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California Children’s Oral Health: Opportunities

California Children’s Oral Health: Opportunities. Hal Slavkin, Dean, School of Dentistry, University of Southern California, Los Angeles, California. 5 th Annual Community Forum on the Conditions of Children in Orange County November 15th, 2006. Today’s Program.

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California Children’s Oral Health: Opportunities

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  1. California Children’s Oral Health: Opportunities Hal Slavkin, Dean, School of Dentistry, University of Southern California, Los Angeles, California 5th Annual Community Forum on the Conditions of Children in Orange County November 15th, 2006

  2. Today’s Program The Changing Landscape of Oral Health in America • Surgeon General’s Report “Oral Health in America” (2000) • Healthy People 2010 (2000) • California’s “The Silent Epidemic” (2000-2006) • HRSA Report on Oral Health Improving the Oral Health in California • A Call to Action • Community-based programs (e.g. WomenAndCommunity) • Fast Food Services vs Community Wellness Strategies

  3. A Changing Environment • Changing patterns of morbidity/mortality • Changing demographics • Changing management of health care • Changing paradigms for health and disease • “Golden era of biomedical research” • Changing societal expectations and “quality of life” • Global information technology

  4. General Background Demographics 1980- - - 235.1 million people 2000- - - 277.8 million people 2006- - - 300.0 million people 2020 - - -332 million people Expenditures For Dental Services 1980 - - - $13 billion (30% dental insurance) 2000 - - - $60 billion (50% dental insurance) 2006 - - $109 billion Demand For Oral Health Services Demand increasing for prevention, periodontics, endodontics, orthodontics, implants, esthetic dentistry 110 million Americans do not have dental insurance (“access issue”) Oral Health Workforce 180,000 dentists in 140,000 dental practices 6,000 dentists retire each year and 4,200 DDS/DMD graduate each year 5,000 dental hygienist graduate per year 4,900 dental assistant graduates per year 490 dental technician graduates per year Expanded Work Force Familes and Communities Preschool and K-12 Educators Pediatricians, Nurses, Pharmacists, Social Services Food and drink services

  5. A Case Study: California • The Neglected Epidemic (1993-1994) • Halting A Neglected Epidemic (2000, 2006) • HRSA Oral Health Survey, (2001-2006) • USC Southern California Center: Health (2001) • California in the New Millennium, Mark Baldassare (2000)

  6. State population of 37.5 million; project 50 million by 2028 Southern California 8 Counties (Santa Barbara, Ventura, Los Angeles, Orange, Riverside, San Bernardino, San Diego & Imperial) 24.4 million Largest ethnic group is Latinos; >58% of State youth are Latino State’s growth primarily driven by immigration Approximately 224 languages/dialects spoken The under-18 population grew >20% from 1990-2000 State Asian-Americans grew by 38% versus 35% for Latinos (1990-2000) Fifth largest economy in the world Major issues include education, health, energy, water & air quality, transportation California in 2006

  7. Only 30% of Californians receive the benefits of fluoridated drinking water More than 20% of children are overweight More than 25% of preschool children without dental insurance More than 40% of high school students without dental insurance Between 50% and 75% of “minority high school students” need dental care California’s children have twice as much untreated tooth decay (dental caries) as the national average Children living in poverty have increased in number with attendant increases in disease; especially “minority children.” The under-18 population increased >20% across Southern California from 1990-2000 California’s Children

  8. Southern California Region • 9 counties (Santa Barbara to San Diego) • 24.4 million people • 55% of all births in the state • Nearly 10,000 cases of structural birth defects annually • 32% speak Spanish at home • 13% earn less than $15,000 annually

  9. Los Angeles County • 11.5 million people • 4,000 square miles • 88 cities • 23% are non-citizens • 36.3% foreign-born • Increases by 300,000 people per year • 1/3 of all births in the State of California

  10. [ Language Spoken at Home Los Angeles County

  11. America and Poor Children • By 2030, non-White children will constitute a majority • From 1969-1997 the number of poor children grew by 46% (more than 4 million) • In 2000, a child is born into poverty every 40 seconds • A child is reported abused or neglected every 11 seconds • A child runs away from home every 24 seconds • A child bears a child every minute • In 2000, >30% of high school females smoked cigarettes (Surgeon General’s Report Women and Smoking, March 26, 2001); tobacco linked with chronic diseases and disorders • #1 Chronic disease of children is tooth decay • #1 Reason for school absenteeism is tooth decay

  12. California Opportunities • Improve oral health and well-being in California • Translate scientific and technology results into oral health promotion, disease prevention, standards of care, diagnosis & treatments, clinical management of diseases and disorders, health services, health outcomes and health professional education • Recruit & retain cultural diversity in the oral health professions workforce • Increase multi-center, multidisciplinary prospective and randomized clinical trials by linking 5 dental schools • Create a coalition between five dental schools, organized dentistry, dental insurance sector, “key” medical programs such as pediatrics and primary care, and other public and private partners • Promote student- and patient-centered, evidence-based, problem-based learning in dental education • Create state-wide oral health coalition with communities, dentistry, medicine, nursing, pharmacy, industry, government and non-profit foundations--- Emphasize Health Promotion!

