10/4/2016 NEBRASKA STATE ORAL HEALTH ASSESSMENT 2016

Transcription

1 NEBRASKA STATE ORAL HEALTH ASSESSMENT 2016 Dr. Charles F. Craft Dental Health Director Office of Oral Health Division of Public Health Nebraska Health and Human Services SILENT EPIDEMIC OF ORAL DISEASE IN THE UNITED STATES 2000 WITHOUT GOOD ORAL HEALTH, YOU ARE NOT HEALTHY PROFOUND DISPARITIES EXIST AMONG CERTAIN POPULATIONS 2.7 TRILLION SPENT ON HEALTH CARE 2011 $110 BILLION (4%) SPENT ON DENTAL CARE IN MILLION PEOPLE DID NOT VISIT DENTIST IN 2010 AMERICA IS IN A DENTAL CRISIS: AMERICAN DENTAL ASSOCIATION

2 200,000 DENTISTS IN THE UNITED STATES 80% ARE GENERAL DENTISTS 20% ARE SPECIALISTS 5% ARE IN PUBLIC HEALTH MAJORITY OF PATIENTS GO TO PRIVATE OFFICES UNDERSERVED GROUPS INCLUDE: RURAL RESIDENTS, LOW INCOME, MINORITIES, DISABLED, YOUNG CHILDREN, ELDERLY, VETERANS, AND NEW IMMIGRANTS/REFUGEES STATE DENTAL PROGRAMS: CRITICAL TO THE SUCCESSFUL IMPLEMENTATION AND COORDINATION OF PREVENTIVE SERVICES, EDUCATION AND ACCESS TO CARE TO HELP BRING HEALTH EQUITY TO ALL AMERICANS. 2

3 DENTAL DATA AND SURVEILLANCE SOURCES NATIONAL HEALTH AND NUTRITION SURVEY CDC DIVISION OF ORAL HEALTH CDC CHILDREN S ORAL HEALTH AMERICAN DENTAL ASSOCIATION NATIONAL ORAL HEALTH SURVEILLANCE SYSTEM NATIONAL SURVEY OF CHILDREN WITH SPECIAL NEEDS COUNCIL OF STATE AND TERRITORIAL EPIDEMIOLOGISTS NEBRASKA ADULT BEHAVIOR RISK FACTOR SURVEY NEBRASKA YOUTH RISK BEHAVIOR SURVEY 2005 NEBRASKA THIRD GRADE DENTAL SURVEY UNMC HEALTH PROFESSIONAL TRACKING SERVICE NEBRASKA MEDICAID AND LONG TERM CARE NEBRASKA HOSPITAL ASSOCIATION NEBRASKA SMOKELESS TOBACCO SURVEY NEBRASKA CANCER REGISTRY NEBRASKA ANNUAL KIDS COUNT REPORT HEALTHY PEOPLE ,200 OBJECTIVES,42 PUBLIC HEALTH AREAS, 26 LEADING HEALTH INDICATORS, 12 TOPICS ORAL HEALTH LISTED FOR FIRST TIME 2010 PROGRESS ON ALL EXCEPT MENTAL AND DENTAL

