1. State Oral Health Plan and Prevention Agenda Update
Jayanth Kumar, DDS, MPH
Director, Bureau of Dental Health
New York State Department of Health

2. Framework for Comprehensive State Oral Health Plans
What should be done?
Setting Optimal National
and State Objectives:
(data-driven)
Data: unmet
Surveillance
needs, service
and data gaps
Data: process,
What is achieved?
outcome, impact
Knowledge for
What could be done?
Implementing
evaluations
Data: proven
Determining
Evidence-Based
prevention and
Effective Strategies
Data: disease
Possible Strategies
Decision Making
best processes
(outcome-driven)
burden, target
(science-driven)
populations, and
implementation
barriers
Data: societal influences,
current capacity,
environmental analysis
What can be done?
Planning Feasible Strategies
(capacity-driven)

3. Setting State Objectives
Increase awareness of the importance of oral health to overall health and well-being.
Reduce the prevalence of tooth decay.
Increase acceptance and adoption of effective preventive interventions.
Reduce disparities in access to effective preventive and dental treatment services.

4. A Framework for Public Health Action: The Health Impact Pyramid
Chairside guide
Campaigns
Evidence-based practice
School Dental Sealant Program
Fluoridation
Insurance coverage
Education & Counseling
Clinical interventions
Long lasting protective interventions
Change the context to make individual’s default decisions healthy
Socioeconomic factors
Increasing population impact
Increasing individual effort needed

5. Prevalence of caries, untreated caries and dental sealant, and New York State 3rd Grade Survey.

6. Dental insurance, fluoride tablet use and dental visit, and New York State 3rd Grade Survey

7. Figure 9a. Trends in tooth loss
Figure 9a. Trends in tooth loss. Percentage of persons (ages 65 and older) who have lost all natural permanent teeth. New York State BRFSS, 1999 to 2010.

8. State Target and Disparities, 2009-2012 Survey

9. State Target and Disparities, 2009-2012 Survey

10. Childhood Caries in NYS: Emergency Department and Ambulatory Surgery Facility Visits
5484
5683
5635
4972
5122
4361
2900
1500
Moderator: Jay, is it really that children need to be seen in operating rooms for treatment of cavities. How frequently does this happen?
Note: renamed titled of slide
Children (< 6 years) Visiting Emergency Departments (EDs) and Ambulatory Surgery Facilities (ASFs) for Treatment of Early Childhood Caries in New York State, SPARCS , 2010

11. Percent with at Least One Dental Visit and One Preventive Dental Visit, NYS Medicaid Program 2011

12. Trends in Dental Visit in Children by Income Groups
Source: ADA

13. Trends in Dental Visits
Source: ADA

14. Clinical Preventive Services
More than half (56%) of children and adolescents did not visit the dentist during the preceding year in 2009, and 86% of children and adolescents did not receive a dental sealant or a topical fluoride application during the preceding year in More than two thirds (69%) of 5–19 year-olds did not have a dental sealant during 2005–2010 (7).

15. Challenges
Improving
public perception
utilization of effective preventive measures
Insurance coverage
diversity and flexibility of the dental workforce, & uneven distribution of dental professionals
measurement and tracking of oral diseases, risk factors, the dental workforce and utilization of dental services.
Addressing the high cost of dental education and the debt burden

16. Goals
Goal 1: Integrate oral health into systems, policies and programs which improve overall health. Goal 2: Prevent oral diseases and address risk factors through evidence-based interventions. Goal 3: Eliminate oral health disparities and improve access to high quality, comprehensive, continuous oral health services for all New Yorkers. Goal 4: Strengthen systems which improve the oral health of people with special health needs. Goal 5: Increase knowledge sharing statewide to enhance the adoption of best practices, replicate proven efforts, and improve community oral health literacy. Goal 6: Increase capacity, diversity, and flexibility of the workforce to meet the needs of all New Yorkers. Goal 7: Maintain and enhance the existing surveillance system to measure key indicators and for tracking progress.

17. Strategies
Bring together stakeholders periodically and develop a statewide agenda for action
Explore opportunities to form regional partnerships
Strengthen the oral health surveillance system
Encourage educational and training programs to update competencies and standards

18. People with special health needs: Objectives
Identify successful reimbursement strategies
Increase inter-professional collaboration
Implement changes in the surveillance system to enable data collection
Identify Centers of Excellence for providing oral health care
Assess the number of dental providers serving people with special health care needs
Address waiting times for appointment
Train caregivers
Develop research activities that address the oral health issues

19. Prevention Agenda Goal #5: Reduce the prevalence of dental caries among NYS children.
Objective 5-1: By December 31, 2017, reduce the prevalence of tooth decay among NYS children by at least 10%.
Objective 5-2: By December 31, 2017, increase the proportion of NYS children who have protective dental sealants by at least 10%.
Objective 5-3: By December 31, 2017, increase the proportion of NYS children who receive regular dental care by at least 10%.
Objective 5-4: By December 31, 2017, increase the percentage of NYS population receiving fluoridated water by 10%.
Objective 5-5: By December 31, 2017, strengthen systems to improve the oral health of people with special health needs.

