Katherine Weno, Senior Advisor NCCDHP, Centers for Disease Control and Prevention

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1 Katherine Weno, Senior Advisor NCCDHP, Centers for Disease Control and Prevention Krista Postai, Chief Executive Officer Community Health Center of Southeast Kansas

2 Today s Objectives. * Understand the role dental staff play in early Identification of chronic disease & mental illness * Recognize opportunities to integrate care * Learn how a safety net clinic can evolve into treating the whole person * Avoid costly mistakes and staff conflicts during organizational change

3 Centers For Disease Control and Prevention America s Health Protection Agency Founded in 1946 Part of the U.S. Department of Health and Human Services Headquartered in Atlanta, GA 15,000+ employees in 170 occupations Field staff in all 50 states and more than 50 countries

4 National Center Chronic DPHP s Nine Divisions Smoking and Health Nutrition, Physical Activity and Obesity Reproductive Health Oral Health Community Health Population Health Cancer Prevention and Control Diabetes Translation Heart Disease and Stroke Prevention

5 Cooperative Agreement DP State Oral Disease Prevention New Hampshire Vermont ID CO ND MN IA KS WI MI CO WV NY VA Rhode Island Connecticut Maryland LA MS SC GA Legend: Component 1 Grantees Component 2 Grantees HI

6 Topics for Chronic Disease and Oral Health Collaboration at CDC Tobacco Cessation Heart Disease and Stroke Prevention Diabetes Prevention and Management Obesity Prevention Led to new funding opportunity in 2016: 1609: Models of Collaboration for State Chronic Disease and Oral Health Programs

7 Tobacco and Oral Health Tobacco use smoking and smokeless is associated with: Tooth loss Periodontal disease Oral cancer Increased caries risk Poor dental surgical/ restorative outcomes Second hand smoke may impact caries in children Hanioka T, Ojime M, Tanaka K, et al: Causal assessment of smoking and tooth loss: a systematic review of observational studies. BMC Public Health 2011;11:221. Eke PI, Thornton-Evans G, Dye BA, Genco R. Advances in Surveillance of Periodontitis: The Centers for Disease Control and Prevention Periodontal Disease Surveillance Project. J Periodontol 11 February 2012: 1 9 Aligne CA, Moss ME, Auinger P, et al: Association of pediatric dental caries with passive smoking. J Am Med Assoc 2003;289:

8 Dentists and Tobacco Cessation Activities Tobacco dependence education taught in a majority of dental schools and hygiene educational programs ADA Policy: The Association urges its members to become fully informed about tobacco cessation intervention techniques to effectively educate their patients to overcome their addiction to tobacco. This information should include education on primary prevention of tobacco use. HP 2020: Increase tobacco screening in health care settings Screen dental patients for tobacco use (TU-9.3) Increase tobacco cessation counseling in healthcare settings Provide counseling for tobacco cessation (TU-10.3) Davis, Arnett, Loewen, Tobacco Dependence Education A Survey of US and Canadian Dental schools, JADA 2016:147(6):

9 Dental Professionals and Tobacco Cessation *Oral Path, Radiology, and Public Health < 10 respondents (not listed) ** ** % who answered Always/usually ⱡ Total based on all GPs and specialists Counseling for Tobacco Use and Cessation by Dental Health Care Providers, Jennifer L. Cleveland DDS, MPH 1 ; Jon Ruesch MA 2 ; Laurie Barker MSPH 1 ; Chien-Hsun Li MS, MA 3 ; Gina Thornton-Evans DDS, MPH, 2010 ADA Annual Survey of Dentists

10 1609 Grantee Project - Tobacco Georgia Pilot tobacco cessation project for dental professionals working with young pregnant women Tobacco cessation and quitline referral training for targeted dental providers Development of a oral health provider tool kit on tobacco Education campaign in collaboration with GA Medicaid program Social Media campaign Oral health/chronic disease program advisory group to oversee project

11 Oral Health and Diabetes Diabetics at higher risk for periodontal disease Diabetics with periodontal disease may have more difficulties with glycemic control Glycemic Control can be improved by periodontal treatment Diabetes is often associated with dry mouth Tooth decay Fungal infections Tooth loss -Diabetes doubles tooth loss in US adults African American diabetic adults lose more teeth than whites and Mexican American Pregnancy related diabetics with periodontal disease are at higher risk of poor maternal outcomes Eke PI, Dye B, Wei L, Thornton-Evans G, Genco R. Prevalence of Periodontitis in Adults in the United States: 2009 and J Dent Res. Bei Wu, Forty-Year Trends in Tooth Loss Among American Adults With and Without Diabetes Mellitus: An Age-Period-Cohort Analysis. Preventing Chronic Disease, Vol. 12, November Xiong X, Elkind-Hirsch KE, Vastardis S, Delarosa RL, Pridjian G, Beukens P. Periodontal disease is associated with gestational diabetes mellitus: A case-control study. J Periodontol. 2009;80(11):

12 CDC Collaborations Healthy People 2020 Objective: Diabetes Objective #8 (D 8): Increase the proportion of persons with diagnosed diabetes who have at least an annual dental examination. Target: 61.2%. Baseline: 55.6% Working Together to Manage Diabetes: A Toolkit for Pharmacy, Podiatry, Optometry, and Dentistry (PPOD)

13 1609 State Grantee - Diabetes Colorado Department of Health and Environment Collaboration between the oral health unit and diabetes unit to in include oral health providers in diabetes prevention and case management Collaboration with Federally Qualified Health Centers to facilitate trainings, screening and bi-directional referral Oral health providers/medical providers will have mutual performance measures on diabetes in their Medicaid program Oral health is included in their state chronic disease plan, and staff from both the oral health program and the diabetes program are administering the project

