1. Oral Health and Its Implications
Suzanne Martin, MSW
Debbye Krueger, RDH, BS, FAADH
Wendy Schwade, RDH, BS
Thank you for having me here today. I appreciate the opportunity to speak with you and tell you more about the North Carolina Oral Health Collaborative. My name is _______________________ and I am the _____________________ at the Collaborative.

2. Presentation Highlights
NC Oral Health Collaborative
Oral Health = Overall Health
Potential Signs of Abuse/Neglect
Q & A
I like to start by letting the group know what we will discuss today so this slide outlines my presentations highlights.
I am happy to answer any questions you have at the end, as long as time allows.

3. NCOHC Purpose
North Carolina Oral Health Collaborative convenes diverse stakeholders to identify and resolve consumer-level and systemic barriers to good oral health and to accelerate implementation of policies and practices that reduce oral health disparities and promote improved oral health for all North Carolinians.
Our purpose is to convene diverse stakeholders to identify and resolve consumer-level and systemic barriers to good oral health and to accelerate implementation of policies and practices that reduce oral health disparities and promote improved oral health for all North Carolinians.

4. Achieve oral health for ALL North Carolinians
NCOHC Mission
Achieve oral health for ALL North Carolinians
Our mission is even simpler – to achieve oral health for all North Carolinians.

5. NCOHC Values Prevention Whole Person Care Equity* Cultural Competence
Patient Engagement
Efficiency
Guided by Science and Evidence
Our values are both a way to prioritize our work and a call to action. They express our underlying assumptions about what it will take to improve oral health for all North Carolinians.
Prevention – Increasing acceptance and adoption of preventive interventions is the most effective way to reduce incidence and burden of disease.
Whole person care – Oral health is a critical component of good overall health throughout a person’s life span and a focus on oral health is a component of the comprehensive medical home.
Equity* – Addressing complex barriers to accessing oral health services will reduce health disparities.
Cultural competence – Respectful interaction between providers and patients and their families is a critical component of quality care.
Patient engagement – We promote service delivery that engages and supports patients to learn more about their health and to set personal goals to increase healthy behaviors. We work with consumers to develop the Collaborative’s agenda and strategic direction.
Efficiency – Our oral health care system works best when patients have access to the right care at the right place at the right time, this may not be in a dentist’s office.
Guided by Science and evidence – While we welcome and value different perspectives, we endeavor to base our policy recommendations on scientific evidence, proven best practices, and tested pilot models.

6. Another important clarification/distinction to make up front is what I mean when I say equity, and how this is quite different from equality.
Equality = Sameness
Giving everyone the same thing. This only works if everyone starts from the same place.
Equity = Fairness
Access to the same opportunities. We must first ensure equity before we can enjoy equality.
These are the FRAMES that shape the work of the NC Oral Health Collaborative. I enter this work with openness, curiosity, eagerness to learn and connect and to build upon the great work that has already begun to address oral health disparities in our state.

7. Guiding Principles Accountability* Boldness Collaboration Commitment
Our guiding principles are a compass for decision making and provide context about how the work needs to be done.
Accountability*
Boldness
Collaboration
Commitment
Impact
Our guiding principles are a compass for decision making and provide context about how the work needs to be done.
Accountability – We make decisions consistent with the best interests of the people of North Carolina.
Boldness – We are willing to have tough conversations, to innovate and to take bold action to challenge positions that are inconsistent with the common good.
Collaboration – We are better together. We communicate and work as a team, and we partner with the community to understand and solve problems.
Commitment – We ask our members to devote time and energy in service of the shared direction.
Impact – We make a measurable difference. We use data to drive to drive our decisions. We actively promote best practices that have robust evidence.

8. Foundation for Health Leadership & Innovation
FHLI builds leadership, shapes practice, affects policy, and drives innovation through its programs and collaborative partnerships.
To begin, the NC Oral Health Collaborative is a program within the Foundation for Health Leadership & Innovation. The Foundation is a home for growing programs that work to improve the health of the whole-person through a whole-community approach. FHLI provides the space, resources and expertise that programs need and it acts as a convener for partnerships by creating an open environment that advances new ideas.
<NOTE: Only go into detail on program list and/or descriptions as time allows.>
Besides the Collaborative, other programs within the Foundation you may have heard of include:
Bernstein Fellows Program – prepares emerging health leaders to work in and improve the health of rural and underserved communities in NC.
Bernstein Health Center Scholarship Program – provides scholarships to families employed in NC’s rural health clinics.
Catalyst for Healthy Eating and Active Living – works with communities to address key risk factors for chronic disease and accelerates change to make healthier living easier.
Center of Excellence for Integrated Care – assists health systems in integrating physical and behavioral healthcare services.
NC Rural Health Alliance – supports partnerships and strategies that improve health outcomes in rural NC.
Practice Sights – uses retention software and strategies to help keep healthcare providers in rural areas.
Rural Forward NC – amplifies the impact of rural leaders, organizations and coalitions through capacity-building and resource development.