20. Achieving targets State Oral Health Program
Surveillance & Epidemiology
State Oral Health Program
Achieving targets
Population-based Programs
Health Systems Interventions
Community-Clinical Linkages

22. Fluoridation in New York State Prevention Agenda Target 78.5%
Population served:
12.9 m (71.4%)
Fluoridating Systems: 123
Moderator (transition to Jay): So there seems to be a lot of options for oral health prevention, what does NYS recommend?
New York ‘s fluoridation program began in 1945 with a classic epidemiological study in Newburgh and Kingston. Since then, more than 40 reports have been published covering fluoridation’s effect on health outcomes and cost savings. These reports have been disseminated widely via scientific publications, symposia and webinars.
The population receiving fluoridated water has steadily increased. At present, about 12.9 million residents served primarily by 123 water systems receive fluoridated water. However, there are several large geographic areas without fluoridation.

23. Fluoridation: Defend and Promote
Monitoring the fluoride level
Training
Upgrading equipment & technical assistance
Evaluation

25. Prevalence of Caries by Subgroups
Moderator: You are suggesting that overall we are seeing improvements in oral health indicators. Are there groups where we haven’t seen improvements and what might explain this lack of improvement.

26. Addressing common risk factors in dental offices
The best kick-off question:
Do you and your family typically drink bottled water or tap water?

27. School policies and programs
School dental screening
School dental programs

28. ECC Learning Collaborative
Partnered with DentaQuest Institute for their Phase III ECC Learning Collaborative
Enrolled four teams from WNY
Developing New York State faculty to replicate the collaborative
Goals
Reduce % of patients with new cavitation by 50%
Reduce % of patients complaining of pain by 30%
Reduce % of patients with referral for operating room treatment and sedation by 50%
Ends on February 28, 2015
Planning expansion strategies

29. HRSA Maternal and Child Health Initiative
PERFORMANCE MEASURE 12
A) Percent of women who had a dental visit during pregnancy and
B) Percent of infants and children, ages 1 to 6 years, who had a preventive dental visit in the last year
Learning Collaborative
Integration into MCH programs
Education & Training
Reimbursement for primary care providers
Collaboration with Perinatal Networks
Community linkage
Perinatal Care Standards in Medicaid

30. Policy and Guidance
Reimbursement for smoking cessation counseling (SCC) must meet the following criteria:
SCC must be provided face-to-face by either a dentist or by a dental hygienist that is supervised by the dentist.
SCC must be billed by either an office-based dental practitioner or by an Article 28 clinic that employs a dentist.
Dental practitioners can only provide individual SCC services, which must be greater than three minutes in duration, NO group sessions are allowed.
Dental claims for SCC must include the CDT procedure code D1320 (tobacco counseling for the control and prevention of oral disease).

31. Health Workforce Shortage
Creating incentives to locate practices in shortage areas
Loan repayment
Practice support
Innovative workforce solutions
Virtual dental home
Teledentistry

32. SUMMARY State Oral Health Programs Achieve the Vision of Healthy People in Healthy Communities
Build consensus, develop a common agenda, and mobilize for action
Build and foster partnerships
Collaborate and promote integration
Leverage resources
Support communities
Measure progress and review policies and programs

33. Thank You

34. Salience Promote oral health as integral to overall health
Eliminate health disparities
State Oral Health Program
Salience
Improve the quality of life
Promote oral health as integral to overall health
Promote optimum oral health for all

35. Collecting, Analyzing & Providing Data State Oral Health Program
Supporting communities
Education & Training
Program Support
Grants, Technical Assistance, Guidance
Building Partnerships, Coalitions, Networks

36. State Oral Health Program Establishing Collaborations
Federal Funding
CDC, HRSA
State Oral Health Program
Leveraging resources
State Funds
Foundations
Establishing Collaborations

37. People with special health needs
Objective 4.a: By 2017, identify successful reimbursement strategies for providers and hospitals that address the additional time and resources needed to treat people with special health needs.
Objective 4.b: By 2017, ensure that systems developed to increase interprofessional collaboration and inform consumers about dental care address the challenges faced by people with special health needs.

38. Objective 4.c: By 2017, implement changes in the surveillance system to enable data collection on oral health and access to dental care for people with special health needs.
Objective 4.d.: By 2017, identify Centers of Excellence for providing oral health care to people with special health needs.
Objective 4.e: By 2017, assess the number of dental providers serving people with special health care needs and determine how many are needed to serve people with special health needs.

39. Objective 4.e: By 2017, develop and implement strategies to ensure that waiting times for routine appointments are no longer than one month, and dental emergencies are addressed within 24 hours for patients with special health needs.
Objective 4.f.: By 2020, ensure that all health care workers employed to assist people with special health care needs are trained in their daily oral health care.
Objective 4.g: By 2017, develop research activities that address the oral health issues of people with special health care needs.