Draft State Oral Health Plan Rural Health Association of Tennessee Workshop May 12, 2017 Veran Fairrow, DDS, MPH, Director of Oral Health Services; 05/11/17

Legislation

What the Initial Plan May Contain: State-specific data Current and relevant; updates every 5 years Distributed broadly to public partners S.M.A.R.T. Objectives

Where to Start: Centers for Disease Control & Prevention Association of State & Territorial Dental Directors National Public Health Performance Standards

What Path Do We Take:

Tennessee State Health Plan “We can’t wait until we fix our massively expensive and broken health care system to prevent preventable disease. We must focus as a culture on primary ‘upstream’ prevention.” TN Commissioner of Heath, Dr. John Dreyzehner

Draft: State Oral Health Plan

Draft: Purpose and Use 1. Monitoring Dental Disease in Tennessee Framing the Issue of Dental Disease 1. Monitoring Dental Disease in Tennessee 2. Oral Health Education & Advocacy 3. Prevention 4. Oral Health Resources & Workforce

Draft: Efforts of the Tennessee Department of Health Oral Health Objectives-may be revisited Local Health Departments School-Based Sealant Program Funding for Safety Net Providers

Draft: Tennessee Oral Health Timeline

Draft: Framing the Issue of Dental Disease Dental Disease, better known as tooth decay Transmission of Dental Caries Bacteria Infections, Dry Mouth, Prescriptions and Over the Counter Medications Diet and Nutrition and Oral Health Community Water Fluoridation-Primary Prevention Oral Health Literacy and Comprehension True Cost of a Cavity Oral Health and Chronic Disease

Is Tooth Decay Still an Issue?

Facts About Tooth Decay “It is the most common chronic disease of children 6 to 11years and adolescents aged 12 to 19 years.” “It is 4 times more common than asthma among adolescents 14 to 17 years.” “9 out of 10 over the age of 20 have some degree of tooth decay.” “By age 34, more than 80% of people have had at least one cavity.” “Over $6 billion of productivity is lost each year because of people miss work to get dental care.” CDC.org

The Burden of Oral Disease Poor oral health can affect an adults’ job prospects and social life. It has been shown that most employers “make instant judgements based on appearance, including one’s simile and teeth.” A 2008 study found that people with missing front teeth were viewed as less intelligent, less desirable and less trustworthy than people with a healthy smile. CDHP.org

The Burden of Oral Disease Due to limited access to oral health services teeth are often left untreated or are extracted because of pain or discomfort. Throughout the world, losing permanent teeth is still seen as a natural consequence of ageing *WHO “Dentistry is the only profession that accepts amputation as treatment.” =

The Cause of Tooth Decay

The Cycle of Tooth Decay Dental caries (decay) is largely preventable. Fluoride re-mineralizes tooth enamel, after it has been demineralized by bacteria and acid.

Draft: Development of the Oral Health Plan

Draft: Recommendations Monitoring Dental Disease in Tennessee Recommendation 1: Develop a TN oral health data source grid specific for TN Recommendation 2: Caries Risk Assessment performed by all providers Recommendation 3: Research and review best practices for an oral health surveillance system Recommendation 4: Develop TDH surveillance system to monitor the Tennessee Cancer Registry and craniofacial health in Tennessee

Draft: Recommendations Oral Health Education and Advocacy Recommendation 1: Raise dental providers awareness of their role in substance abuse Recommendation 2: Work internally with TDH Tobacco program, partner on messaging for public awareness of the effects of tobacco in the oral cavity Recommendation 3: Work internally with TDH Family Health and Wellness program and TN Department of Education, partner on messaging for public awareness of sugary drinks and the dietary impact on oral health Recommendation 4: Work internally with TDH Chronic Disease program to develop messaging and an educational course for providers Recommendation 5: Highlight the Meharry Dental-Medical model

Draft: Recommendations Prevention Recommendation 1: Organize state-wide information and support meeting with TN Dental Association, TN Department of Health and TN Dept of Environment and Conservation to raise awareness of community water fluoridation and the prevention vs. treatment model Recommendation 2: Advocate the usage of Silver Diamine Fluoride and its effectiveness as a preventive measure, similar to the UTHSC Silver Diamine Fluoride model Recommendation 3: Organize efforts to adapt the Tooth Wisdom Project model for the elderly population Recommendation 4: Advocate the “lift the lip” and fluoride varnish campaigns for medical providers

Silver Diamine Fluoride

Draft: Recommendations Oral Health Resources and Workforce Recommendation 1: Map existing providers/activity/services/oral health efforts and develop a hub Recommendation 2: Actively seek funding for TDH dental clinics to expand target population to include uninsured adults and partner with FQHCs to expand their oral health reach Recommendation 3: Request TDH, Health Related Boards mandate employment status during licensure for dentist and hygienist Recommendation 4: Provide CDC Summary of Infection Prevention Practices in Dental Setting on TDH and other websites Recommendation 5: Raise awareness and provide access to the ADA Center for Evidence-Based Dentistry Guidelines

Accessibility to Current Resources:

Oral Health Prevention Oral bacteria can be spread from person to person If brushing is not possible, rinse the mouth with water If brushing is not possible, chew sugar-free gum for 10 mins Drink all drinks, except water, within a small timeframe PLEASE Do not lick pacifiers to clean them PLEASE Do not share spoons or cups