  13. Cultural competencies Clinical competencies & skills required for primary care oral health/dentistry Health administration & management Epidemiology Biostatistics Human behavior Cultural anthropology Nutrition Conflict resolution and mediation skills Critical thinking and life-long learner Communications Public health education Behavioral modifications Skills of fluoridation, dental sealants, oral hygiene, infection control Human genetics & counseling Manage oral infections & systemic diseases Information technology Competencies for Oral Health Professionals

  14. Oral Health in America: A Report of the Surgeon General (2000) Department of Health and Human Service

  15. The Charge Define, describe, and evaluate the interaction between oral health and health and well-being (quality of life), through the life span in the context of changes in society. Secretary Donna Shalala, 1996

  16. The SG Report Project Team • Caswell A. Evans • Asst Director, Los Angeles County Department of Health Services • Dushanka V. Kleinman • Deputy Director, NIDCR, NIH • William R. Maas • Chief Dental Officer, USPHS and Director, Division of Oral Health, CDC • Harold C. Slavkin • Director, NIDCR, NIH

  17. Organization of the SG Report • What is Oral Health? • What is the Status of Oral Health in America? • What is the Relationship Between Oral Health and General Health and Well-Being? • How is Oral Health Promoted and Maintained and How are Oral Diseases Prevented? • What are the Needs and Opportunities to Enhance Oral Health?

  18. Surgeon General’s ReportOral Health in America • Oral diseases affect health and well being throughout lifespan • Safe and effective preventive measures do exist • Lifestyle behaviors that affect general health such as tobacco & alcohol use, and poor dietary choices, also affect oral health • Major oral health disparities • The mouth reflects general health and well being

  19. SG ORAL HEALTH MESSAGES • Over 4.2 million live births each year • A major complication is low birth weight, premature babies • Most common birth defects being craniofacial, oral and dental deformities • The most common chronic disease in children is dental caries • Over 70 million children in US (26% US population)

  20. Tooth Decay: The Most Common Chronic Disease of Children

  21. Oral Health Disparities - Children • Dental caries are caused by transmissible bacterial infections from caregiver to infant • Inhibition of oral bacterial colonization into biofilms is a major target for caries prevention (antibodies? chemicals?) • Dental sealants are proven to be 100% effective in preventing dental caries on chewing surfaces of teeth • Fluoride varnish is an effective “tool” • Fluoridation of community drinking water appears to be the major factor responsible for the decline of dental caries in the US • More than 52 million school hours are lost due to dental pain and suffering in children

  22. Oral Infection Associated With Low Birth Weight Premature Babies and Congenital Craniofacial Birth Defects

  23. Craniosynostosis

  24. Cleft Lip & Cleft Palate • One of the most common birth defects • Prevalence is one per hour in the United States; 1 per 500 live births in California • Direct health costs are approximately $110,000 per child

  25. Dental Caries is a Transmissible Bacterial Infectious Disease

  26. SG ORAL HEALTH MESSAGES • Unintentional injuries to head and neck in children is a major health issue • Oral cancer is the sixth most common cancer • One American dies every hour of oral cancer • Periodontal diseases found in >60% of adults • Tobacco linked with all major chronic diseases; in 2000, 30% of high school females smoked cigarettes • Oral infections associated with systemic diseases • Systemic diseases have oral complications

  27. In a recent survey of adults 40 yrs & older, only 14% of respondents said they had ever been examined for oral cancer • Regular oral self-examination to inspect lips, gums, inside of cheeks, tongue, back of throat, and floor and roof of mouth • Annual oral health professional examination

  28. Towards understanding oral neoplastic biological processes • Inherited and acquired gene mutations • Multiple and sequential gene mutations • Multiple gene-gene and gene-environment interactions • Significant candidate gene mutations associated with transcription controls, mitosis, and apoptosis

  29. Genetic Modifiers Inflammation in Oral Tissues Clinical Disease Severity Microbes in Biofilms Environmental Modifiers Genetic Factors in Oral Microbial Infections

  30. Oral Infection and Systemic Diseases • Low birth weight, premature babies • Cardiovascular disease • Cerebrovascular disease • Pulmonary diseases • Osteoarthritis • Diabetes complications with oral infection • Cancer therapy (radiation, surgery, chemotherapy) and oral complications (e.g. “dry mouth” and rampant tooth decay)

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