Moving the Dial to Improve Children’s Dental Health: A National Picture

1. Moving the Dial to Improve Children’s Dental Health: A National Picture Shelly Gehshan Pew Children’s Dental Campaign

2. The Pew Children’s Dental Campaign Our Mission: The Pew Children’s Dental Campaign strives for cost-effective policies that will mean millions more children get the basic dental care they need to grow, learn and lead healthy lives. 2

3. We Focus on 3 Areas of Policy • Strengthen prevention: working with states to expand water fluoridation to more communities • Funding to improve access: secure federal funds to support state-based initiatives • Expand the dental workforce: encourage states to license new types of providers to reach underserved communities 3

4. PCS Campaign Structure 4

5. Fluoridation

6. Community Water Fluoridation:Don’t look now, but it is under attack Spring Hill votes to stop fluoridating its water Dentist voices concern 6

7. Support is Ebbing Among Some Groups • Groups that are more likely to oppose fluoridation: • The 18-34 age group • Men • Hispanics • Asians • Those who currently don’t have CWF • Those who describe themselves as conservative or liberal (as opposed to “moderates”) • Those who report being more knowledgeable of CWF (SalterMitchell, November 2010 survey ) 7

8. Focus on Prevention Fluoridated Water: Highest 10 Lowest 10 • 72 million Americans don’t receive fluoridated water. • Texas study: Savings of $24 per child, per year from fluoridation. l l 8 8

9. A “settled issue” is now a debate Media analysis: 4 out of 5 front-page stories about fluoride framed the issue as a “debate.” The Jan. 2011 HHS/EPA announcement about fluoride was well covered by news media and gave opponents a new chance to sow fear and doubt. l Health: Not in My Water Supply Somebody put a dead rat in Curtis Smith's mailbox. Someone else has made anonymous phone calls accusing him of trying to poison his neighbors. And all around the usually placid university town of Bellingham, Wash., activists from a group called Citizens Against Forced Fluoride have planted lawn signs adorned with skull and crossbones. "I had no idea it would get this intense," says Smith, 70, a retired dentist who is leading a Nov. 8 ballot initiative to add fluoride to the local drinking water. l Debate over adding fluoride to water continues A Denham Springs councilman says he wants more information before following a new Louisiana law ordering public water systems to start adding fluoride to their water "to protect the dental health of this state." Councilman John Wascom calls the water from his tap "Grade A." He says it is clean, clear and refreshing. He sayshe needs more information from 9

10. Fighting Back • The Campaign for Dental Health--a diverse pro-fluoridation coalition. • A strong online presence • A network for advocates 10

11. Tools for Advocates 11

12. Tools for Local CWF Advocates FLUID: searchable database of legal cases and policies on CWF Create customized local web presence for their CWF campaign 12

13. Pew Fluoridation Efforts Adopting CWF in Wichita, Kan. S Pushed for CWF in Portland S S S S Helped DoD with data that led to order all bases fluoridate Expanding CWF in Santa Clara County (San Jose) S Advocacy for passage of new CWF law Assisted state health dept.’s strategy to expand CWF 13

14. Sealants & Fluoride Varnishes

15. New Report Due in November 15

16. WA ME ND MT OR VT ID MN NH MA WI NY SD WY MI RI CT PA IA NJ NE NV OH UT IN DE IL MD CO CA WV VA DC KS MO KY NC TN AZ OK SC AR NM GA AL MS TX LA FL AK HI Removing Barriers to Sealants Prior Exam Requirements (2012) Dentist’s exam and direct or indirect supervision required (10) Dentist’s exam always required (10) Dentist’s exam sometimes required (16) Dentist’s exam never required (15) Source: Pew Center on the States data from survey of state oral health programs and state boards of dentistry, 2011-2012. 16

17. Sealant Programs in High-Risk Schools (2010) # of States Percentage of high-risk schools with sealant programs 17 Source: Pew Center on the States, The State of Children’s Dental Health: Making Coverage Matter (2012)

18. States that Reimburse Physicians for Oral Health Preventive Services ME WA MT ND MN OR NY WI SD ID MI WY PA IA VT NE OH IN NV IL NH WV UT VA CO MA MO CA KS KY RI NC TN CT OK SC AR AZ NM NJ GA AL MS DE LA MD TX DC FL AK No Policy HI Policy Adopted 18