9. Membership Representation & Organizational Structure
Extended Stakeholder Group
Full Collaborative (150+ members)
Workgroups & Capacity Building Grantees
CAT = Collaborative Acceleration Team & Staff
Statewide
Grass Blade Levels
Social
Public
Private
Our members represent diverse stakeholder groups across NC, which include:
Grass-top, intermediary, and grassroots organizations
Social interties, such as nonprofits and faith-based agencies
Public universities, colleges, federal, state and county agencies, schools and elected officials
Private foundations, dentists, doctors, child care providers and other businesses
The visual on the right provides an overview of the NCOHC’s structure. We are very proud that our membership has grown to over 150 members who comprise a portion of the overall extended stakeholder group, which includes all North Carolinians. One thing I will note is while the Collaborative had strong representation from “content experts”, that is folks working directly on issues related to oral health, what was missing was the voices of “context experts”. For this reason, we launched our Capacity Building Mini-Grants program that enables us to partner with 7 community-based and intermediary organizations that already had some inclination towards health equity and/or social justice, to begin incorporating oral health into their repertoire. The inner-most layer is where our staff and advisory group, the Collaborative Acceleration Team (CAT), are situated. This illustration is a reminder to those of us at the center that our work impacts more than ourselves and it is our duty to use our power to ensure others have access to good oral health care.

10. NCOHC Reports <NOTE: Both documents are hyperlinked in slide>
One of our reports, titled Innovations in Oral Health Care: Programs, Projects and Strategies for Improving Access to Quality Oral Health Care in NC, highlights exemplary stories of individuals who are transforming the delivery of dental care and dramatically improving the lives of people in NC and in other states. Each story includes an overview of the history, purpose, structure, and impact of the program, as well as a feature on the innovators themselves.
The second report, Portrait of Oral Health in NC: An Overview of Our Current Realities and Opportunities for Change, provides a rich overview of the current state of oral health in North Carolina, acknowledging the progress that has been made since the 1999 NC Institute of Medicine Report, while highlighting the challenges that persist and the opportunities for systemic change.

11. Claves para la Salud Oral It Takes All of Us
The Keys to Oral Health
Claves para la Salud Oral
It Takes All of Us
Se Necesitará de Todxs Nosotrxs
<NOTE: The videos and first titles are hyperlinked to the English language videos and the Spanish titles are linked to their respective Spanish language versions.>
We developed a series of 3 videos that illustrates the multi-faceted layers of the oral health system, which can be found on our website.
The Keys to Oral Health: An important part of overall health is oral health—having a healthy mouth, including teeth, gums, and tongue. Achieving good oral health can be thought of like going through a series of doors.
It Takes All of Us: When it comes to oral health, we know we can reduce costs by stopping problems before they even start.
Let’s Use Our Resources Wisely: When it comes to oral health, we know we can reduce costs by stopping problems before they even start.
The fourth video is a tool we use to inform people about Oral Health Day at the NC Legislature that started in 2017 when over 100 participants joined us for our Oral Health Day: Join us as we continue to build the movement to achieve oral health equity for ALL!
Let’s Use Our Resources Wisely
Usemos Nuestros Recursos Sabiamente
Oral Health Day
El Primer Dia de La Salud Oral en la Legislatura

12. Oral Health is not Las Vegas ~ What Happens in the mouth does not stay in the mouth!
Suzanne will transition to Debbye for Oral Health = Overall Health portion
Oral Health = Overall Health

13. Breaking News!
The head is attached to the body!

15. Is your mouth making you sick?
Periodontal Disease Heart Disease Stroke Diabetes Cavity Infections (abscess) Gastrointestinal problems Ulcers Stomach cancers Oral Lesions Autoimmune disorders HIV/AIDS Nutritional deficiencies Immune deficiency Cancer

