Oral Health Workforce Development Reducing Caries One Population at a Time Richard Niederman DMD, New York University College of Dentistry Louisa Santos BDS, Pacific Basin Dental Association, Republic of Palau Mikako Deguchi DDS MBA, JABSOM, University of Hawaii
Thank you Pacific Island Health Officers Association Pacific Island Primary Care Association Pacific Basin Dental Association Dr. Gregory Dever, PIHOA
Request Offer Collaborate with PIHOA/PIPCA/PBDA to improve oral health Collaborate with Health Ministers to improve oral health Workforce development plan assistance Business case for oral health Technical assistance with implementation Top down (Ministerial level) Bottom up (Community level) Offer
Poor oral health associated with NCDs
Oral Health Yin/Yang Integration Poor oral health associated with other NCDs Good oral health needed for Good eating/health School/work performance
USA Caries Problem Reliance on Dentists to Improve Oral Health Future $2b/year $7b/year1,2 +10% DDS/RDH3 Increased inequality4 1. US Healthy People 1990, 2000, 2010 2. CMS. National Health Expenditure Projections 2011-2021. 2011 3. Solomon, E.S. J Dent Educ, 2012. 76: p. 1028. 4. Capurro, D.A., et al.Community Dent Oral Epidemiol, 2015. 43: p. 500. © R. Niederman 2004-2015 R. Niederman © 2004-2016
“Every system is perfectly structured to get the results it gets.” Paul Batalden, MD Sr. Fellow Institute for Healthcare Improvement Professor, Dartmouth Institute for Health Policy and Clinical Practice
One Solution: CariedAway Change Care Delivery & Care Delivered: Envisioned Future 1. Bring Preventive Care to People; Not People to Preventive Care 2. Care Delivered by RDH, not DDS N=4,000 Niederman R, et al. J Am Dent Assoc. 2008; 139:1040 © R. Niederman 2004-2015 R. Niederman © 2004-2016
Software for Mobile Health on iPad Parallel workforce development + implementation for 14,000 in rural: Colorado Kansas Maine Massachusetts New Hampshire Molokai Pilot programs in: Argentina Brazil Colombia
Workforce & Social Determinants of Oral Health Policy Determinants Delivery Agent Taxes (SSB) Political Insurance fees, Licensing, Guidelines Organizations Program Determinants Place-based prevention Vaccine, Vision, Hearing, Dental CHW/MT/RDH/DA WIC, School, Church Individual Determinants Office treatment DDS Home care Patient Niederman R, et al. Dentistry. DCP3, World Bank, 2015
Workforce & Caries Prevention Agents Frequency Est. Efficacy Est. Cost/App Est. Cost/ Year Delivery Agent Policy F-H2O Daily 20% $0.50 Piped water Program Silver-diamine-F 2X/year 75% $0.20 $0.40 CHW/MT/RDH F-Varnish 2-4/year 40% $1.00 $3.00 Classic Sealant 1X/tooth 80% CHW/RDH Therapeutic Sealant PRN/tooth Individual Toothpaste 25% $0.05 $30.00 Patient Extract/Fill 100% D. Therapist Niederman R, et al. Dentistry. DCP3, World Bank, 2015
Workforce & CariedAway Bring Preventive Care to People; Not People to Preventive Care Patient 25% CHW/RDH 40% CHW/RDH 75% CHW/RDH 80% Toothbrush + F Toothpaste Fluoride Varnish Silver-diamine-fluoride Care by DA/RDH 5 min to 20 min/visit $15 to $65/visit Glass Ionomer (white epoxy) : 1. Classical Sealants: all pits & fissures 2. Therapeutic Sealants: all cavities © R. Niederman 2004-2016 R. Niederman © 2004-2016
CariedAway met Obama Care Triple Aim Improved Health Reduced Cost Improved Patient Experience
CariedAway met Healthy People Goals Exceeded Healthy People 2020 Oral Health Goals for Untreated Caries
CariedAway met IOM Quality Aims Place-based Prevention Safe Yes Effective Patient Centered Timely Efficient Equitable R. Niederman © 2004-2016
Request Offer Collaborate with PIHOA/PIPCA/PBDA to improve oral health Collaborate with Health Ministers to improve oral health Workforce development plan assistance Business case for oral health Technical assistance with implementation Top down (Ministerial level) Bottom up (Community level) Offer
Mahalo