4 National Healthy People Dental Objectives Nebraska Healthy People Dental Objectives U.S. BASELINE U.S. TARGET NE BASELINE NE TARGET OH-1 Decrease dental caries experience: Child Age % Age % 49.0% 59.3% 53.4% Age % 48.3% OH-2: OH-3: Decrease untreated dental decay: Child Age % 21.4% Age % 25.9% 17.0% 15.3% Age % 15.3% Decrease untreated dental decay: Adult Age (any surface) 27.8% 25.0% Age (coronal caries) 17.1% 15.4% Age 75+ (root surface caries) 37.9% 34.1% OH-4: OH-5: Decrease tooth extractions: Adult years (single due to caries or perio) 76.4% 68.8% 47.7% 45.3% years (all teeth) 24.0% 21.6% 11.3% 10.7% Decrease moderate or severe periodontitis years 12.8% 11.5% OH-6: Increase early detection of oral cancer 32.5% 35.8% OH-7: Increase access oral health care system/year 44.5% 49.0% 67.6% 71.0% OH-8: Increase low-income children to preventive care 30.2% 33.2% 50.4% 55.4% OH-9: Increase school-based health centers with Dental sealants 24.1% 26.5% Dental treatment care 10.1% 11.1% Topical fluorides 29.2% 32.1% OH-10: INCREASE ORAL HEALTH PROGRAMS IN: FQHCs 75% 83% Local health departments 25.8% 28.4% OH-11: Increase FQHC # of dental patients/year 17.5% 33.3% 21.0% 31.6% OH-12: Increase # of dental sealants on molar teeth 3-5 years (primary) 1.4% 1.5% 6-9 years (permanent) 25.5% 28.1% 45.3% 47.6% years (permanent) 19.9% 21.9% OH-13: Increase community water fluoridation 72.4% 79.6% 68.2% 75.4% OH-14: Increase adults receiving preventive intervention Tobacco cessation Oral cancer screening Glycemic control DNA DNA DNA OH-15: Increase state recording of cleft lip and palates Recording system Referral system DNA DNA OH-16: Increase states with dental surveillance systems 32 states 51 states/dc OH-17: Increase dental programs directed by dental professional with public health training. Local agencies > 250,000 pop l 23.4% 25.7% IHS/Tribal > 30,000 pop l 11 programs 12 programs STATEWIDE HEALTH NEEDS ASSESSMENT 2013/2016 NEBRASKA HEALTHY PEOPLE NEBRASKA STATE HEALTH IMPROVEMENT PLAN DHHS DIV. OF PUBLIC HEALTH ACCREDITATION

5 77,353 SQUARE MILES 1,868,516 PEOPLE 93 COUNTIES 2/3RDS LIVE IN 13 METRO COUNTIES OMAHA/LINCOLN/GRAND ISLAND U.S. DENTAL DISEASE ACROSS THE LIFESPAN 1/3 OF CHILDREN 0-5 HAVE EXPERIENCED DECAY 1/2 OF YOUTH 6-15 HAVE EXPERIENCED DECAY 90% OF ADULTS HAVE EXPERIENCED DECAY 75% OF ADULTS HAVE HAD TOOTH EXTRACTION 1/4 OF ADULTS HAVE HAD ALL TEETH EXTRACTED U.S. Decay Rates Child and HP2020 Objectives OH-1 and OH % 33.30% 30.00% 30% 25.00% 20.00% 23.8% 21.4% 15.00% 10.00% 5.00% 0.00% Children age 3 5 year old had a history of dental decay Children age 3 5 year old had untreated decay US Baseline HP Target U.S. CHILDREN 0-5 EARLY CHILDHOOD CARIES HOSPITAL OPERATION ROOM COSTS FIRST NE. HS SURVEY

6 NEBRASKA Youth Decay Rates Age 6-18 Compared to U.S. Baseline and HP2020 Objectives OH-1 and OH % 60.0% 50.0% 54.4% 49.0% 59.3% 40.0% 28.8% 25.9% 20.0% 17.0% 10.0% 0.0% History of Dental Decay Untreated Dental Decay US baseline HP2020 target NE 3rd Grade Survey 2005 U.S. /NE. YOUTH 6-18 NEED PROPER ORAL HYGIENE HIGH SUGAR IN DIET NEW NE. 3 RD GRADE SURVEY U.S. Adult Age with Untreated Decay and HP2020 Objective OH % 28.0% 27.8% 27.5% 27.0% 26.5% 26.0% 25.5% 25.0% 25.0% 24.5% 24.0% 23.5% US Baseline HP2020 Target U.S. ADULTS WORKING CLASS CARIES EXPERIENCE 80-90% 90.0% NEBRASKA Adult Permanent Tooth Extractions Compared to U.S. and HP2020 OH % 76.4% 70.0% 68.8% 60.0% 50.0% 47.7% 45.3% 40.0% 20.0% 10.0% 0.0% US Baseline HP2020 Target NE Baseline NE Target U.S./NE. ADULT TOOTH EXTRACTIONS BRFSS SURVEY DATA 6

