oral health panel - wisconsin womens health foundation · creating access to dental care for...

Oral Health Panel

Objectives

1) Discuss Clinical Issues Related to Oral Health

2) Explore Systemic Innovations for Improving Access to

3) Discuss Policy Challenges and Opportunities in Assuring

Oral Health for All

Introductions

Matt Crespin, MPH, RDHAssociate DirectorChildren’s Health Alliance of Wisconsin

Dixie Schroeder, MBACenter Research AdministratorMarshfield Clinic

Kelsey Van Handel, RDH

Dental Hygienist/Periodontal Therapist

Meridian Endodontics & Periodontics

PERIODONTAL HEALTH CONCERNS RELATED TO WOMEN

Kelsey Van Handel, RDH, Periodontal Therapist

WHAT IS PERIODONTICS?

THE BRANCH OF DENTISTRY CONCERNED WITH THE STRUCTURES SURROUNDING AND SUPPORTING THE TEETH.

Gingivitis (gum disease)

• Mildest form of periodontal disease caused by poor

oral hygiene and plaque accumulation.

• Easily reversible with meticulous oral hygiene and

professional dental treatments.

Periodontitis

• Untreated gingivitis can advance to periodontitis.

• Toxins produced by the bacteria in plaque irritate the

gums which stimulates a chronic inflammatory

response.

• Tissues and bone that support the teeth are broken

down and destroyed.

Signs of periodontal disease:

• Red, swollen or tender gums

• Bleeding while brushing or flossing

• Gums that pull away from the teeth

• Loose or separating teeth

• Pus between the gum and the tooth

• Persistent bad breath (halitosis)

• A change in the way your teeth fit together when you

• A change in the fit of partial dentures

PERIODONTAL DISEASE AND WOMEN

• Puberty

• Menstruation

• Pregnancy

• Menopause and Post-

Menopause

Strong correlations exist between periodontal disease and heart disease, diabetes, atherosclerosis, HPV, oral cancer and respiratory problems in both women and men.

How can YOU help to educate and decrease incidence?

• Establish good dental hygiene habits early

• Serve as a good role model

• Schedule regular dental visits

• Check child’s mouth frequently

1.) HORMONAL (PUBERTAL)

GINGIVITISDirectly associated with increased levels of

progesterone and estrogen.

Etiology: Increased permeability of the

periodontal vascular system.

2. MENSTRUATION

Menstruation gingivitis typically

occurs right before a woman’s period

and clears up once her period has

started.

Progesterone:

• Exaggerated response to

plaque accumulation

(irritants)

• Blocks the repair of

collagen, the main protein

that comprises the

connective tissue of the

periodontium

Estrogen:

• Keeps oral mucous

membranes moist and

flexible

Estrogen:

• Low estrogen is associated

with reduced levels of bone

remodeling, thereby

compromising tooth-

supporting alveolar bones

3. PREGNANCY:

“Pregnancy gingivitis” occurs due to

increased progesterone secretion

causing gum tissue to increasingly

swell, bleed and redden in response to

a very small amount of plaque.

Active periodontal disease is a risk factor for pre-eclampsia.

3. PREGNANCY (cont’d)

PYOGENIC GRANULOMA (PREGNANCY

TUMOR): Non-malignant lesion formed due to

extreme response to gingival irritants.

• Highly vascular, ulcerated and bleeds very

easily

• Generally will subside on their own and are

not painful

• May be excised by a surgical dentist, such as

a periodontist or oral surgeon, if they

become painful or impede eating or speech

4. MENOPAUSE and POST-MENOPAUSE

• Dry mouth

• Pain and burning sensations

• Altered taste- especially salty, peppery

or sour

• Gingivostomatitis

• ONJ (Osteonecrosis of jaw) relating to

bisphosphonates

• Tooth loss resulting in lack of osseo-

perception and proprioception

TODAY WE HAVE DISCUSSED VARIOUS WOMEN’S HEALTH ISSUES AS THEY PERTAIN TO PERIODONTAL DISEASE, WHICH IN TURN WILL BETTER OUR OVERALL DENTAL AWARENESS AND WELL-BEING. WITH KNOWLEDGE ON PREVENTION, AND THE PERIODONTAL DISEASE PROCESS, I HOPE I HAVE

HELPED YOU ACHIEVE CONFIDENCE AS YOU TAKE THIS INFORMATION FOR THE BETTERMENT OF YOUR COMMUNITY IMPROVEMENT MISSIONS.

