1. 2020 Oral Health Objectives: Much progress but More to be Done Rebecca S King, DDS, MPH Section Chief, NC Oral Health Section

2. Introduction Background Background 2010 Healthy Carolinian Objectives 2010 Healthy Carolinian Objectives 2020 Healthy Carolinian Objectives 2020 Healthy Carolinian Objectives

3. Weve come a long way baby!! But we still have a ways to go!! Why?

4. Major Factors Sociodemographic Sociodemographic Dental workforce Dental workforce Need for prevention and education Need for prevention and education

5. Social and Demographic Trends New Majority … South is the only region… where low income children = majority of public school students – 54%. … South is the only region… where low income children = majority of public school students – 54%. % low income children in schools doubled since 1989 % low income children in schools doubled since 1989 2000-07: pop. <5 year olds grew by 20% 2000-07: pop. <5 year olds grew by 20% 2001-05: Hispanics = 50% of growth in public schools 2001-05: Hispanics = 50% of growth in public schools Southern Educational Association, 2007 Poverty, poor education, and inequality lead to poor dental health!

6. Dentist Workforce Trends 4 counties have no dentist 10 counties have 1 or fewer dentists/ 10,000 population NC Supply lags behind US supply Slight increase over the last 10 years Future: expanding dental school graduates

7. GAO Report 2008 Millions of poor American children have untreated tooth decay Millions of poor American children have untreated tooth decay 6.5 million children enrolled in Medicaid had untreated tooth decay (2005) 6.5 million children enrolled in Medicaid had untreated tooth decay (2005) –some could not find a dentist willing to treat them –only 1 in 3 received any dental care in a year Report was ordered after young boy died in 2007 Report was ordered after young boy died in 2007 http://www.cnn.com/2008/US/09/23/dentalcare.medicaid/ind

9. Early Treatment is Essential

10. Dental Care Safety Net Clinics Prior to 1996* * NC Oral Health Section

11. Dental Care Safety Net Clinics March 2010* * NC Oral Health Section

12. Need for Prevention and Education Weve never cured a disease through a treatment program.

13. Tooth Decay: Most Common Chronic Childhood Disease Mortality: can be fatal, usually not Mortality: can be fatal, usually not Morbidity: quality of life Morbidity: quality of life –6X more common than asthma –Advocacy groups rate high Largely preventable Largely preventable Once diseased, have to repair Once diseased, have to repair Able to track because it leaves a record Able to track because it leaves a record

14. Pain Difficulty Eating Percent Quality of Life* Missed School Financial Difficulties Occasionally, often or very often in lifetime Occasionally, often or very often in lifetime Impacts on Child and Family by Race, Grades K-3 *2003-2004 NC OHS Statewide Dental Survey

15. Disparities in Disease Mean DMFT 7.6 3.1 1.4 *NC OHS Statewide Dental Survey Data Trends in Tooth Decay in 12-17-Year-Old Children *

16. Disparities in Access Percent WhiteBlack Other *2003-2004 NC OHS Statewide Dental Survey % Permanent Teeth with Untreated Decay, by Race*

17. Percent PrivatePublicNone White Black Hisp *2003-2004 NC OHS Statewide Dental Survey % Children with Dental Insurance by Type and Race* * Disparities in Access

18. Costs of Dental Treatment 2006 MEPS data Expenditures 7.4% of total health care Expenditures 7.4% of total health care Mean/person $607 Mean/person $607 42% had an expenditure 42% had an expenditure –43% paid by private insurance –49% out of pocket http://www.meps.ahrq.gov/data_files/publications/st263/stat263.pdf

19. Cost-Effective Preventive Measures CDC recommends as most beneficial preventive measures CDC recommends as most beneficial preventive measures –Water Fluoridation Benefits children and adults Benefits children and adults 50 cents - $1/person/year 50 cents - $1/person/year Lifetime costs less than cost of one filling Lifetime costs less than cost of one filling –Dental Sealants Fluoride varnish Fluoride varnish

20. Early Stage Decay and Obvious Cavities in Permanent Teeth* Early stage decay only Obvious cavities only 65% 10% 24% Both Children *2003-2004 NC OHS Statewide Dental Survey

21. Why Education? You cant be healthy without good oral health You cant be healthy without good oral health –Dr. C. Everett Koop Value placed on oral health Value placed on oral health

22. Value Placed on Oral Health Percent WhiteBlack Hispanic Baby teeth do not need to be filled because they are going to fall out anyway! % of parents who agree *2003-2004 NC OHS Statewide Dental Survey

23. Update on Healthy Carolinians 2010 Oral Health Objectives

24. HC-2010 Oral Health Objective 1. Reduce tooth decay in preschool children. Target: 1.3 average # decayed, missing and filled primary teeth (dmft). Baseline, 1999: 1.45 average # decayed, missing and filled primary teeth (dmft).

