Pew Children s Dental Campaign. From the Community to the Clinic: Conversations About Fluoride. William Maas, DDS, MPH, MS, The Pew Charitable Trusts

Transcription

1 Pew Children s Dental Campaign From the Community to the Clinic: Conversations About Fluoride 2014 National Primary Oral Health Conference William Maas, DDS, MPH, MS, The Pew Charitable Trusts Mary McNamara, The Pew Charitable Trusts 1

2 % Caries- Free Trends in Cavity-Free School Children (Permanent Teeth) 80% Ages 5-17 years Ages 6-19 years 70% 60% 50% 40% 37% 50% 56% 58% 30% 26% 20% 10% 0% Source: National Survey Findings 2

3 Setbacks and Rollbacks Wichita and Portland? Attempts to discontinue CWF in your community? Attempts to discontinue CWF in nearby communities (state or region)? Rollbacks are highly leveraged by opponents of CWF. 3

4 Involvement of Community Health Professionals Makes a Difference August 28,

5 The Concern: Despite water fluoridation s being used for more than one-half of a century to prevent dental caries... a considerable degree of misunderstanding remains about its purpose and effects. (Source: M.L.R. Melbye & J.M. Armfield, Journal of the American Dental Association, January 2013, Vol. 144, pp ) 5

6 The Concern: Misinformation and unsubstantiated concerns regarding water fluoridation are critical public health issues because the introduction of fluoridation frequently relies on the outcome of community consultation, or more directly on a public referendum (Source: M.L.R. Melbye & J.M. Armfield, Journal of the American Dental Association, January 2013, Vol. 144, pp ) 6

7 Dentists Role: Unfortunately, researchers in several studies have indicated that the percentage of people who obtain information about water fluoridation from dentists is quite low. (Source: M.L.R. Melbye & J.M. Armfield, Journal of the American Dental Association, January 2013, Vol. 144, pp ) 7

8 Dentists Role: Dentists have a major responsibility to convey the importance of water fluoridation. Evidence suggests that, in terms of the relative effect on individual and population oral health outcomes, dentists tend to overemphasize oral hygiene compared with use of fluorides. (Source: M.L.R. Melbye & J.M. Armfield, Journal of the American Dental Association, January 2013, Vol. 144, pp ) 8

9 Possible Barriers: Not seeing this topic as an important public health issue Needing preparation to discuss the science and/or perform an advocacy role Concerns about negative reactions from patients (Source: M.L.R. Melbye & J.M. Armfield, Journal of the American Dental Association, January 2013, Vol. 144, pp ) 9

10 What we ll cover: What CHC health professionals should know about CWF? What the public knows? How the public gets their information? How the public perceives risk? Tips for effective communication Chairside toolkit for fluoride conversations Common Questions Fluoride Safety Fluorosis Facts (parents and health professionals) August 28,

11 Fluoridation Prevents Tooth Decay U.S. Task Force on Community Preventive Services strongly recommends CWF Updated April

12 Fluoridation Works Throughout the Lifespan Fluoridation is the single most effective public health measure to prevent tooth decay and improve oral health over a lifetime, for both children and adults. --David Satcher, MD, PhD Surgeon General ( ) 11/5/

13 Fluoridation reduces tooth decay about 25% 13

14 Fluoridation still works in the U.S. even in communities where children brush with fluoridated toothpaste and get fluoride treatments at the dentist. National survey of 40,000 schoolchildren ( ): Almost all toothpaste had fluoride Twice annual fluoride treatments were common Findings: Regional data demonstrated halo effect 14

15 Fluoridation is Safe The Environmental Protection Agency (EPA) is responsible for regulating public drinking water and enforcing the Safe Drinking Water Act. The EPA does not have a position per se on the fluoridation, only on the level of fluoride in the drinking water. Fluoride occurs in U.S. water supplies at levels from 0.1 to 8.0 mg/l or parts per million (ppm). The EPA does not permit levels above 4.0 mg/l to be used for drinking water. 15

16 National Research Council has Weighed and Debated all the Evidence The EPA is guided by the National Research Council NRC, for fluoride and other issues. No findings of the 2006 NRC report question the safety of fluoride at mg/l. Know the four page Report in Brief. Future EPA action will address severe dental fluorosis, the well known adverse health effect of 2-4 mg/l, not the imagined health effects claimed by opponents. 16