7 NEBRASKA Age With All Teeth Extracted Compared to U.S. Rate and HP2020 OH % 24.0% 21.6% 20.0% 15.0% 10.0% 11.3% 10.7% 5.0% 0.0% US Baseline HP2020 Target NE Baseline NE Target U.S. ELDERS 65+ FASTED GROWING POPULATION MEDICAL ISSUES/TRANSPORTATION FUTURE NE. OLDER ADULT SURVEY 2017/2018 Severe Gum Disease Age and HP2020 Target in U.S % 47.50% 47.00% 46.00% 45.00% 44.00% 43.00% 42.80% 42.00% 41.00% 40.00% U.S. Baseline HP2020 Target U.S. ADULTS PERIODONTAL DISEASE DIFFICULT TO MEASURE NEBRASKA VULNERABLE POPULATION GROUPS 7

8 NEBRASKA RURAL RESIDENTS Rural Residents' Oral Health Status Compared to Urban Residents in NE 80.0% 70.0% 72.7% 73.7% 62.9% 65.1% 60.0% 50.0% 40.0% 46.1% 35.6% 20.0% 18.0% 14.4% 10.0% 0.0% All permanent teeth extracted, Adults 65+ Any permanent tooth Teeth cleaned in past 12 Dental visit for any reason extracted months in past 12 months Rural Urban ONE THIRD RURAL.OVER 600,000 PEOPLE HALF OF STATE IS A DENTAL SHORTAGE AREA 20 COUNTIES HAVE NO FULL TIME DENTIST RURAL / URBAN POPULATION SHIFTING NOW Number of Dentists in Rural and Urban Counties, Nebraska Percentage of Dentists 70.0% 61.3% 60.5% 61.0% 61.3% 60.8% 60.0% 50.0% 38.7% 39.5% 39.0% 38.7% 39.2% 40.0% 20.0% 10.0% 0.0% Year Rural Urban 8

9 LOW INCOME AND UNINSURED % OF WORKING CLASS W/O HEALTH INSURANCE TWO TIMES AS MANY WITHOUT DENTAL INSURANCE ABOUT 350,000 NEBRASKANS W/O DENTAL BENEFITS ACA HAS LOWERED HEALTH % BUT DENTAL ONLY FOR CHILDREN MANY PEOPLE TURN TO SAFETY NET SYSTEM FOR EPISODIC CARE FEWER PEOPLE HAVE ESTABLISHED DENTAL HOMES The Comparison of Oral Health Status Between Low and High Income Families among Nebraska Youth 2005 Oral Health Status Comparison among NE Residents Age 18+ by Income Level 79.5% 81.2% 80.0% 70.0% 60.0% 50.0% 47.8% 70.0% 52.2% 48.0% 46.9% 59.6% 53.4% 53.1% 40.0% 20.0% 10.0% 12.8% 21.4% 7.7% 29.8% 12.7% 30.2% 27.8% 0.0% Caries Free Caries Experience Untreated Decay Rampant Caries Needing Dental Sealants Treatment 5.9% All permanent teeth Any permanent tooth Teeth cleaned in past Dental visit for any extracted, Adults 65+ extracted 12 months reason in past 12 months <25.0% of students participating in FRL Program >75% of students participanting in FRL Program Less than $15K $50K and more Nebraska Hospital Dental ER Visits and Costs #8652 #[VALUE] #[VALUE] #7853 $7.92 #7361 $6.81 #6537 #6710 $6.68 #5654 $5.83 $5.09 #4829 #4979 #4548 $4.16 $3.43 $2.55 $1.93 $1.43 $ Total cost per million Total ER dental visits 9

