Mississippi State Oral Health Plan Building Bridges to Improve Oral Health Dr. Nicholas Mosca Dental Director, Mississippi Department of Health Mississippi State Oral Health Plan Building Bridges to Improve Oral Health Dr. Nicholas Mosca Dental Director, Mississippi Department of Health

Government Protects Health Traditional government view of ‘filling a cavity’ Most oral diseases are completely preventable at low cost Governor Musgrove by executive order formed task force to develop a plan. Most oral diseases are completely preventable at low cost Governor Musgrove by executive order formed task force to develop a plan.

Preventable Oral Diseases Tooth decay or ‘dental caries ’ Gingivitis / periodontal disease Cleft lip / cleft palate (folic acid deficiency) Oral cancer (tobacco use) Tooth decay or ‘dental caries ’ Gingivitis / periodontal disease Cleft lip / cleft palate (folic acid deficiency) Oral cancer (tobacco use)

High Prevalence in Mississippi 7 in 10 school-age children in public schools have tooth decay experience (fillings or cavities) 1 in 3 school-age children have untreated decay (cavities) 1 in 10 school-age children have urgent need for dental care due to pain or infection Nationally, unmet need for dental care is 3 times greater than for medical care 7 in 10 school-age children in public schools have tooth decay experience (fillings or cavities) 1 in 3 school-age children have untreated decay (cavities) 1 in 10 school-age children have urgent need for dental care due to pain or infection Nationally, unmet need for dental care is 3 times greater than for medical care

Diagnosis and Treatment (Repair) Solutions balance costs? Predict and manage people at-risk Implement disease prevention

New View of an Old Problem Tooth decay is 5 x more common than asthma Infectious Transmissible Predictable Culturally dependant Highly prevalent and consequential The ‘cavity’ is the disease manifestation Tooth decay is 5 x more common than asthma Infectious Transmissible Predictable Culturally dependant Highly prevalent and consequential The ‘cavity’ is the disease manifestation

Dental caries is well-understood Caused by acid producing bacteria in dental plaque Streptococcus mutans

White Spot Lesions

Cavitated Enamel

Dental caries is transmissible Vertical transmission from kissing, feeding and playing Window of infectivity during first 2 years of life Prevention should begin before age 2 Vertical transmission from kissing, feeding and playing Window of infectivity during first 2 years of life Prevention should begin before age 2

State Medicaid EPSDT FY 2003Total eligibles Ages 1-2Ages 3-5 Receiving any dental srvcs 28% (118,424) 1.6% (8,784) 49% (29,490) Receiving preventive dental srvcs 24% (101,726) 0.1% (6,617) 44% (26,415)

New View of an Old Problem Tooth Mouth Child Family Community Society

HealthDISEASE Dental caries is manageable (like diabetes)

Mobilizing Partnerships for Oral Health Partner with Extension Service to utilize area health agents to deliver oral health education and prevention Promote local community water fluoridation programs

KY Land Grant Mission and the Cooperative Extension Service Although not directly funded by the Department for Public Health, one more partner emerges in the fight to improve oral health The Cooperative Extension Service develops “Health Education Through Extension Leadership” using the extensive infrastructure available to provide community based partners to enhance health. Funding from state Department of Agriculture August 2005, UK Colleges of Agriculture and Dentistry sign an agreement. Dentistry faculty becomes coordinator for oral health educational materials and training programs for extension agents. Although not directly funded by the Department for Public Health, one more partner emerges in the fight to improve oral health The Cooperative Extension Service develops “Health Education Through Extension Leadership” using the extensive infrastructure available to provide community based partners to enhance health. Funding from state Department of Agriculture August 2005, UK Colleges of Agriculture and Dentistry sign an agreement. Dentistry faculty becomes coordinator for oral health educational materials and training programs for extension agents.

Plan provides opportunities “Creates interagency initiatives” “Assures synergy” “Convenes strategic alliances” “ Supports CSHCN projects (i.e. Special Olympics)” “Disease surveillance” (e.g. BRFSS, YRBS) “Creates interagency initiatives” “Assures synergy” “Convenes strategic alliances” “ Supports CSHCN projects (i.e. Special Olympics)” “Disease surveillance” (e.g. BRFSS, YRBS) “Obtain and share federal dollars” HRSA, CDC, USDA “Addresses licensing and regulatory issues” Oral health plan sets “clear expectations”

Areas of collaboration Agreements for preventive services Oral disease surveillance Community or population-level prevention (public water fluoridation, dental sealants, fluoride rinse programs) Planning Coalition / Summit Meeting / Collaborations Consultation Education Continuing education / extramural training Student projects (i.e. community-based education or outreach services) Agreements for preventive services Oral disease surveillance Community or population-level prevention (public water fluoridation, dental sealants, fluoride rinse programs) Planning Coalition / Summit Meeting / Collaborations Consultation Education Continuing education / extramural training Student projects (i.e. community-based education or outreach services)

Key Barriers “Administrative “red tape” & “bureaucracy” “Tight budget” or “cuts” “Insufficient staff to get involved” “Time constraints” “Dentists won’t treat the kids that need care” “Restricted auxiliary staff practice laws” “Few elderly care initiatives” “Administrative “red tape” & “bureaucracy” “Tight budget” or “cuts” “Insufficient staff to get involved” “Time constraints” “Dentists won’t treat the kids that need care” “Restricted auxiliary staff practice laws” “Few elderly care initiatives”

Collaborations for Oral Health Community water fluoridation program Community-based Dental Partnership for those with HIV infection Weekly school-fluoride mouthrinse School-based dental sealant program Head Start Oral Health Advisory Committee State Comprehensive Cancer Control Plan Regional oral health consultants Community water fluoridation program Community-based Dental Partnership for those with HIV infection Weekly school-fluoride mouthrinse School-based dental sealant program Head Start Oral Health Advisory Committee State Comprehensive Cancer Control Plan Regional oral health consultants

School fluoride rinse program

School-based Dental Sealants UMMC School of Nursing Mercy Delta Health Express

Consumer / Professional Education

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