19. Why Focus on Workforce?

20. 37.5 48.4 43.1 44.4 48.7 (VT) 37.1 32.2 38.7 42.6 (NH) 36.2 (MA) 44.8 37.1 40.4 39.6 47.6 41.7 (RI) 42.8 (CT) 42.6 40.4 36 (NJ) 40.3 27.4 42.2 38.1 32.9 39.2 (DE) 36.9 39.2(MD) 36.4 32.6 42.3 38.1 46.4 (DC) 41.1 45.8 38.4 35.9 43.3 31.9 40.1 39.9 39.7 45.5 33.8 37.1 37.3 36.2 41.5 40.7 37 36.5 New Providers are Needed Percentage of Dentists over age 55 (2009) ≥45 % 40-44.9% 35-39.9% <35% Source: www.cdc.gov/nohss Source: American Dental Association. (2011) Distribution of Dentists In the United States By Region and State, 2009. 20

21. WA ME ND MT NH OR VT ID MN MA WI NY SD MI WY RI CT PA IA NE NJ NV OH UT IN DE IL MD WV CO CA VA KS MO KY NC TN AZ OK SC AR NM GA AL MS LA TX AK FL HI % of Population (by state) Living in Dentist Shortage Areas: 6,400 Dentists Needed DC Less than 10% 10-14.9% 15-19.9% 20% or more Source: www.ersrs.hrsa.gov/ReportServer?/HGDW_Reports/BCD_HPSA/BCD_HPSA_SCR50_Smry&rs:Format-HTML3.2 , accessed 9/14/2012. 21

22. WA ME ND MT NH OR VT ID MN MA WI NY SD MI WY RI CT PA IA NE NJ NV OH UT IN DE IL MD WV CO CA VA KS MO KY NC TN AZ OK SC AR NM GA AL MS LA TX AK FL HI Workforce Innovation is Growing States that are exploring new ways to expand the dental workforce 22

23. Theme: Get Care to PeopleWhere They Are “If you live in the suburbs, if you have a car, plenty of money, dental insurance, and no dental disease, we have the perfect delivery system for you.” – Charles Bertolami, Dean New York University College of Dentistry 23

24. A Ladder for Dental Professionals? Dental specialists Dentists Advanced Dental Hygiene Practitioners Dental Hygienist/therapists Dental Therapists Dental Hygienists Dental Assistants 24

25. Steady Trickle of “Never” Events In 2005, Teron Francis, a 13-year old boy from New York was declared brain dead after suffering from severe swelling from an infected tooth from an infected tooth • In 2007, just days after Deamonte Driver died, Alexander Callender, a 6-year old boy died from an abscess in his mouth where 2 teeth had previously been removed • In August 2011, Kyle Willis, a 24-year old man died of a tooth infection because he couldn’t afford the antibiotics prescribed to him Source: Inside Dentistry, “Once Upon a Time”, May 2008, Volume 4, Issue 5. Available at: http://www.dentalaegis.com/id/2008/05/once-upon-a-time 25

26. Biggest Unmet Need Among Adults Now is not the time? • Need picture of mission of mercy lines, or punchy graphic on need Free clinic in Brighton, CO, about 30 minutes outside of Denver. The first person in line arrived at 5:00 p.m. The clinic opened the following day at 5:00 a.m. Source: Denverpost.com, http://www.denverpost.com/news/ci_13320334, accessed 4/6/2011. . 26

27. Oral health is a winnable battle • Cheaper and easier than achieving world peace! • Many policy solutions • Solid research basis and return on investment • Bipartisan political support and momentum is on our side : 27

28. WA ME ND MT NH OR VT ID MN MA WI NY SD MI WY RI CT PA IA NE NJ NV OH UT DE IL IN MD WV CO CA VA KS MO KY NC TN AZ OK SC AR NM GA AL MS LA TX AK FL HI Children’s Dental Campaign Progress Gains in CWF Workforce expansion Access to sealants 28

29. Keep informed... of these and other oral health issues by receiving Pew's monthly e-newsletter – Dental News & Views. Send an email to mjacob@pewtrusts.orgwith the words “Sign me up" in the subject line.