Moving the Dial to Improve Children’s Dental Health: A National Picture

www.pewcenteronthestates.com

Moving the Dial to Improve Children’s Dental Health: A National Picture

Shelly Gehshan

Pew Children’s Dental Campaign


Our Mission: The Pew Children’s Dental

Campaign strives for cost-effective policies that will mean millions

more children get the basic dental care they need to grow, learn and

lead healthy lives.

The Pew Children’s Dental Campaign

2


We Focus on 3 Areas of Policy

• Strengthen prevention: working with states to expand water fluoridation to more communities

• Funding to improve access: secure federal funds to support state-based initiatives

• Expand the dental workforce: encourage states to license new types of providers to reach underserved communities

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PCS Campaign Structure

GOALCreate cost-effective

policies that will mean millions more children

get the basic dental care they need to grow, learn and lead healthy lives.

PARTNERSHIPSEngaging state and

national partners and stakeholders to influence policy

FEDERAL ADVOCACYAdvocating for federal

policies that support our goals

RESEARCHStudies that answer

policy-relevant questions about evidence-base

STATE ADVOCACYProviding funding and

technical assistance for state-based advocacy campaigns in states

CONVENINGFacilitating state and national partners to

network and share best practices

COMMUNICATIONSStrategy and messaging

that raises campaign visibility, promotes

research findings and supports state efforts

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Fluoridation


Community Water Fluoridation:Don’t look now, but it is under attack

Spring Hill votes to stopfluoridating its waterDentist voices concern

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Support is Ebbing Among Some Groups

Americans’ Supportfor Water Fluoridation

Online survey of 1,503 adults

Favor 44%

Neutral 34%

Oppose 23%

Groups that are more likely to oppose fluoridation:

• The 18-34 age group• Men• Hispanics• Asians• Those who currently don’t have CWF • Those who describe themselves as

conservative or liberal (as opposed to “moderates”)

• Those who report being more knowledgeable of CWF

(SalterMitchell, November 2010 survey )

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Focus on Prevention

72 million Americans don’t receive fluoridated water.

Texas study: Savings of $24 per child, per year from fluoridation.

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Fluoridated Water: Highest 10 Lowest 10

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A “settled issue” is now a debate

Health: Not in My Water Supply Somebody put a dead rat in Curtis Smith's mailbox. Someone else has made anonymous phone calls accusing him of trying to poison his neighbors. And all around the usually placid university town of Bellingham, Wash., activists from a group called Citizens Against Forced Fluoride have planted lawn signs adorned with skull and crossbones. "I had no idea it would get this intense," says Smith, 70, a retired dentist who is leading a Nov. 8 ballot initiative to add fluoride to the local drinking water.

Debate over adding fluoride to water continues A Denham Springs councilman says he wants more information before following a new Louisiana law ordering public water systems to start adding fluoride to their water "to protect the dental health of this state." Councilman John Wascom calls the water from his tap "Grade A." He says it is clean, clear and refreshing. He says he needs more information from

Media analysis: 4 out of 5 front-page stories about fluoride framed the issue as a “debate.”

The Jan. 2011 HHS/EPA announcement about fluoride was well covered by news media and gave opponents a new chance to sow fear and doubt.

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Fighting Back

• The Campaign for Dental Health--a diverse pro-fluoridation coalition.

• A strong online presence

• A network for advocates

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Tools for Advocates

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Create customized local web presence for their CWF campaign

Tools for Local CWF Advocates

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FLUID: searchable database of legal cases and policies

on CWF


Pew Fluoridation Efforts

S

S

SS

S

Advocacy for passage of new CWF law

ExpandingCWF in Santa Clara County(San Jose)

Assisted state health dept.’s strategy to expand CWF

Helped DoD with data that led to order all bases fluoridate

Pushed for CWF in Portland

S

Adopting CWF in Wichita, Kan.

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Sealants & Fluoride

Varnishes


New Report Due in November

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Removing Barriers to Sealants

Dentist’s exam and direct or indirect supervision required (10)

Dentist’s exam always required (10)Dentist’s exam sometimes required (16)Dentist’s exam never required (15)

Prior Exam Requirements (2012)

NH MA

ME

NJCT

RI

DE

VT

NY

DCMD

NC

PA

VAWV

FL

GA

SC

KY

IN OH

MI

TN

MS AL

MO

IL

IA

MN

WI

LA

AROK

TX

KS

NE

ND

SD

HI

MT

WY

UTCO

AK

AZ

NM

IDOR

WA

NV

CA

Source: Pew Center on the States data from survey of state oral health programs and state boards of dentistry, 2011-2012.