25. Tooth Decay in Kindergarten Children (primary teeth)* *NC OHS annual assessment data Target 1.3 Baseline 1.45

26. HC-2010 Oral Health Objective 2. Increase the proportion of 5th graders whose permanent teeth are free of decay. Target: 87% Baseline, 1999: 79% fifth grade children have never had a cavity in a permanent tooth.

27. Fifth Grade Children with Permanent teeth Free from Decay* Baseline 79% Target 87% *NC OHS annual assessment data ?

28. Fifth Grade Children: Avg. # Decayed Permanent Teeth* *NC OHS annual assessment data

29. HC-2010 Oral Health Objective 3. Increase the proportion of children < age 19 at or below 200% Federal poverty level who received any dental preventive service during the last year. Developmental Objective, baseline data to be collected and analyzed by 2001.

30. Access to Care for Medicaid Children* *NC Div. of Medical Assistance

31. Into The Mouths of Babes Statewide Medicaid Dental Prevention Program for Young Children

32. Dental Prevention Service Package Medicaid children from tooth eruption to age 3 ½ Provided in a medical setting Provided in a medical setting Oral evaluation and risk assessment Oral evaluation and risk assessment Referral for dental care Referral for dental care Caregiver education Caregiver education Fluoride varnish Fluoride varnish

33. HC-2010 Oral Health Objective 4. Increase the proportion of adults who visited a dentist within the past year. Target: 73.9% Baseline, 1999: 67.2% of adults 18 years and older visited a dentist during the past year.

34. How many visited dentist, clinic for any reason in last year?* Year Percent *BRFSS ? 67.2 69.4 67.6 67.5 65.2 67.2 73.9 60 62 64 66 68 70 72 74 1999 200120022004200620082010 Target Baseline

35. HC-2010 Oral Health Objective 5. Decrease the proportion of adults, ages 45 – 65 years, who lost 5+ teeth due to tooth decay or gum disease. Target: 20% Baseline, 1999: 22.3% of adults, ages 45- 64, had a tooth removed due to decay or gum disease.

36. Proportion of adults, ages 45-64, who lost 5+ teeth due to tooth decay or gum disease* % People Who Lost 6+ Teeth *NC State Center for Health Statistics ?? Year Target

37. Healthy Carolina 2020 Draft Oral Health Objectives

38. HC-2020 Oral Health Objective 1 Increase the % of children enrolled in Medicaid ages 1-5 who received any dental service during the previous 12 months. Target: 56.4% Target: 56.4% Baseline: 46.9% (2008) Baseline: 46.9% (2008) Method: 90 th percentile for NC counties Method: 90 th percentile for NC counties Draft

39. % Medicaid children receiving dental services, last 12 months Year Target Percentage Baseline

40. HC-2020 Oral Health Objective 2 Decrease the average number of decayed, missing, or filled teeth (dmft) among kindergartners. Target: 1.06 average # decayed, missing and filled primary teeth (dmft). Baseline, 2008-09: 1.5 average # decayed, missing and filled primary teeth (dmft). Method: Best 10 th percentile of NC counties. Draft

41. 2. Tooth Decay in Kindergarten Children (primary teeth)* *NC OHS annual assessment data Target 1.06 Baseline 1.5

42. HC-2020 Oral Health Objective 3 Decrease the percent of people (ages 18+) who have had permanent teeth removed due to tooth decay or gum disease* # teeth removed due to tooth decay or gum disease? Dont include teeth lost for other reasons, such as injury or orthodontics. # teeth removed due to tooth decay or gum disease? Dont include teeth lost for other reasons, such as injury or orthodontics. Target: 35.8% Target: 35.8% Baseline: 54.3% (2001) Baseline: 54.3% (2001) Method: NC Pace applied out to 2020. Method: NC Pace applied out to 2020. *BRFSS data Draft

43. 3. Percent of adults who had a permanent tooth removed due to tooth decay or gum disease* Percentage Year Target *BRFSS data

44. Questions Later