10 Nebraska Minority Access to Dental Care 70.2% 71.5% 68.3% 66.8% 59.1% 61.4% 55.5% 59.2% 55.5% 58.9% Teeth cleaned in past 12 months Any dental visit in past 12 month White Asian African American Hispanic Native American NEBRASKA MINORITIES 19.5%, 350,000 PEOPLE HISPANIC LARGEST POPULATION 10% EXPECTED TO INCREASE TO 20% IN 2050 NATIVE AMERICANS 3-5 TIMES U.S DISEASE RATE Nebraska Minority Adult Tooth Extraction Status 55.4% 50.9% 41.7% 38.9% 24.8% 26.5% 23.1% 13.5% 15.9% 8.4% Had ANY permanent teeth Had ALL permanent teeth extracted extracted African American Native American Hispanic White Asian Nebraska Children with Disability Preventive Dental Care Need Compared to U.S. Nebraska Children with Disability Other Dental Care Needs Compared to U.S. 95.0% 90.0% 85.0% 80.0% 75.0% 81.1% 85.2% 89.6% 2005/ /10 U.S. NE 91.7% 29.0% 28.0% 27.0% 26.0% 25.0% 24.0% 23.0% 22.0% 24.2% 26.4% NEB PEOPLE WITH DISABILITY NEEDS OVER 10% WITH ONE OR MORE DISABILITIES MORE THAN 200,000 PEOPLE PHYSICAL BARRIERS / COMMUNICATIONS CHALLENGES TO ORAL HYGIENE DIFFICULT TO FIND TRAINED PROVIDERS 26.7% 2005/ /10 U.S. NE 28.4% NEBRASKA 140,000 VETERANS 9,500 RESERVE AND NATIONAL GUARD 8,000 ACTIVE DUTY 5,500 OEF/OIF VETERANS MUST QUALIFY FOR DENTAL BENEFITS 10

11 NEBRASKA IMMIGRANTS AND REFUGEES 115,000 LEGAL 45,000 UNDOCUMENTED 1,300 NEW REFUGEES IN 2015 HIGHER DENTAL NEEDS CULTURE / HEALTH LITERACY CHALLENGES 12.0% 10.0% 8.0% 6.0% 4.0% 2.0% 0.0% Nebraska Youth Smokeless Tobacco Use 10.3% 8.3% 9.0% SMOKELESS TOBACCO USE SMOKING GOING DOWN SMOKELESS STEADY 9 MILLION USERS IN US 75K IN NEBRASKA 400,000 AGE ATHLETES TARGETED $450 MILLION SPENT BY COMPANIES TO PROMOTE 6.6% % 10.0% 8.0% 6.0% 4.0% 2.0% 0.0% 3.2% Nebraska Adult Smokeless Tobacco Use 4.1% 3.7% 4.8% 4.3% 3.7% 4.8% ORAL AND PHARYNGEAL CANCER 28 KNOWN CARCINOGENS 12 TH LEADING CAUSE OF CANCER U.S. 30,000 NEW CASES EACH YEAR U.S. 8,000 DEATHS PER YEAR NE. CLEFT LIP AND PALATE REGISTRY 11

12 Nebraska Pregnant Woman Dental Visit Status by Race 100.0% 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 20.0% 97.1% 89.6% 88.8% 83.0% 76.3% 50.4% 42.5% 38.9% 38.2% 37.7% 32.7% 32.7% 34.1% 31.5% 31.4% Teeth Cleaning During Pregnancy Teeth Cleaning After Pregnancy Histroy of Tooth Cleaning NEBRASKA PREGNANT WOMEN 25,000 NEW BIRTHS PER YEAR PRAMS PREVENTIVE CARE MOTHER ORAL HEALTH NEW BORN COUNSELING White Hispanic Asian/Pacific Islander African American Native American DHHS ORAL HEALTH MISSION GOAL: TO ACHIEVE BETTER ORAL HEALTH AND OVERALL HEALTH FOR ALL NEBRASKA POPULATIONS ACROSS THE LIFESPAN. NEBRASKA ORAL HEALTH FOCUS AREAS #1- PUBLIC POLICY / OH WORKFORCE CAPACITY #2- ENHANCE DENTAL DISEASE SURVEILLANCE #3- INCREASE CARE ACCESS AND REDUCE DISPARITIES #4- EXPAND COMMUNITY PREVENTION PROGRAMS #5- PROMOTE ORAL HEALTH AND LITERACY STATEWIDE 12