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Sealant Programs in High-Risk Schools (2010)

Percentage of high-risk schools with sealant programs

None 1-24% 25-49% 50-74% 75-100%0

5

10

15

20

25

Series 1# of States

Source: Pew Center on the States, The State of Children’s Dental Health: Making Coverage Matter (2012)17


VT

HI

NH

MA

RI

CT

NJ

DE

MD

DC

No Policy

MEWAMT ND

SD

MNOR

IDWY

COUT

NV

CA

AZ NM

NE

KS

OK

TX

AK

LA

AR

MO

IA

WIMI

IL IN OH

PA

NY

WVVA

KY

TN

MS AL GA

SC

NC

FL

Policy Adopted

States that Reimburse Physicians for Oral Health Preventive Services

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Why Focus on Workforce?


New Providers are Needed

Source: www.cdc.gov/nohss

Source: American Dental Association. (2011) Distribution of Dentists In the United States By Region and State, 2009.

≥45 %

40-44.9%

35-39.9%

<35%42.6 (NH)

36.2 (MA)

48.4

36 (NJ)42.8 (CT)

41.7 (RI)

39.2 (DE)

48.7 (VT)

37.1

46.4 (DC)39.2(MD)

35.9

42.6

38.142.3

37

33.8

39.9

38.4

38.1 42.2

39.6

43.3

37.3 37.1

45.8

36.9

40.4

38.744.8

41.5

39.740.1

36.2

41.1

40.3

43.1

40.4

36.5

44.4

47.6

32.936.4

40.7

31.945.5

32.237.1

37.5

27.4

32.6

Percentage of Dentists over age 55 (2009)

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% of Population (by state) Living in Dentist Shortage Areas: 6,400 Dentists Needed

NH

MA

ME

NJCT

RI

DE

VT

NY

MD

NC

PA

VAWV

FL

GA

SC

KY

INOH

MI

TN

MS AL

MO

IL

IA

MNWI

LA

AROK

TX

KS

NE

ND

SD

HI

MT

WY

UTCO

AK

AZ

NM

IDOR

WA

NV

CA

21Source: www.ersrs.hrsa.gov/ReportServer?/HGDW_Reports/BCD_HPSA/BCD_HPSA_SCR50_Smry&rs:Format-HTML3.2 , accessed 9/14/2012.

DC

Less than 10%

10-14.9%

15-19.9%

20% or more


Workforce Innovation is GrowingStates that are exploring new ways to expand the dental workforce

NH

MA

ME

NJCT

RI

DE

VT

NY

MD

NC

PA

VAWV

FL

GA

SC

KY

INOH

MI

TN

MS AL

MO

IL

IA

MNWI

LA

AROK

TX

KS

NE

ND

SD

HI

MT

WY

UTCO

AK

AZNM

IDOR

WA

NV

CA

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Theme: Get Care to PeopleWhere They Are

“If you live in the suburbs, if you have a car, plenty of money, dental insurance, and no dental disease, we have the perfect delivery system for you.”

– Charles Bertolami, Dean New York University College of Dentistry

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A Ladder for Dental Professionals?Dental specialists

Dentists

Advanced Dental Hygiene Practitioners

Dental Hygienist/therapists

Dental Therapists

Dental Hygienists

Dental Assistants

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Steady Trickle of “Never” Events

In 2005, Teron Francis, a 13-year old boy from New York

was declared brain dead after suffering from severe

swelling from an infected tooth from an infected tooth

Source: Inside Dentistry, “Once Upon a Time”, May 2008, Volume 4, Issue 5. Available at: http://www.dentalaegis.com/id/2008/05/once-upon-a-time

• In 2007, just days after Deamonte Driver died, Alexander Callender, a 6-year old boy died from an abscess in his mouth where 2 teeth had previously been removed

• In August 2011, Kyle Willis, a 24-year old man died of a tooth infection because he couldn’t afford the antibiotics prescribed to him

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Biggest Unmet Need Among Adults

Now is not the time?• Need picture of mission of mercy lines, or punchy graphic on need

Free clinic in Brighton, CO, about 30 minutes outside of Denver. The first person in line arrived at 5:00 p.m. The clinic opened the following day at 5:00 a.m.

Source: Denverpost.com, http://www.denverpost.com/news/ci_13320334, accessed 4/6/2011..26

http://www.denverpost.com/news/ci_13320334


Oral health is a winnable battle

• Cheaper and easier than achieving world peace!

• Many policy solutions• Solid research basis and return

on investment• Bipartisan political support

and momentum is on our side

:

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Children’s Dental Campaign Progress

NH

MA

ME

NJCT

RI

DE

VT

NY

MD

NC

PA

VAWV

FL

GA

SC

KY

INOH

MI

TN

MS AL

MO

IL

IA

MNWI

LA

AROK

TX

KS

NE

ND

SD

HI

MT

WY

UTCO

AK

AZ

NM

IDOR

WA

NV

CA

Gains in CWF

Workforce expansion

Access to sealants

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Moving the Dial to Improve Children’s Dental Health: A National Picture