16. Link Between Periodontal disease & Systemic Inflammatory Diseases: A risk continuum
Bacterial Challenge
Iatrogenic Factor
Crowded Teeth
Poor Oral Hygiene
Host Response Exaggerated Hyperinflammatory Response
Smoking
Diabetes
Genetics
Obesity
Stress Medications
Compromised Immunity
Periodontal Disease
Low Grade Chronic Infection/ Inflammation
Exacerbates On-Going Inflammation in Distant Organs Increased Risk for:
Atherosclerosis
Diabetic Complications
Adverse Pregnancy Outcomes
Respiratory Diseases
Neurodegenerative Diseases

17. The Connection Between Your Oral Health & Your Overall health Effects of Poor Dental Hygiene

19. Can You See What’s Going On???
Debbye will transition to Wendy for Oral Health Indicators of Potential Abuse/Neglect
Recognizing Abuse Through Oral Health Assessments

20. NC Courts Definition of Elder Abuse
Intentional or neglectful acts by a caregiver or “trusted” individual that led to harm of a vulnerable elder.
Physical
Emotional/Psychological
Neglect
Abandonment
Sexual
Financial

21. Physical Abuse
Involves bodily harm

22. Psychological or Emotional Abuse
Involves using harsh or threatening language.
This abuse can involve isolating the elder from family and friends.
Completely ignoring someone.

23. Neglect
Basic needs are ignored.

24. Abandonment
Leaving the elder alone without a plan for basic care.

25. Sexual
Forcing an elder to watch or participate in sexual acts.

26. Financial
Illegal or unauthorized use, or exploitation of the elder’s resources.

27. Oral Health Problems as a Sign of Abuse or Neglect.
From the oral health perspective, abuse or neglect often includes all the areas mentioned.

28. Poor Oral Hygiene
Can progress to tooth loss and worse…

29. Untreated Dental Disease
Acts as an incubator for bacteria that cause systemic infection and inflammation, exacerbating other chronic conditions.

30. Abscessed Tooth
An abscessed tooth can lead to a life- threatening infection if left untreated.

31. Sexual Abuse
This is syphilis on the tongue.

32. Dirty Dentures
First, check to see if the elder wears a partial or denture.
If so, remove and clean nightly to avoid risk of pneumonia.

33. Burns in Oral Cavity Food and drink served too hot.
Can be considered abuse if it occurs repeatedly.

34. Resources for Reporting Elder Abuse
(N.C. GEN. STAT. §108A-102(a)) If you receive information regarding elder abuse or neglect from a member of the public: Make an Adult Protective Services (APS) report to the County Department of Social Services (DSS) where the elder resides (
More information and resources can be found at:
Elder Justice and Adult Protective Services
North Carolina Court System
NCEA
NCDHHS APS is required by statute (N.C. GEN. STAT. § 108A-109) to notify the district attorney upon finding evidence indicating that a person has abused, neglected, or exploited a disabled adult.

35. You are part of the oral health Care team
Wendy will transition to Suzanne for Using This Knowledge to Make the Difference
Using This Knowledge to make the difference

36. What Work Lies ahead for 2018 & beyond
June 5, 2018 Oral Health Day at the Legislature
Finalize & Pilot Oral Health Equity Curriculum
Growing & Strengthening the NCOHC Network
2018 Fall Convening
What Work Lies ahead for 2018 & beyond
Turning our focus to the future work of the Collaborative, here are a few items to look forward to.

37. Get Involved with NC Oral Health Collaborative
Become a Member – It’s FREE!
Join Our Newsletter Listserv
Text NCOHC to 22828 Us
Visit Our Website
Now comes the best part of my presentation when I warmly welcome you to get involved in the NC Oral Health Collaborative! There are several ways to engage our network.
BECOME A MEMBER – it’s FREE! If you support the mission, values, and guiding principles, please sign our statement of support at this website.
If you would like to learn more please join our mailing list by texting “NCOHC” (all caps) to the phone number “22828”. This send a text response asking for your , which will be added to our list. Don’t worry, we keep your information private and do not clutter up your inboxes!
If you want to send us your questions or requests for more information on the Collaborative please us at
Finally, you can visit our website for more about us, our members, and resources at oralheatlhnc.org.

38. “Let people’s experiences be the truths we build our solutions on.”
Wendy, Debbye and I are so grateful to be with you all today! Thank you for your time and attention. I would like to leave you with a quote from Dr. Crystalee Crain that summarizes what the NC Oral Health Collaborative believes is imperative as we seek to achieve oral health for all North Carolinians…
“Let people’s experiences be the truths we build our solutions on.”
Thank you again, and we are happy to take your questions as long as time allows.
~ Crystallee Crain, PhD