surveillance data collection has resource implications. Movement toward self-reported data collection and other non-invasive data collection may enhance the evenness of oral health data collected across populations. Efforts must continue to integrate oral health with systemic health, with implications for both oral health monitoring and oral disease prevention and management. A summary of the meeting and the background paper have been finalized and are under review prior to submission for publication in a major public health journal. Communications and collaborations with CDC, NIDCR and NCHS continue

19. Innovative State Medicaid Dental ProgramsProgress Report Review of successful practices and program innovations Partnerships and collaborations among State partners and stakeholders in addressing access to dental services; Collaboration with dental schools and loan repayment programs; Increased reimbursement; Simplifying administrative processes; Grant funding; Educating families; Targeting young children; and Dental home initiatives Increase the rate  of low income children ages 1-20 enrolled in Medicaid or CHIP who received any preventive dental services by 10 percentage points over a five-year period. Increase the rate  of low income children ages 6-9 enrolled in Medicaid or CHIP who receive a dental sealant on a permanent molar tooth by 10 percentage points over a five-year period.

20. National Study on Oral Health Access to ServicesProgress Report Hearings/meetings have been held for the: Assessment of the current oral health care system. Development of strategies to improve access to and the effectiveness of oral health services to vulnerable populations Preparation of a strategic plan for addressing issues and improving the particular role of Federally Qualified Health Centers in meeting the oral health needs of the underserved. The IOM Oral Health Initiative Committee will recommend actions for DHHS agencies and, if relevant and important, other actors to:  Design of a future system for providing oral health care for women and children who are most vulnerable to oral disease The report is currently on track for March 2011 submission to HRSA and publication of the final report in August 2011.

21. National Study on an Oral Health InitiativeProgress Report Hearings/meetings have been held for the: Assessment of the current oral health care system. Examination of preventive care interventions, their use and promotion, including greater health literacy; Review of the elements of a national oral health initiative encompassing regulations, statutes, programs, research, data, financing, and policy The IOM Oral Health Initiative Committee will recommend actions for HHS agencies and, if relevant and important, other actors to Improve and expand the HHS Oral Health Initiative The report is currently on track for March 2011 submission to HRSA and publication of the final report in August 2011.

22. The Early Childhood Caries InitiativeProgress Report Overall Goal: Reduce the prevalence of ECC among 0-5 year old AI/AN children by 25% by FY 2015. Increase dental access for 0-5 year old AI/AN children by 10% in FY 2010 and 50% by FY 2015. Increase the number of children 0-5 years old who received a fluoride varnish treatment by 10% in FY 2010 and 25% by FY 2015. Increase the number of sealants among children 0-5 years old by 10% in FY 2010 and 25% by FY 2015. Increase the number Interim Therapeutic Restorations provided for children ages 0-5 by 10% in FY 2010 and 50% by FY 2015.

23. ECC Initiative Packet Together we can prevent ECC!!! Available now! www.doh.ihs.gov/ecc

24. Clinical and Translational Science ProgramCreation of Dental Network ToolkitProgress Report • A clinical data management system to support: • Dental Clinical Trials • Patient Registries • Longitudinal & Observational Studies • Key functionality included: • Study configuration - Protocol details, visit schedules, site specific definitions, eligibility determination & treatment assignment • Case Report Form (eCRF) management- online form design, custom and standard eCRFs from central library • Electronic data capture- custom field validation, complex conditional logic, automated data queries • Integration of external data feeds- laboratory and reading center imports • Data extract and reporting - CDISC ODM data interchange, standard and ad hoc reports

26. Oral health educational materials have been added to materials distributed by OWH staff at all exhibits and in www.womenshealth.gov. The OWH fact sheet on oral health and the OWH pregnancy module is in the final stages of revision for publication and distribution to the public at exhibits and also via the www.womenshealth.gov website. Quick Health Data Online (QHDO), a database through www.womenshealth.gov providing state- and county-level data has updated its list of oral health data sources and subcategories to increase the number of oral health indicators for the database. An added link to QHDO provides data on women’s dental visits and dental cleaning as one of eleven indicators focusing on preventive measures women can take to improve their physical and mental health and prevent disease. Oral Health as Part of Women’s Health Across the LifespanProgress Report

29. Healthy People 2020 There are 4 Overarching Goals: Attain high quality, longer lives free of preventable disease, disability, injury, and premature death. Achieve health equity, eliminate disparities, and improve the health for all. Create social and physical environments that promote good health for all. Promote quality of life, healthy development and healthy behaviors across all life stages.

30. HP 2020 Oral Health Objectives Objectives Retained as is from HP 2010: Oral Health HP2020 1: Increase the proportion of oral and pharyngeal cancers detected at the earliest stage. (21.6) Oral Health HP2020 2: Increase the proportion of the U.S. population served by community water systems with optimally fluoridated water. Oral Health HP2020 3: Increase the proportion of children and adults who use the oral health care system each year. (21.9) Oral Health HP2020 4: Increase the proportion of low-income children and adolescents who received any preventive dental service during the past year. (21.12) Oral Health HP2020 5: Increase the number of States and the District of Columbia that have an oral and craniofacial health surveillance system. (21.16)

31. HP 2020 Oral Health Objectives Objectives Retained but Modified from HP 2010: Oral Health HP2020 6: Reduce the proportion of children and adolescents who have dental caries experience in their primary or permanent teeth. (21.1) Oral Health HP2020 7: Reduce the proportion of children, adolescents, and adults with untreated dental decay. (21.2) Oral Health HP2020 8: Increase the proportion of adults who have never had a permanent tooth extracted because of dental caries or periodontal disease. (21.3/21.4) Oral Health HP2020 9: Reduce Periodontitis (21.5b) Oral Health HP2020 10: Increase the proportion of children who have received dental sealants on their molar teeth.(21.8a/b)

32. HP 2020 Objectives Objectives Retained but Modified from HP 2010: Oral Health HP2020 12: Increase the proportion of school-based health centers with an oral health component. (21.13a/b) Oral Health HP2020 13: Increase the proportion of local health departments and Federally Qualified Health Centers, that have an oral health component. (21.14) Oral Health HP2020 14: Increase the number of States, and DC that have a system for recording and referring infants and children with cleft lips and cleft palates to craniofacial anomaly rehabilitative teams. (21.15) Oral Health HP2020 15: Increase the number of health agencies that have a public dental health program directed by a dental professional with public health training. (21.17a/b)

33. HP 2020 Objectives New Objective to HP 2020: Oral Health HP2020 16: (Developmental) Increase the proportion of adults who receive preventive screening and counseling from dental professionals. Increase the proportion of adults who received information from a dentist or dental hygienist focusing on reducing tobacco usage or smoking cessation Increase the proportion of adults who received an annual cancer screening from a dentist or dental hygienist. (Formerly 21.7) Increase the proportion of adults who are tested or referred for glycemic control from a dentist or dental hygienist

34. HP 2020 Resources Resources: http://healthypeople.gov http://cdc.gov/nchs/ http://wonder.cdc.gov/ Healthy People Listserve (HEALTHYPEOPLE@LIST.NIH.GOV) 34

35. Vision for the Future – Other Possibilities National Oral Health Plan Quality measures Improved communication and collaboration between public and private entities Increased focus on older adults Utilizing Health Information Technology to improve care

36. Questions?