KELSEY VAN HANDEL, RDH, PERIODONTAL THERAPIST

In Closing-

School-Based Dental Programs

2000 Oral Health In America:

A Report of the Surgeon General• Reduced disease and costs through school-based sealant and fluoride

programs

Wisconsin’s 2010-2020 Dental Workforce Report• The majority of children do not need to be seen by dentists;

• Children are screened periodically and receive appropriate preventive

services, reducing the incidence of decay;

• Students and parents lose less time from school or work;

• School administrators and teachers support the program;

• Organized dentistry supports the program

School-Based Dental Programs

Seal-A-Smile

Give Kids A Smile

Celebrate Smiles

Seton Dental Clinic - Smart Smiles

Brown County Oral Health Partnership

Community and School-Based Dental Programs

Seal A Smile

Give Kids A Smile

Touch Twice

Mission of Mercy

Celebrate Smiles

Seton Dental Clinic - Smart Smiles

Verona Smiles

• Verona Smiles is a

collaborative effort between

First Choice Dental, Bridging

Brighter Smiles, and the

Verona schools.

• The mission is to ensure that

all students in the Verona

school district have access to

oral health care.

Badger Ridge and Savannah Oaks Middle Schools

• 28.5% of the students are

part of the free and reduced

lunch program

• 132 students at Badger Ridge

• 156 students at Savannah Oaks

Verona Smiles

During out first visits

to the Badger Ridge

and Savannah Oaks

Middle Schools,

comprehensive

exams and x-rays of

students also seeing

BBS show that

30.8% of the

students seen

needed restorative

treatment.

Verona Smiles

After our second visit to the schools 6 months

later, no new treatment needs were found.

Verona Smiles

Of those students that

need treatment, the

majority need only

fillings and extractions of

deciduous teeth. A select

few, however, have

extensive dental needs.

Verona Smiles

The extent of decay

ranges greatly with

students that have only

1 or 2 areas of decay to

students that have 7 or

more. 33% of the

students that have decay

need 1-2 fillings while

the remaining 67% need

at least 3 fillings.

Out of the 54 appointments

scheduled for students to

come into a First Choice

office, there have been 3

canceled appointments and 4

missed appointments.

Parents have been receptive

to our office policies and

willing to come in when we

have availability in the

schedule.

Verona Smiles

This school-based

program has

allowed us to

complete 116

patient encounters

with 67 different

students.

Lessons Learned

Challenges:

• Securing consent forms to complete restorative treatment

• Scheduling care for a small number of hard to reach guardians

• Mobile equipment and clinic, while functional, were much less efficient

than doing office-based restorative work

Successes:

• School-based comprehensive exams and Nomad x-rays allowed for

the identification and creation of treatment plans for students in need

• Completing restorative treatment in offices close to target schools

made scheduling and completion of care much more efficient.

Questions?

2018 GRAPEVINE NURSES CONFERENCE – ORAL HEALTH PANELDixie Schroeder, MBA – Center Research Administrator

MCHS PRIMARY SERVICE AREA

• 49 clinical locations in 34 communities in the State of Wisconsin

• 3.5 million patient encounters representing approximately 350,000 unique patients

• Operates:

o 4 ambulatory surgery centers

o 7 urgent care centers

o 33 clinical laboratory locations

o 17 pharmacies

o 10 dental clinics

o 3 hospital facilities

o 3 skilled nursing facilities

CREATING ACCESS TO DENTAL CARE FOR DISADVANTAGED POPULATIONS

• Marshfield Clinic’s first regional dental center open in Ladysmith in July 2003

• Current Infrastructure:

– 10 Dental Centers

– 204 Operatories

– 46 General Dentists & Oral Surgeons

– 42 Dental Hygienists

– Total FTEs = 310.8Mr. Greg Nycz, Executive Director

Family Health Center of Marshfield, Inc. Marshfield Clinic Health System

• 10 FQHC providing dental services to people from all of Wisconsin's 72 counties

• 46,815 unique dental patients [2012]

MANY POPULATIONS LACK OF ACCESS TO DENTAL CARE

• Low-income

• Individuals on Medicaid

• Veterans with Limited Incomes

• Elderly on Fixed Incomes without a Dental Benefit

• Disabled

• Mentally Impaired

• Individuals with Addictions

• Individuals with Significant Medical Complications

MOUTH IS THE MIRROR TO ONE’S BODY

• A healthy mouth is a reflection of a healthy body

• A thorough examination of the mouth can detect diseases of the body

• First sign of diseases are visible in mouth. For example mouth ulcers, gum disease, etc.

• There is a bi-directional association of oral diseases and some health diseases

ORAL-SYSTEMIC HEALTH CONNECTION

INTEGRATED MEDICAL-DENTAL EHR ENVIRONMENT

MCHS’s unique Medical-Dental EHR Environment, supports:

➢ Comprehensive Care for over 120,000 Unique Patients

➢ Oral-Systemic Health Research Initiatives

➢ Inter-Professional & Patient Education

INTEGRATED MEDICAL & DENTAL CARE TO IMPROVE OVERALL HEALTH

WHY IS DIABETES A CONCERN?

