1. Oral Health Promotion – A Family Centered Approach to Screening and Education The Smiles for Life – STFM Oral Health Curriculum Hugh Silk, MD, University of Connecticut A Stevens Wrightson, MD, University of Kentucky

2. Learning Agenda  Introductions  Objectives  Audience Survey  How to teach physicians about oral health  How to teach patients about oral health  Group Brainstorming Session  Wrap Up

3. Objectives Participants will be able to:  Discuss and implement strategies for screening and educating families on the topic of maintaining good oral health.  Describe the general content of the new national STFM oral health curriculum “Smiles for Life: The STFM Oral Health Curriculum”

4. Audience Survey  What are you presently doing about: Teaching residents and medical students about oral health issues? Teaching residents and medical students about oral health issues? Addressing patient oral health issues? Addressing patient oral health issues?

5. How to Teach Physicians about Oral Health

6. How to teach physicians…  Lectures  Cases  Laminated Cards  PDA programs  Well visit form modifications  Precepting reminders  Patient Education Materials

7. Lectures  Smiles for Life – STFM National Curriculum on Oral Health  4 modules available on FMDRL The relationship of oral to systemic health The relationship of oral to systemic health Child oral health Child oral health Adult/geriatric oral health Adult/geriatric oral health Dental emergencies Dental emergencies  Implementation Guide  Speaker Notes with references

8. Smiles for Life: FMDRL and “a web site of our own” New Resources in the works:  2 more modules: Prenatal oral health Prenatal oral health Applying varnish Applying varnish  Web cases  PDA applications  Patient materials – posters, handouts

9. Funders

10. Steering Committee  Alan Douglass, M.D. (Editor) Middlesex Hospital, University of Connecticut Middlesex Hospital, University of Connecticut  Wanda Gonsalves, M.D. Medical University of South Carolina Medical University of South Carolina  Russell Maier, M.D. (Group Chair) University of Washington University of Washington  Hugh Silk, M.D. University of Connecticut University of Connecticut  Nancy Stevens, M.D., M.P.H. University of Washington University of Washington  James Tysinger, Ph.D. University of Texas Medical Branch, San Antonio University of Texas Medical Branch, San Antonio  A. Stevens Wrightson, M.D. University of Kentucky University of Kentucky

11. Advisors  Joanna Douglass, B.D.S. D.D.S. University of Connecticut University of Connecticut  Sara Kim, Ph.D. University of Washington University of Washington  Mark Koday, D.D.S. University of Washington University of Washington  Rosie Roldan, D.M.D., M.D. University of Texas University of Texas  Judith Skelton, M.Ed., Ph.D. University of Kentucky University of Kentucky

12. Smiles for Life Module 1 - Relationship of oral to systemic health

13. Smiles for Life: Module 2 - Child oral health

14. Smiles for Life: Module 3 - Adult/geriatric oral health

15. Smiles for Life: Module 4 - Dental emergencies

16. Cases  Example: UCONN Web Cases (http://oralhealth.uchc.edu) UCONN Web Cases (http://oralhealth.uchc.edu) Pediatric Pediatric Adult Adult (coming soon)

17. Laminated Cards

18. PDA Applications Palm or Pocket PC

19. Precepting  Office Well visits – the Life Cycle Well visits – the Life Cycle PediatricPediatric AdultsAdults PrenatalPrenatal Acute visits (where appropriate) Acute visits (where appropriate) Know your referral system Know your referral system  Hospital Get learners to notice state of oral health of inpatients Get learners to notice state of oral health of inpatients

20. Incorporated Oral Health Questions into Well Child Exam Forms

21. Well Child Exam Form - 18 month

22. Patient Education Materials  Helps remind providers to promote the topic

23. How to Teach Patients About Oral Health

24. How to Teach patients  Teach Providers, including nursing staff Lectures, cases, etc Lectures, cases, etc Make it part of the Life cycle Make it part of the Life cycle  Posters  Video  Hand outs  Office Newsletters  Community Activities  Follow Up  Repetition and reinforcement

25. Nursing Staff  In-services Tooth brushing Tooth brushing Flossing Flossing Fluoride varnish application Fluoride varnish application  Patient education before and after physician visit

26. Posters

27. Video  Waiting room Examples: Examples: What You Should Know About Dry Mouth VideoWhat You Should Know About Dry Mouth Video American Dental Hygienist Association My Trip to the DentistMy Trip to the Dentist Children’s Oral Health Program of Monterey County. 2002 Brushing Baby Teeth Daily: Teaching the Cleaning of Erupting TeethBrushing Baby Teeth Daily: Teaching the Cleaning of Erupting Teeth University of Washington, School of Dentistry. Baby Teeth: Love ‘Em and Lose ‘EmBaby Teeth: Love ‘Em and Lose ‘Em (English and Spanish). Washington Association of WIC Agencies.

28. Handouts  AAFP  ADA – American Dental Association  AAPD – American Academy of Pediatric Dentistry  AAP – American Academy of Pediatrics  ACOG – American College of Obstetrics and Gynecology  Children’s books

29. ADA

30. AAFP

31. AAP

32. Books

33. Office Newsletter

34. Follow Up  Like any chronic health issue – have patient’s follow up for oral issues  Call to see that the patient went to see the dentist  Be consistent with your exam and advice

35. Repetition  How many times do you need to counsel your patient to quit smoking?  How often do you counsel your diabetic patients about diet and exercise to help them bring down their HgbA1c?  How many times do you need to tell your toddler’s parents that they need to get rid of the sippy cup of juice because of the white spots that are developing on the child’s teeth?

36. Behavior Change  How do you change a physician’s behavior?  How do you change a patient’s behavior?  Impacts “Health Beliefs” as well as health financing  May take more than individual or even family preventive counseling

37. Community Activities  Free dental clinics  Advocacy for better access to dental care  Oral health fair  School based programs

38. School-based programs  Some success with recognition and referral for treatment  Limited success with prevention given the late entry into the dental system

39. “Kids Smile”  Program involving education of Health Department staffs in Kentucky  Provides Fluoride varnish and patient education to children who seek care through the Health Departments  Some areas link it to WIC and food stamp programs with significant success and compliance  Currently, about 3000 children a month access this program across Kentucky

40. Brainstorming What else can we do to teach learners, ourselves and patients about oral health?

41. Discussion Topics Discuss current venues for family oral health education Discuss current venues for family oral health education Discuss new areas for education – group visits, screenings, education nights Discuss new areas for education – group visits, screenings, education nights Discuss turning individual teaching moments into family teaching moments Discuss turning individual teaching moments into family teaching moments How to keep teaching materials easy to access and distribute – paper vs web based, posters, etc How to keep teaching materials easy to access and distribute – paper vs web based, posters, etc Illustrate and further develop chart/EMR prompts for oral care Illustrate and further develop chart/EMR prompts for oral care

42. Wrap Up

43. Take Home Messages  Use “Smiles For Life” to teach your learners about oral health  Provide learners with tools – cards, PDA applications, charting prompts  Have available patient education materials  Discuss with your staff how to promote oral health better in your office/program

44. Thanks for coming!  Hugh Silk hughsilk@yahoo.com hughsilk@yahoo.com  Steve Wrightson aswrig2@email.uky.edu aswrig2@email.uky.edu