Communicating the Communicating the Role of Oral Health on Role of Oral Health on

Pregnancy Outcomes in Pregnancy Outcomes in Rural KentuckyRural Kentucky

Sharlee Shirley Burch, RDH, MPHSharlee Shirley Burch, RDH, MPHJudy Skelton, RDH, PhDJudy Skelton, RDH, PhDMR Mullins, DMD, MPHMR Mullins, DMD, MPH

University of Kentucky

College of Dentistry

The Value of PartnershipsThe Value of Partnerships Health Education through Health Education through

Extension Leadership – Extension Leadership – University of Kentucky University of Kentucky College of AgricultureCollege of Agriculture

Kentucky Consortium for Kentucky Consortium for Applied Research and Applied Research and Treatment – University of Treatment – University of Kentucky College of DentistryKentucky College of Dentistry

Health Education Through Health Education Through Extension LeadershipExtension Leadership

Addressing the health issues of Addressing the health issues of KentuckiansKentuckians

Bridging people, resources, ideas and Bridging people, resources, ideas and actionsactions

Outreach, education and researchOutreach, education and research Formal collaborations with long term Formal collaborations with long term

partnershipspartnerships

HEEL PROGRAM GOALSHEEL PROGRAM GOALS Build community capacity to improve

health Educate consumers to make

informed health choices Educate and empower individuals

and families to adopt healthy behaviors and lifestyles

University of Kentucky College University of Kentucky College of Dentistry Division of Public of Dentistry Division of Public

Health DentistryHealth Dentistry

Tackling the Epidemic of Oral Tackling the Epidemic of Oral DiseaseDisease

Beyond the Dental ProfessionalBeyond the Dental Professional A History of CollaborationA History of Collaboration

A track record for thriving A track record for thriving partnershipspartnerships

Cabinet for Health and Family ServicesCabinet for Health and Family Services Tobacco Prevention ProgramTobacco Prevention Program Ronald McDonald CharitiesRonald McDonald Charities Fayette County Public SchoolsFayette County Public Schools Pikeville School of Osteopathic MedicinePikeville School of Osteopathic Medicine College of Public HealthCollege of Public Health College of MedicineCollege of Medicine Area Health Education CentersArea Health Education Centers Family Resource CentersFamily Resource Centers State and Local Health Department’sState and Local Health Department’s

Agriculture and Dentistry: Not Agriculture and Dentistry: Not so Strange Bedfellowsso Strange Bedfellows

Health Education Through Extension Health Education Through Extension Leadership ProjectLeadership Project

Chronic Disease Education – Chronic Disease Education – diabetes, heart disease, obesity, diabetes, heart disease, obesity, cancercancer

Oral health linkagesOral health linkages Economic DevelopmentEconomic Development

Oral Health Wellness and Oral Health Wellness and Disease Prevention Program – Disease Prevention Program –

a HEEL Partnership a HEEL Partnership Collaborative projectsCollaborative projects Public educationPublic education Public policyPublic policy Applied researchApplied research Service programmingService programming Technical assistanceTechnical assistance InstructionInstruction

The Outreach and Research The Outreach and Research Connection: KY-CARATConnection: KY-CARAT

KY CARATKY CARATKKentuckentuckyy – – CConsortiumonsortium forfor

AAppliedpplied Oral HealthOral Health RResearch esearch aandnd TTreatmentreatment

PurposesPurposes provide an infrastructure for educating provide an infrastructure for educating

dental, medical and health professionalsdental, medical and health professionals provide state-of-the-art clinical care and provide state-of-the-art clinical care and

education to patients in communitieseducation to patients in communities enable the development of outreach enable the development of outreach

research capabilities in rural regions of research capabilities in rural regions of the Commonwealththe Commonwealth. .

Purposes Purposes (cont.)(cont.)

provide an economic impact by: provide an economic impact by: decreasing expenditures for “major/heroic” oral health decreasing expenditures for “major/heroic” oral health

care of children and adultscare of children and adults focusing oral health dollars for regional implementation focusing oral health dollars for regional implementation

of preventive and early intervention strategiesof preventive and early intervention strategies providing an economic stimulus to the regional sites providing an economic stimulus to the regional sites

through creation of jobsthrough creation of jobs increasing oral health care access, thus broadening the increasing oral health care access, thus broadening the

participation and generating a new funding base that participation and generating a new funding base that remains and/or flows into the regions.remains and/or flows into the regions.