17 Does Fluoride Affect IQ? August 28,

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19 August 28,

20 August 28,

21 Fluoridation is Equitable 21

22 Fluoridation is Cost-effective Every $1 invested in water fluoridation Saves $38 in unnecessary dental costs 22

23 Fluoridation is Cost-effective Fluoridation is the single most important commitment a community can make to the oral health of its children and to future generations. Dr. C. Everett Koop Surgeon General,

24 Fluorosis: Old Issue, Better Understanding Dental Fluorosis (severe) Dental Fluorosis (mild) Our better understanding enables us to make sound policy decisions, IF we can overcome the strategies and tactics of fluoridation opponents. 24

25 Conversations about Fluoride: In the Clinic or in the Community 2014 National Primary Oral Health Conference Mary McNamara, The Pew Charitable Trusts 25

26 Public Knowledge of Community Water Fluoridation 20% Well informed of fluoridation 80% Just somewhat informed or not at all informed (Source: Survey commissioned by the Pew Charitable Trusts survey, conducted in October 2010 by SalterMitchell LLC of 1,000 U.S. adults) 26

27 How do people hear about fluoride? August 28,

28 August 28,

29 Groups most likely to oppose: under age 34 men Hispanics Asians those who don t currently have CWF those who describe themselves as conservative or liberal (as distinct from middle of the road) those who report being more knowledgeable of CWF 29

30 Age Gap Respondents under the age of 35 were significantly more likely to be neutral or opposed to fluoridation compared to older respondents. Attitude Toward CWF Total Sample (n=1503) Age (n=416) Age 35+ (n=1807) Favor 44% 27% 50% Neutral 34% 40% 32% Oppose 23% 33% 19% 30

31 Tested Messages Statement (% saying makes them much more supportive of CWF) Oral health is an important part of overall health Proven public health measure supported by major medical organizations. Total (n=1503) Initially in Favor of CWF Initially Neutral Initially Opposed to CWF 44% 65% 35% 18% CWF helps prevent cavities in kids years ago Americans routinely lost all their teeth after age million American kids don t have dental insurance Benefits all by lowering healthcare costs

32 Credibility on Issues of Low Concern All other factors State Mandate 15-20% Competence/Expertise 80-85% When you have not heard the anti arguments. Believe you if you are an expert August 28,

33 Credibility on Issues of High Concern Honesty/openness 15-20% Competence/expertise 15-20% Science All other factors 15-20% Listening/caring 50% Emotion 33

34 Hazard (real risk) Versus Outrage (perceived risk) According to the World Health Organization, shark attacks typically kill 10 people a year, mosquitos kill 750-thousand people a year. August 28,

35 Perception of risk Voluntary versus Imposed Natural versus Manmade Familiar versus exotic Generated by a trusted source versus Generated by an untrusted source A Primer on Health Risk Communication Principles and Practices. U.S. Department of Health and Human Services, Public Health Service, Agency for Toxic Substances and Disease Registry August 28,

36 Fluoride refusal and vaccination Both prevent diseases Refusal of preventive care can lead to treatments that place additional strain on the health care system. August 28,

37 Fluoride refusal and vaccination 36.2% who refused immunizations also refused topical fluoride, Fluoride and vaccination refusal most prevalent 35 and younger White 4 years of college or more August 28,

38 Effective Messaging Empathy frame: Acknowledging people may have fears and concerns about fluoride helped to ease both. People get confused when they hear conflicting information, and discounting their concerns makes people defensive. Importance of authority: People are pleased to learn that recognizable organizations not only support fluoride, but have researched it. August 28,

39 What Public Health Can Learn from Parks & Rec "All I have on my side is facts and science...and people hate facts and science". -Leslie Knope August 28,

40 What Public Health Can Learn from Parks & Rec Science, facts, and reason are not always enough to change public attitudes and behaviors. Language matters Keep trying August 28,

41 Introducing the Chairside Fluoride Toolkit Joint project of NNOHA and the American Academy of Pediatrics Available for download at ILikeMyTeeth.org Common Questions about Fluoride Fluoride Safety: Guide for Health Professionals Fluorosis Facts: Guide for Health Professionals Fluorosis Facts: Guide for Parents/Caregivers Say This, Not That AAP Clinical Report, Fluoride Use in Caries Prevention in Primary Care Settings, will be released August 25. August 28,

42 August 28,

43 Chairside Tools August 28,

44 Chairside Tools August 28,

45 Chairside Tools August 28,

46 Keep informed of these and other oral health issues by receiving Pew's monthly e-newsletter Dental News & Views. Send an to with the words Sign me up in the subject line. August 28,