A MODEL FOR DENTAL CARE IN A SCHOOL BASED PROGRAM CHEMAWA INDIAN HEALTH CENTER DENTAL PROGRAM Beth 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 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 ( ) 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 School Forest Grove

Chemawa Indian School Indian Boys

Chemawa Indian School Salem, OR

Chemawa Indian School Totem Pole

Chemawa Health Center Comprehensive health care facility MedicalPharmacy DentalPublic Health OptometryBehavioral Health LabSchool Nursing RadiologyPodiatry 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 NameHygiene care ChartSealants Home stateRetention Rates Screen dateExtractions Exam dateRoot canals Number of cariesPTC Urgent needsDrop

Screen Results students, aged screened 99% have had dental caries 82% with untreated decay 15% reported oral pain

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

Screen Results students, aged screened 97% have had dental caries 73% with untreated decay (1395 carious teeth) 14% reported oral pain

2010 Target = 57% Receipt of Preventive Services by Low Income Children Obj Note: 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.

Total 2010 Targets 6-11 Years12-18 Years BlackMexican American White TotalBlackMexican American White Dental Sealants: and Obj 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

Obj. 21-1c Adolescents Years Who Ever Had Caries in Permanent Teeth, and 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. TotalBlackMexican American White MaleFemale Percent 2010 Target

Oregon Smile Survey ,865 1st,2nd & 3rd graders Oregon ranks 25/32 states Disease disparities –Geographic –Poverty –Dental insurance –Race/ethnicity

Oregon Smile Survey % 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…

Tooth Taxi

Questions ? Beth Finnson, RDH, MPH Chemawa Indian Health Center 3750 Chemawa RD NE Salem, OR