Bureau of Dental Health: Bureau of Dental Health: An Overview of ProgramsAn Overview of Programs

Timothy Cooke, BDS, MPHTimothy Cooke, BDS, MPH

Bureau of Dental Health Bureau of Dental Health

Albany, NY.Albany, NY.

(518) 474-1961(518) 474-1961

tlc06@health.state.ny.ustlc06@health.state.ny.us

Vision & Mission

The Bureau of Dental Health will provide an environment to encourage all New Yorkers to develop an awareness of the importance of oral health, and to assure it’s inclusion in public health programs targeted toward the building of healthier communities.

Our mission is to improve the oral health of all New Yorkers. We design and implement public health initiatives to prevent and control oral diseases and other adverse conditions, promote healthy behaviors, and improve the skills of all dental care providers. We partner with local health departments, health care providers, community organizations, and residents of the state to build healthier communities.

Functions

Assess and monitor oral health status Provide guidance for planning policy development to support

community efforts directed toward assuring oral health Mobilize community partnerships to design and implement

programs directed toward prevention and control of oral diseases and conditions

Inform and educate the public regarding issues related to healthy lifestyle, health plans, and availability of care

Functions continued………….

Integrate oral health programs and policies into other health care programs

Assure the capacity and promote the competency of public health dentists, general practitioners, and dental hygienists

Evaluate the effectiveness, accessibility, and quality of population-based and personal service

Promote research and demonstration programs to develop innovative solutions to problems

Organizational chart

Preventive Dentistry Program

School based dental progams

School Fluoride Rinse/Tablet Program

PHCP Orthodontic program

Fluoridation

NYS Collaborative System

Innovative Dental Services

Preventive Services & Dental Care

Surveillance system

Program evaluation

Oral cancer prevention

Guidelines and Recomm endations

New burgh-Kingston study

Research & Epidemiology

Dental Public Health Residency

School of Public HealthInternship Program

In-service training

W ebsite

Educational m aterials

Education

Office of Public HealthCenter of Com m unity Health

Division of Fam ily HealthBureau of Dental Health

Com m issioner

Technical Support

BUREAU OF DENTAL HEALTH

Indian Health

Migrant Health

School Health

Community Health Centers Dental Care for

persons with HIV

Investigation of disease transmission

Local Health

Medicaid

Child Health Plus

Office of Children and Families

Rural Health

Managed care

Oral Diseases

Despite improvements in overall disease levels, dental caries remains the commonest childhood disease* 7x as common as asthma Responsible for children missing 52m school days annually

54% of 3rd grade children in NY have suffered dental caries, 33% have active disease+

Caries can affect teeth soon after eruption: Early Childhood Caries 3000 children annually in NY are hospitalized for treatment Cost close to $1m

Major disparities in caries experience by income

*Oral Health in America: A Report of the Surgeon General ~ DHHS 2000*Oral Health in America: A Report of the Surgeon General ~ DHHS 2000

+ NY surveillance 2002-04, unpublished data+ NY surveillance 2002-04, unpublished data

Dental Caries

Early Childhood Caries

Severe periodontal disease (measured as 6 millimeters of periodontal attachment loss) affects about 14 percent of adults aged 45 to 54

Twenty-three percent of 65- to 74-year-olds have severe periodontal disease

About 30 percent of adults 65 years and older are edentulous, compared to 46 percent 20 years ago

Potential link to pre-term/ low birth weight babies Associated with heart disease Two-way link with diabetes

Oral Health in America: A Report of the Surgeon General ~ DHHS 2000Oral Health in America: A Report of the Surgeon General ~ DHHS 2000

Periodontal Disease

Oral and pharyngeal cancers are diagnosed in about 30,000 Americans annually; 8,000 die from these diseases each year

Oral and Pharyngeal Cancer

Oral Health in America: A Report of the Surgeon General ~ DHHS 2000Oral Health in America: A Report of the Surgeon General ~ DHHS 2000

TestisThyroid

ProstateMelanomas of Skin

Breast (Females)Corpus & Uterus, NOS*

Hodgkin’sUrinary Bladder

Cervix UteriLarynxColon

Kidney/RenalRectum

Oral Cav & PhynxNon-Hodgkin’s

OvaryLeukemias

Brain & NOS*Multiple Myeloma

StomachLung and Bronchus

EsophagusLiver & Intrahep

Pancreas 4

3

9

11

22

31

39

33

47

41

34

51

58

52

53

59

62

76

56

71

68

84

89

6

13

14

19

28

30

44

50

52

56

61

60

62

66

71

83

82

86

85

88

93

9588

4

96

*Note: NOS= not otherwise specified

Source: Kosary, 1996

Oral Health in America: A Report of the Surgeon General ~ DHHS 2000Oral Health in America: A Report of the Surgeon General ~ DHHS 2000

White Patients

Black Patients

Five-year relative survival rates

Five-year relative survival rates for select cancers for White and

Black persons

Programs

Fluoridation

*http://apps.nccd.cdc.gov/MWF/Index.asp

New York State Fluoride Supplement Program

Self Applied Fluoride Education and Rinse Program (SAFER) 95,000 children in 300 schools

Fluoride tablets and drops 5000 children in Head-Start, WIC, Migrants and County-

based public health programs

Public Insurance

Medicaid:

About 1.6 m (23%) eligible children receive dental care

$76.7 million or 2% of all expenditures

Program has been enhanced substantially

Adult dental coverage always under threat

Child health plus:

Approximately 450,000 are enrolled

Municipal Health Services Plan

State supports local health units. Activities are: Dental health education Dental clinics School-based programs Assessment

Orthodontic Program

Supports reimbursement for Cleft lip, cleft palate or ankylosis Severe deviations resulting from disease or trauma in

either jaw Malocclusions best described as:

Maxillary prognathismMandibular protrusionMicro or macro development of jaws

School-based Programs

Programs that do not need DOH oversight: Dental health in school curricula Dental note program in New York City Fluoride rinse/tablet program Screening & referral program

Providing clinical services requires approval by DOH: Prophylaxis & dental sealant application Treatment programs

Mobile dental equipment

Clinical Service Provision

Fixed school site

Mobile Van

Health Education Program

FluoridationPreventive CareEarly Childhood CariesPregnancy and oral health Dental Sealants Infection ControlManagement of persons with HIV and AIDSOral Cancer

Grants

Preventive Dentistry Grants

Establish community partnerships Identify effective intervention and mobilize resourcesFacilitate linkages and assure quality systems of careExpansion of the use of preventive servicesEvaluate outcomes and monitor progressDevelop local coalition

Innovative Services Grants

Innovative projects: Try new approaches to meeting local oral health needs Piloting potential “best practices” Disseminate new ideas

Technical Assistance Center

Recent Activities

CDC funded projectApproach used for all chronic disease programsDeveloped by 80-90 stakeholdersOutlines key Goals, Objectives and Strategies

Short and long term Organizations and coalitions will select

appropriate activities and interventions

New York State Oral Health Plan

Statewide Oral Health Coalition

Will coordinate activities around State Oral Health Plan implementation

Core of members active in developing the planWill work with regional and local oral health

coalitions

Guidelines for the dental care of pregnant women and young children

No precedent for these guidelinesConvened expert panel:

OB/Gyns Dentists Pediatricians

Will (hopefully!) be released soon

Guidelines Project

Uses CDC outlinePresenting all the available data on oral disease in

NY in one placeWill be published later in 2006

Burden Document

Questions?