14 Oral Health and Heart Disease/Stroke No strong evidence of direct link - Poor oral health doesn t cause heart disease, and dental treatment doesn t prevent heart disease/stroke BUT Share risk factors: smoking, age, diabetes, poor nutrition Both cause inflammatory reactions

15 Hypertension One third of Americans have hypertension (70 million) Over half of these have poorly controlled hypertension 40% don t even know they have it Strategy: Increase Opportunities for Blood Pressure Screening in Community Sites Vital signs: awareness and treatment of uncontrolled hypertension among adults--united States, MMWR Morb Mortal Wkly Rep 2012,61: James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, et al evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA 2014,311: Egan BM, Zhao Y, Axon RN. US trends in prevalence, awareness, treatment, and control of hypertension, JAMA 2010,303: Donahue KE, Vu MB, Halladay JR, Miller C, Garcia BA, Cummings DM, et al. Patient and practice perspectives on strategies for controlling blood pressure, North Carolina, Prev Chronic Dis 2014,11:E69; quiz E69.

16 Measuring Blood Pressure in Dental Offices Recommendation: BP readings for all new patients, at every recall for all patients, hypertensive patients at every appointment Dentists should also take health and medication histories, refer and follow up with hypertensive patients Well accepted practice in dental community: Standard taught in dental and dental hygiene schools Over 90% of dentists were willing to measure BP for patients, 96% of dentists would refer a patient with high BP to a physician Most dental patients ( %) would like to have their BP measured during dental visits Herman. W, Konzelman J., New national guidelines on hypertension: A summary for dentistry, J Am Dent Assoc, Vol. 135, May 2004 Greenberg BL, Glick M, Frantsve-Hawley J, Kantor ML. Dentists' attitudes toward chairside screening for medical conditions. J Am Dent Assoc 2010,141:52-62.

17 1609 State Oral Health/Heart Disease Grantees Minnesota - Bi-directional referrals by dentists and medical providers working in community health clinics. Primary care providers will screen patients for periodontal disease and provide referrals to dental clinics. Dental professionals will monitor patients blood pressure to identify patients with hypertension and refer to medical providers. Maryland - The Office of Oral Health and the Center for Chronic Disease Prevention will do a pilot social marketing campaign on hypertension targeting African American women in areas of with documented high health needs. Dental providers in pilot area will screen and refer for hypertension and tobacco cessation.

18 Oral Health and Obesity Prevention Role of Food in Caries Sugars and carbohydrates are metabolized by bacteria, producing acid. The acid demineralizes tooth enamel over time Caries doesn t occur without sugar Increased caries is associated with increased sugar consumption Te Morenga L, Mallard S, Mann J (2013) Dietary sugars and body weight: systematic review and meta-analysis of randomised controlled trials and cohort studies. Br Med J (Clin Res Ed). doi: /bmj.e7492

19 1609 Grantees Oral Health and the Reduction of Sugar Sweetened Beverages Alaska - The Oral Health Program and the Obesity Prevention and Control Program collaborating to train dental professionals and tribal dental providers to educate and counsel children and child caregivers to reduce child consumption of sugared beverages and promote increased consumption of water, including fluoridated water where available. The program will also seek to increase awareness and promote behavior change through public service announcements on this issue. New York - The Oral Health Program and the Chronic Disease Program will develop a healthy beverage social media campaign targeting African American and Hispanic teenage boys in Western New York. Messages will focus on the contribution of sugar sweetened beverages to chronic diseases such as obesity and tooth decay.

20 Parting Thoughts Build relationships through common goals Think about new partners commercial insurers, workplaces, community groups Be ready for opportunities Think about how you will show your impact from the start of the project

21 11 Sites 5,250 sq. miles 175,859 population

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24 2016 County Health Factors All SEK counties in bottom quartile of Kansas

25 Our Health * SEK has the highest rates of Heart disease Cancer Stroke Diabetes Asthma Depression *1 in 2 adults obese * 25% lack adequate prenatal care; *Age-adjusted death rate is 1,075 vs. state average of per 100,000

26 Our beginnings

27 CHC/SEK Designated FQHC ,000 patients to 40,000 patients 11,000 visits to 150,000 patient visits

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29 CHC/SEK Dental Program the largest safety net in Kansas

30 Outreach to Children 23,000+ children from 11 counties screened annually Area Schools, Head Starts, WIC, Child Care Facilities

31 FREE DENTAL CARE FOR VETERANS & THEIR FAMILIES WOODSON ALLEN BOURBON Outreach to Veterans and Families coming in 2017 COUNTY WILSON NEOSHO CRAWFORD Columbus MONTGOMERY LABETTE CHEROKEE

32 Early Initiatives *Blood Pressures *Blood Glucose, INR *HIV/AIDs Screening *Case Collaboration *Joint Inservices

33 MORE PROGRESS FORWARD *Joint policies & procedures *Shared provider experiences *EMR access and reminder system *Roving hygienists *Expanded provider meetings

34 FULL INTEGRATION *Medical record for all! *Hygienist embedded in medical clinic *Dental clinic connected *Dental Coordinator *Integrated Care Coordinator *Depression & Substance Abuse Screening

35 MORE TO COME *Mission Control Communication Center Coordinates Care *Common clinic design one stop appointments *Leadership Team expansion

36 QUESTIONS? CONTACT INFORMATION