A MODEL FOR DENTAL CAREA MODEL FOR DENTAL CARE

IN A SCHOOL BASED PROGRAMIN A SCHOOL BASED PROGRAM

CHEMAWA INDIAN HEALTH CENTER CHEMAWA INDIAN HEALTH CENTER DENTAL PROGRAMDENTAL PROGRAM

Beth Finnson, RDH, MPHBeth Finnson, RDH, MPH

Oral Health in America• A Report of the Surgeon General

– David Satcher, MD, 2003• Silent epidemic affecting…

– Poor children– Elderly– Racial and ethnic minority groups

World Health Organization

“Dental…disease is not eradicated, but only controlled…”

Dental Caries

– Chronic childhood disease– 51 million school hours lost yearly– 164 million work hours lost yearly– 16,000 school hours lost yearly in Oregon

Oral Health and General Health• Optimal oral health provides…

– Speaking– Smiling– Chewing– Tasting– Swallowing

Oral Health and Learning• Early tooth loss results in…

– Failure to thrive– Impaired speech development– Malocclusion– Reduced self esteem

Oral Health and Learning• Chronic Dental Pain causes…

– Anxiety– Fatigue– Irritability– Depression– Inability to concentrate– Poor nutrition

OUR MISSION…

• To raise the physical, mental, social, and spiritual health of American Indians and Alaska Natives to the highest level.

OUR GOAL…

• To assure that comprehensive, culturally acceptable personal and public health services are available and accessible to American Indian and Alaska Native People.

OUR FOUNDATION…• To uphold the Federal Government’s

obligation to promote health American Indian and Alaska Native people, communities, and cultures and to honor and protect the inherent sovereign rights of Tribes.

IHS/Tribal Healthcare Systems

• 48 hospitals• 280 health centers• 147 health stations• 34 urban health projects• 9 residential treatment centers• 176 Alaska village clinics

Chemawa Indian Health Center

Indian Health Disparities• 55% AI/AN rely only on IHS healthcare• Reduced life expectancy• Higher infant mortality rate• Safe/adequate water supplies• Waste disposal facilities

Indian Population• 1997-1999 Current Population Survey

– Larger families– Less health insurance– Lower household median income– Lower educational levels– Higher unemployment rates– Young population

Service Population Trends• 65% population increase (1990-2006)• Increase in life expectancy (64-73)• Federal recognition for more tribes• 56% urban• 44% reservation or rural areas• Inadequate IHS budget

Indian Health Service• Mobile Dental Van

Challenges in IHS Dental Programs

• 2,800 patients per IHS dentist• 1,500 patients per U.S. dentist• $50 average IHS expenditure per patient• $300 average U.S. per patient• 25% dental access for Indian people

Oral Disease Trends

• 76% pre-school children with caries• 68% adolescent children with caries• Increased access for sealants• 63% 8 year-olds with at least 1 sealant

Chemawa Indian SchoolForest Grove

Chemawa Indian SchoolIndian Boys

Chemawa Indian SchoolSalem, OR

Chemawa Indian SchoolTotem Pole

Chemawa Health Center• Comprehensive health care facility

Medical PharmacyDental Public HealthOptometry Behavioral HealthLab School NursingRadiology Podiatry

Registration/Billing/Coding

Chemawa’s Model for A Dental SBHC Program– Collaboration

• School staff• Health facility staff• Dental students• Dental hygiene students• Volunteers

Model for Dental SBHC• Screen process• Document, document, document…• Prioritize• Preventive care• Clinical care• Specialty care• Evaluation

Documentation• Name Hygiene care• Chart Sealants• Home state Retention Rates• Screen date Extractions• Exam date Root canals• Number of caries PTC• Urgent needs Drop

Screen Results 2007-2008• 462 students, aged 14-19• 349 screened• 99% have had dental caries• 82% with untreated decay• 15% reported oral pain

Treatment Results 2007-2008

• 51% complete exams• 9% extractions• 99% oral hygiene education & cleaning• 85% received 498 dental sealants • 47% completed treatment

Screen Results 2008-2009• 387 students, aged 14-19• 387 screened• 97% have had dental caries• 73% with untreated decay (1395 carious teeth)

• 14% reported oral pain

31%

2010 Target = 57%

20%

1996 2000

Receipt of Preventive Services by Low Income Children

Obj. 21-12Note: Data are for children under 19 years. Low income is less than 200% of poverty level. Preventive services include examinations, cleaning, x-rays, fluoride treatments and sealant applications.Source: Medical Expenditure Panel Survey, AHRQ.

0

10

20

30

40

50

Total

2010Targets

6-11 Years 12-18 Years

Black MexicanAmerican

White Total Black MexicanAmerican

White

Dental Sealants: 1988-94 and 1999-2000

Obj. 21-8

1999-2000 1999-20001988-94 1988-94

Unreliable estimate, relative standard error >30%.Note: Targets are for children 8 years and 14 years. Black and white exclude persons of Hispanic origin. Persons of Mexican-American origin may be any race.Source: National Health and Nutrition Examination Survey, NCHS, CDC.

Percent

Dental Sealants

0

20

40

60

80

Obj. 21-1c

Adolescents 12-18 Years Who Ever Had Caries in Permanent Teeth, 1988-94 and

1999-2000

Note: Target is for adolescents 15 years old. Black and white exclude persons of Hispanic origin. Persons of Mexican-American origin may be any race.Source: National Health and Nutrition Examination Survey, NCHS, CDC.

Total Black MexicanAmerican

White MaleFemale

Percent 2010 Target1988-94 1999-2000

Oregon Smile Survey 2007

• 3,865 1st,2nd & 3rd graders• Oregon ranks 25/32 states • Disease disparities

– Geographic– Poverty– Dental insurance– Race/ethnicity

Oregon Smile Survey 2007

• 64% of children have had dental caries• 20% of children with rampant decay (7+)• 35% of children with untreated decay• 25% with no dental insurance• 9% with no dental home• 20% need urgent care due to pain/infection• 43% with dental sealants

Oregon Smile Survey• Recommendations

– Community water fluoridation– Early-childhood cavities prevention – School based fluoride supplement program– School based dental sealant programs

Resources• Oregon Dental Association • Oregon Dental Hygienists’ Association• Dental Foundation of Oregon• Tooth Taxi• Medical Teams International Mobile Dental Van• Boys and Girls Club

Resources• Oregon Smile Survey• Burden of Disease in Oregon• Oral Health Data Book• King Fluoride• Dental Sealants Protect Oregon Teeth:

A Guide…

• http://www.oregon.gov/DHS/ph/oralhealth

Tooth Taxi

Questions ?• Beth Finnson, RDH, MPH• Chemawa Indian Health Center• 3750 Chemawa RD NE• Salem, OR 97305• 503-304-7631• beth.finnson@ihs.gov