• The greatest number of people with diabetes are between 40 and 59 years of age

• 46% people with diabetes are undiagnosed

Source: International Diabetes Federation http://www.idf.org/WDD15-guide/facts-and-figures.html

DIABETES ↔ PERIODONTAL DISEASE

• Diabetes has a detrimental effect

on periodontal disease

• Impact of periodontal health on

diabetic control

• Guardians of Health:

Care coordination is critical

• Taylor, G.W. and W.S. Borgnakke, Periodontal disease: associations with diabetes, glycemic control and complications. Oral Dis, 2008. 14(3): p. 191-203.

• Lalla, E. and I.B. Lamster, Assessment and Management of Patients with Diabetes Mellitus in the Dental Office. Dental clinics of North America, 2012.

CARE COORDINATION: ORAL HEALTH AFFECTS PREGNANCY

• Poor oral health has significant adverse pregnancy implications

• Medical providers have multiple interactions with motivated patients during pregnancy:

o Teachable moments:

✓ Introduce importance of good oral hygiene

✓ Oral health treatment is safe during pregnancy (even x-rays)

o Opportunity to refer patients to dental health professionals and coordinate care delivery

CARE COORDINATION: DENTAL CARE DURING PREGNANCY

We strive to provide timely dental care for pregnant patients:

• Promote Good Oral Healthcare to prevent low birth-weight babies and reduce potential for high-risk pregnancies

• Emergent Needs: Walk-in and same day appointments

• Non-Emergent Needs: Scheduled for an exam within one week of contacting our dental centers

PROMOTING GOOD ORAL HYGIENE FOR FUTURE GENERATIONS

Current Pediatric Recommendations*

• Routine Dental Visits: Appearance of first tooth or by 1 year of age

• Brush Twice Daily with:

– Rice sized amount toothpaste (up to 3 years of age)

– Pea sized amount of tooth paste (over the age of 3 years)

• Use of Fluoride

– Partnering with MCHS Family Practice and Pediatric Departments to apply fluoride varnish during regular well-child visits

*American Academy of Pediatric Dentistry. Oral Health Policies

“The best scientific thought is agreed that dentistry is a field of

medicine…There is no logical right whatever to isolate (the oral cavity) from

the rest of the body as if it were made up…of ivory pegs in stone sockets.”

- Dr. Alfred OwreDean of Dentistry

University of Minnesota, 1905-1927Columbia University, 1927-1933

www.chawisconsin.orgChildren’s Health Alliance of Wisconsin

Oral Health at the Alliance, in Wisconsin and beyond

Matt Crespin, MPH, RDH

Associate Director

Oral health at the Alliance

3 Necessary Buckets

• Funding

• Workforce

• Policy and Regulatory

MA access

Source ADA Health Policy Institute

MA enrolled providers

WI – PAs

WI - DDS

Source: Wisconsin Medicaid Data -2014

WI – PCPs

Level of participation

11%17%

Inactive Limited (1-25 pts) Active (26+ pts)

Medical Providers

Dental Providers

Source: Wisconsin Medicaid Data -2014

What’s the trend?

• Dentists: 4352

• 40% expect to retire in next decade

– New graduates won’t replace the retirees

– Unevenly distributed around the state

• Many communities do not have enough DDSs to serve the population

What’s the trend?

• Dental hygienists: 5321

• HRSA predicts a surplus of RDH in 2025 in most states including WI

– 8 DH programs in the state

Direct Access Wisconsin 2007

1. For public or private school 2. For a dental or dental hygiene school 3. For a local public health department health

department

Direct Access Wisconsin 2017

1. For a federal, state, county, or municipal correctional or detention facilities and facilities

established to provide care for terminally ill patients

2. For a charitable institutions open to the general public or members of a religious sect or

3. For nonprofit home health care agencies

4. For nonprofit dental care programs serving primarily indigent, economically

disadvantaged, or migrant worker populations

5. In nursing homes, community-based residential facilities, and hospitals

6. Facilities that are primarily operated for the purpose of providing outpatient medical

services

7. In adult family homes

8. In adult day care centers

9. In community rehabilitation programs. Community rehabilitation program is defined to

mean a nonprofit entity or governmental agency providing vocational rehabilitation

services to disabled individuals to maximize the employment opportunities of such

individuals

Workforce Policy

• Better utilization of dental hygienists

• New provider types

– Expanded Function Dental Auxiliaries

– Dental Therapists

Follow the Alliance on Facebook and Twitter: chawisconsin

Questions and thank youMatt Crespin, MPH, RDH

mcrespin@chw.org

oral health panel - wisconsin womens health foundation · creating access to dental care for...

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