oral health panel - wisconsin womens health foundation · creating access to dental care for...
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Oral Health Panel
Objectives
1) Discuss Clinical Issues Related to Oral Health
2) Explore Systemic Innovations for Improving Access to
Care
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
bite
• 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
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]
• 47,206 unique dental patients [2013]
• 49,708 unique dental patients [2014]
• 50,924 unique dental patients [2015]
• 55,793 unique dental patients [2016]
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
www.chawisconsin.orgChildren’s Health Alliance of Wisconsin
www.chawisconsin.orgChildren’s Health Alliance of Wisconsin
Oral health at the Alliance
www.chawisconsin.orgChildren’s Health Alliance of Wisconsin
3 Necessary Buckets
• Funding
• Workforce
• Policy and Regulatory
www.chawisconsin.orgChildren’s Health Alliance of Wisconsin
www.chawisconsin.orgChildren’s Health Alliance of Wisconsin
MA access
Source ADA Health Policy Institute
www.chawisconsin.orgChildren’s Health Alliance of Wisconsin
MA enrolled providers
91%
9%
WI – PAs
37%
63%
WI - DDS
Source: Wisconsin Medicaid Data -2014
85%
15%
WI – PCPs
www.chawisconsin.orgChildren’s Health Alliance of Wisconsin
Level of participation
11%17%
72%
20%
33%
47%
0%
10%
20%
30%
40%
50%
60%
70%
80%
Inactive Limited (1-25 pts) Active (26+ pts)
Medical Providers
Dental Providers
Source: Wisconsin Medicaid Data -2014
www.chawisconsin.orgChildren’s Health Alliance of Wisconsin
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
www.chawisconsin.orgChildren’s Health Alliance of Wisconsin
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
www.chawisconsin.orgChildren’s Health Alliance of Wisconsin
www.chawisconsin.orgChildren’s Health Alliance of Wisconsin
www.chawisconsin.orgChildren’s Health Alliance of Wisconsin
www.chawisconsin.orgChildren’s Health Alliance of Wisconsin
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
www.chawisconsin.orgChildren’s Health Alliance of Wisconsin
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
order
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
www.chawisconsin.orgChildren’s Health Alliance of Wisconsin
www.chawisconsin.orgChildren’s Health Alliance of Wisconsin
Workforce Policy
• Better utilization of dental hygienists
• New provider types
– Expanded Function Dental Auxiliaries
– Dental Therapists
www.chawisconsin.orgChildren’s Health Alliance of Wisconsin
www.chawisconsin.orgChildren’s Health Alliance of Wisconsin
Follow the Alliance on Facebook and Twitter: chawisconsin
Questions and thank youMatt Crespin, MPH, RDH