13 DHHS OOHD STATE AND FEDERAL FUNDING SOURCES GOAL#1: OH WORKFORCE CAPACITY LICENSED DENTISTS IN NEBRASKA 1350 LICENSED DENTAL HYGIENISTS 100 PUBLIC HEALTH HYGIENISTS 120 COMMUNITY HEALTH WORKERS 65 DENTAL SCHOOLS 4500 GRADUATES 145 PER YEAR IN NEBRASKA UNMC COLLEGE OF PUBLIC HEALTH 2012 OVER 1,450 LICENSED DENTISTS 2012 ONLY 1,030 WERE ACTIVE 50% WORK PART TIME 26% ARE APPROACHING RETIREMENT 13

14 Nebraska Baseline OH Surveys 1. Collection of Information 6. Evaluation 2. Establish Long-term Goals Planning Cycle 5. Implement Programs 3. Specific Objectives 4. Strategic Planning OH Needs Assessment State Oral Health Action Plan GOAL#2: ENHANCED STATE DENTAL SURVEILLANCE STATES COLLECT BASIC SCREENING SURVEY DATA ON CHILDREN AND ELDERS 2005 NEB THIRD GRADE DENTAL SURVEY 60% HISTORY OF CARIES EXPERIENCE/17% ACTIVE DECAY/55% SEALANTS STATEWIDE HEAD START AND THIRD GRADE SURVEY 100 SITES, 6000 STUDENTS, OVERSAMPLE OMAHA AND WESTERN NEBRASKA OLDER ADULT SURVEY TO BE DESIGNED IN

15 Adult Nebraska and US Dental Visit per 12 months. 78.0% 76.0% 74.0% 72.0% 70.0% 68.0% 66.0% 64.0% 80.0% 75.0% 70.0% 65.0% 60.0% Adult Nebraska and US for dental cleaning per 12 months. 62.0% 55.0% NE U.S. NE U.S. CDC/ADA REPORT LOWER RATES 45% FOR ALL AGES GOAL #3: INCREASE ACCESS TO PH CARE FOR VULNERABLE GROUPS OVER 225,000 NEBRASKA MEDICAID/CHIP ENROLLED 150,000 CHILDREN UNDER AGE 18 NEED TO INCREASE EPSDT PREVENTIVE SERVICES NEB MEDICAID HAS ADULT DENTAL BENEFITS NEED TO INCREASE OLDER ADULT ACCESS TO CARE Nebraska Medicaid and CHIP Average Monthly Number of Eligible Persons by Fiscal Year 300, , , , , , , , , , , ,497. Total Children 136, , , , , ,413. Total Children Nebraska Children 0-18 EPSDT Preventive Dental Service 60.0% 50.0% 40.0% 49.3% 44.2% 45.3% 46.5% 35.2% 33.3% 34.6% 36.2% 20.0% 10.0% 0.0% NE US COMMUNITY HEALTH CENTERS (FQHCS) ALL HAVE CLINICAL DENTAL PROGRAMS People s Health Center Lincoln One World South Omaha Charles Drew North Omaha Good Neighbor Columbus Heartland Grand Island Midtown Norfolk CAPWN of Western Nebraska 15

16 GOAL#4: INCREASE COMMUNITY PREVENTION PROGRAMS 20 LPHDS 45% HAVE DENTAL PROGRAMS NOW THAT UTILIZE EVIDENCE BASED PREVENTION SERVICES US-NE Fluoride Status and Goals 85.00% 80.00% 75.00% 72.40% 79.60% 75.4% 70.00% 68.2% 65.00% 60.00% 55.00% 50.00% US Baseline HP2020 Target NE Baseline NE Target NE COMMUNITY WATER FLUORIDATION OVER ONE MILLION HAVE ACCESS GI, HASTINGS, BEATRICE NO FLUORIDE 16

