1. 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

2. Thank you Pacific Island Health Officers Association
Pacific Island Primary Care Association
Pacific Basin Dental Association
Dr. Gregory Dever, PIHOA

3. 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

4. Poor oral health associated with NCDs

5. Oral Health Yin/Yang Integration
Poor oral health associated with other NCDs
Good oral health needed for
Good eating/health
School/work performance

7. 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
3. Solomon, E.S. J Dent Educ, : p
4. Capurro, D.A., et al.Community Dent Oral Epidemiol, : p. 500.
© R. Niederman
R. Niederman ©

8. “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

9. 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
R. Niederman ©

10. 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

11. 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

12. 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

13. 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
R. Niederman ©

14. CariedAway met Obama Care Triple Aim
Improved Health
Reduced Cost
Improved Patient Experience

15. CariedAway met Healthy People Goals
Exceeded Healthy People 2020
Oral Health Goals for Untreated Caries

16. CariedAway met IOM Quality Aims
Place-based
Prevention
Safe
Yes
Effective
Patient Centered
Timely
Efficient
Equitable
R. Niederman ©

18. 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

19. Mahalo