Results and BenefitsResults and Benefitsof KY CARATof KY CARAT

Infrastructure developmentInfrastructure development Training Training Research capacityResearch capacityHealthier Kentuckians!!

Collaborating SightsCollaborating Sights Center for Oral Health Research at the Center for Oral Health Research at the

University of Kentucky in Lexington (Central University of Kentucky in Lexington (Central Kentucky)Kentucky)

The Center for Rural Health in Hazard, KYThe Center for Rural Health in Hazard, KY Mountain Comprehensive Health Corporation Mountain Comprehensive Health Corporation

facility in Whitesburg, KY (Eastern Kentucky)facility in Whitesburg, KY (Eastern Kentucky) St. Clair Hospital in Morehead, KY (Northern St. Clair Hospital in Morehead, KY (Northern

Kentucky)Kentucky) Trover Foundation in Madisonville, KY Trover Foundation in Madisonville, KY

(Western Kentucky) (Western Kentucky)

Areas of FocusAreas of Focus Preterm low birth weight babiesPreterm low birth weight babies

Diabetes and oral disease Diabetes and oral disease linklink

Early childhood Early childhood cariescaries

The rate of preterm/low birth weight (PTLBW) The rate of preterm/low birth weight (PTLBW) infants in the U.S. has not significantly infants in the U.S. has not significantly decreased during the last 3 decadesdecreased during the last 3 decades

Spontaneous preterm births account for 10% Spontaneous preterm births account for 10% of all live births in the US and is a of all live births in the US and is a predominant cause of perinatal morbidity predominant cause of perinatal morbidity and mortalityand mortality

These rates tend to be highest in These rates tend to be highest in underserved rural populationsunderserved rural populations

Background on Preterm Background on Preterm Low Birth Weight Low Birth Weight

BabiesBabies

Cost to the government between $1.4 and Cost to the government between $1.4 and $2.6 billion annually in Medicaid and Aid to $2.6 billion annually in Medicaid and Aid to Families with Dependent ChildrenFamilies with Dependent Children

It is estimated that an additional $6.4 to $12 It is estimated that an additional $6.4 to $12

billion dollars cost to society as a result of billion dollars cost to society as a result of both short term and long term careboth short term and long term care

In Kentucky >5,000 PTLBW occur annually In Kentucky >5,000 PTLBW occur annually with an estimated acute care cost of nearly with an estimated acute care cost of nearly $40,000/birth$40,000/birth

Preterm Low Birth Preterm Low Birth Weight BabiesWeight Babies

Oral Health and Oral Health and PTLBWPTLBW

periodontal (gum) disease has been periodontal (gum) disease has been implicated as a contributing factor to an implicated as a contributing factor to an increased incidence of PTLBW increased incidence of PTLBW

periodontal infection periodontal infection periodontal pathogens periodontal pathogens low-level, chronic bacteremia low-level, chronic bacteremia

release of chemical release of chemical mediatorsmediators

cross placentacross placenta initiate labor initiate labor

Oral Health and Oral Health and PTLBWPTLBW

Periodontal disease is preventable and Periodontal disease is preventable and treatabletreatable

Cost to maintain periodontal health is Cost to maintain periodontal health is minimal when compared to the costs minimal when compared to the costs attributed to negative birthing attributed to negative birthing outcomesoutcomes

The potential reduction of cost to The potential reduction of cost to society, impact on family structure, and society, impact on family structure, and prevention of disease related to prevention of disease related to preterm birth validate the need to preterm birth validate the need to clarify the association between clarify the association between periodontal disease and preterm birthperiodontal disease and preterm birth

Oral Health Wellness and Oral Health Wellness and Disease Prevention Program – Disease Prevention Program –

HEEL Contribution to KY CARATHEEL Contribution to KY CARAT Oral health resources for each community Oral health resources for each community

on pregnancy and oral wellnesson pregnancy and oral wellness Training of Extension Agents on oral health Training of Extension Agents on oral health

and pregnancy outcomes for spreading and pregnancy outcomes for spreading knowledge to at-risk mom’s in rural knowledge to at-risk mom’s in rural communitiescommunities

Community based outreach and education Community based outreach and education on oral health and pregnancyon oral health and pregnancy

The Model for Outreach The Model for Outreach and Service:and Service:

Centering Pregnancy Centering Pregnancy

Reaching Rural Women - Reaching Rural Women - Project site: Trover ClinicProject site: Trover Clinic

Women’s Center Women’s Center Madisonville, KentuckyMadisonville, Kentucky

routine, individually-based prenatal care is routine, individually-based prenatal care is abolishedabolished

replaced by a system that provides replaced by a system that provides complete prenatal care to groups complete prenatal care to groups composed of 8-10 women of similar composed of 8-10 women of similar gestational agegestational age

incorporates the three components of incorporates the three components of prenatal care – risk assessment, education, prenatal care – risk assessment, education, and support – in a unified format and support – in a unified format

Centering Centering Pregnancy™ Pregnancy™

encourages the women to take encourages the women to take responsibility for their own healthresponsibility for their own health

at each visit, standard prenatal risk at each visit, standard prenatal risk assessment is followed by an assessment is followed by an educational session using a discussion educational session using a discussion formatformat

free exchange among the group free exchange among the group members is encouraged members is encouraged

Centering Centering Pregnancy™ Pregnancy™

an atmosphere of mutual support an atmosphere of mutual support is developedis developed

more efficient and cost effectivemore efficient and cost effective

additional peer-support occurring additional peer-support occurring within these maternal networks within these maternal networks

Centering Centering Pregnancy™ Pregnancy™

Adaptation of the Centering Adaptation of the Centering Pregnancy model Pregnancy model

Designed to create an integrated Designed to create an integrated oral/medical health education oral/medical health education and an intervention model and an intervention model

Centering Centering Pregnancy™ Pregnancy™ with Smileswith Smiles

Integrated educational unitsIntegrated educational units Treatment to control oral Treatment to control oral

infectionsinfections Self-assessment of oral diseasesSelf-assessment of oral diseases

Centering Centering Pregnancy™ Pregnancy™ with Smileswith Smiles

Oral diseasesOral diseases Plaque control and disease preventionPlaque control and disease prevention Relationship of nutrition & oral healthRelationship of nutrition & oral health Oral anatomy and eruption patternsOral anatomy and eruption patterns Maintaining baby’s oral healthMaintaining baby’s oral health

Centering Centering Pregnancy™ Pregnancy™ with Smileswith Smiles

Formative Research: The Formative Research: The Process of Centering Process of Centering

Pregnancy in Madisonville Pregnancy in Madisonville KentuckyKentucky

In the Beginning…In the Beginning… 2 days, possibly two groups2 days, possibly two groups Slow, “ramp up” processSlow, “ramp up” process Hiring a Registered Dental HygienistHiring a Registered Dental Hygienist Equipment and material needsEquipment and material needs Scheduling and BillingScheduling and Billing Will this model work???Will this model work???

Currently…Currently… Groups every day! Groups every day! Several groups a day!Several groups a day! RDH works full time with educating RDH works full time with educating

groups and serving pregnant moms!groups and serving pregnant moms! Dental chair and equipment housed Dental chair and equipment housed

in the Center!in the Center! Scheduling and Billing in process!Scheduling and Billing in process! Is this model working???Is this model working???

Project Completion: Goal Early Project Completion: Goal Early 20072007

Centering Pregnancy with Smiles Centering Pregnancy with Smiles continues on large scale basiscontinues on large scale basis

Continued “tweaking” of projectContinued “tweaking” of project Data GatheringData Gathering Continued Community Education and Continued Community Education and

OutreachOutreach

Early Findings…Early Findings… Rural Women in Kentucky will accept Rural Women in Kentucky will accept

group prenatal caregroup prenatal care Rural Women in Kentucky will accept Rural Women in Kentucky will accept

dental treatment during pregnancydental treatment during pregnancy Rural Women in Kentucky are Rural Women in Kentucky are

engaging with each other and engaging with each other and providers and learning more about providers and learning more about their bodies and their babiestheir bodies and their babies

Questions/Comments?Questions/Comments?

Thank you!Thank you!

Communicating the Communicating the Role of Oral Health on Role of Oral Health on

Pregnancy Outcomes in Pregnancy Outcomes in Rural KentuckyRural Kentucky

Sharlee Shirley Burch, RDH, MPHSharlee Shirley Burch, RDH, MPHJudy Skelton, RDH, PhDJudy Skelton, RDH, PhDMR Mullins, DMD, MPHMR Mullins, DMD, MPH

University of Kentucky

College of Dentistry