17 How Nebraska Youth Compare to US baseline and HP2020 Objective on Dental Sealants 60.0% 50.0% 45.3% 49.8% 40.0% 20.0% 25.5% 19.9% 28.1% 21.9% 10.0% 0.0% US baseline for age 6 9 US baseline for age NE baseline from 3rd Grade Survey HP2020 target for age 6 9 HP2020 target for age NE target OOHD Funds Five OHAYC Communities Target is Low Income Age 0-5 OOHD FUNDS ENDURING SMILES PROJECT IN PARTNERSHIP WITH UNMC DENTAL COLLEGE OVER 50 DENTAL HYGIENISTS TRAINED IN ELDER CARE OVER 50 SENIOR CENTERS CAREGIVER SESSIONS EDUCATIONAL CDS SENT TO OVER 300 FACILITIES 17

18 GOAL #5: PROMOTE DENTAL EDUCATION AND OH LITERACY CONNECT ORAL TO TOTAL HEALTH IMPROVE CULTURAL COMPETENCY UTILIZE COMMUNITY HEALTH WORKERS ADA Campaign 12,000 OH Kits to NE Head Start sites ,000 Dental Starter Kits NE. Early Development Network Early Head Start/Sixpence/N-MIECHV OOHD PARTNERS ON STATEWIDE ORAL HEALTH CAMPAIGNS DENTAL SAFETY NET SYSTEM Sharing Clinic Nights Children s Dental Day Panhandle Dental Days Grand Island Extraction Clinics One World Nights Give Kids a Smile Special Olympics Special Smiles St. Francis Indian Mission 18

19 COMMUNITY CHARITY CLINICS MISSION OF MERCY PEOPLES CITY MISSION OPEN DOOR MISSION 1,788 Value and Number of Patients Served by MOM in Nebraska 1,393 1,427 1,478 $ $638.9 $ ,065 $571.5 $608.6 $ $ , $554.7 $425.6 Third City Community Clinic Clinic with a Heart Fred Leroy Health Clinic North Platte Grand Norfolk Mitchell Omaha Lincoln Grand Alliance Lincoln 2005 Island Island Cost of Care ($1000) Number of Patient HRSA ORAL HEALTH WORKFORCE GRANT Nebraska one of eight states to be awarded Two Year 500,000 Grant Work with 7 Local Health Departments in HPSAs Partner PH RDHs with CHWs Form Community Dental Disease Prevention Teams Utilize portable equipment to increase access to care Increase educational/preventive services to young and old Survey Nebraska Dental Hygienists Epi. position to set up surveillance system framework FUTURE VISION: TO HAVE ALL PARTS OF THE NEBRASKA DENTAL HEALTH SYSTEM (PRIVATE/PUBLIC AND CHARITY) COLLABORATE TO IMPROVE DENTAL HEALTH FOR ALL OF OUR STATE CITIZENS. 19

20 15 YEARS AFTER SG REPORT SOME STATES HAVE MADE PROGRESS BUT IT IS SLOW. THE SCIENCE SAYS.. IF ALL WE DO IS PUT ON FLUORIDE AND SEALANTS IT WOULD MAKE A SIGNIFICANT DIFFERENCE IN REDUCING DENTAL DECAY. WE NEED TO GET THIS MESSAGE OUT TO THE PUBLIC AND LEGISLATURES SO PEOPLE CAN UNDERSTAND THAT DAVID SATCHER MD 2015 The test of our progress will not be whether we add more to the abundance of those who have much, it is whether we provide enough for those who have too little President Franklin D. Roosevelt Dr. Charles F. Craft charles.craft@nebraska.gov # Jessica O. Ball jessica.o.ball@nebraska.gov # Performance Dashboard Health Promotion Unit Page: 20