WELCOME TO ORAL HEALTH BOOT CAMP II. Stonewall Jackson Resort, Roanoke WV June 15 & 16, 2016

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1 WELCOME TO ORAL HEALTH BOOT CAMP II Stonewall Jackson Resort, Roanoke WV June 15 & 16, 2016

2 BOOT CAMP noun : a camp where people who have recently joined the U.S. Army, Navy, or Marine Corps receive their basic training : a short but very difficult training program : a program or situation that helps people become much better at doing something in a short period of time

3 PURPOSE To build alignment with the Statewide Grassmiddles Organizations, Local Community Level Oral Health Coalitions and the WV Oral Health Coalition, and bring together a unified team focused on a path forward toward realizing the 2020 vision: To improve oral health across the lifespan and eradicate dental disease in children.

4 WELCOME YEAR 2 GRASSMIDDLE GRANTEES WV Long Term Care Partnership Cabell County FRN WV Dental Hygienists Association WV Head Start Association

5 ICE BREAKER

6 CHOICE TO STEP INTO THE ARENA- It is not the critic who counts; not the man who points out how the strong man stumbles, or where the doer of deeds could have done them better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood; who strives valiantly; who errs, who comes short again and again, because there is no effort without error and shortcoming; but who does actually strive to do the deeds; who knows great enthusiasms, the great devotions; who spends himself in a worthy cause; who at the best knows in the end the triumph of high achievement, and who at the worst, if he fails, at least fails while daring greatly, so that his place shall never be with those cold and timid souls who neither know victory nor defeat. -Theodore Roosevelt, Paris, France, April 23, 1910

7 THANK YOU FOR AGREEING TO BE A LEADER AROUND ORAL HEALTH. YOUR CHARGE OVER THE NEXT DAY AND HALF- Increase our knowledge about oral health Return to your local community with a plan Develop a deeper connection with the WV Oral Health Network

8 When we change the conversation, we change the future. -Juanita Brown This is why we have YOU here! Changing the conversation by including each of you! And expecting you to move the conversation forward.

9 This project is funded by the DentaQuest Foundation Specific oral health targets, with particular aims, objectives and goals. In conjunction with Claude W. Benedum Foundation

10 EQUITY

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14 ORAL HEALTH EQUITY Currently, the oral health provisions in health care reform that stand to provide dental coverage for 5.3 million underserved and uninsured children are not funded. Also unfunded are school oral health education programs, state sealant programs, and workforce expansion projects. The health care reform law is funded through Congress appropriations process. Think About it.. Dental Coverage for All...Everyone has a toothbrush....all Dentist Accept Medicaid What issues still remain?

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16 Oral Health 101 The Basics Ashley Logan, MU Staff/Regional Oral Health Coordinator

17 Oral Health 101 Poor Oral Health impacts Overall Health and Well Being The single most common chronic childhood disease is dental caries. Social/economic impact - 51 million school hours are lost each year to dental-related illness. The most common dental diseases (dental cavities and periodontal disease) are preventable!!

18 HIGHLIGHTS FROM THE US SURGEON GENERAL S REPORT Oral Infection is associated with Diabetes, Heart Disease, Stroke, Bacterial Endocarditis, Respiratory Disease and adverse Birth Outcomes Psycho-Social Implications: Reduced Self-Esteem, Job eligibility

19 UNTREATED CAVITIES CAN LEAD TO. Extreme Pain Spread of Infection Difficulty chewing, poor nutrition, below average weight Costly dental treatment Additional decay and malocclusion in permanent dentition Consequences of untreated Decay in the School Aged Population : Missed School Days Impaired Speech development Inability to Concentrate Reduced Self-esteem

20 Boy Dies After Bacteria From Tooth Spread to Brain Source: Washington Post, February 28, 2007, Page B01, Mary Otto

21 A SILENT EPIDEMIC

22 The Reality

23 ETIOLOGY OF DENTAL DECAY

24 FROM HEALTHY TO DISEASE Healthy Diseased

25 DENTAL PLAQUE - WHAT IS IT? Plaque is a sticky film of food, saliva, and germs. Plaque loves to settle at the gum line. The goal of your daily tooth brushing and flossing is to clean away plaque. When plaque is not removed, it hardens into tartar.

26 From Gingivitis to Gum Disease Bacteria multiply and multiply and multiply some more. Gums separate from the teeth, forming pockets. Often, this destructive process has very mild symptoms. Eventually, teeth become loose, leading to extractions.

27 WARNING SIGNS AND SYMPTOMS Bleeding gums when you brush or floss is not normal; even if your gums don t hurt, get them checked Red, swollen, or tender gums Gums that have pulled away from teeth making teeth appear longer Pus between the teeth and gums Bad breath Teeth that are loose or moving away from each other Changes in the way you bite Changes in the fit of partials, dentures, or bridges

28 HOW TO TAKE CARE OF YOUR TEETH Brush and brush often 3 X day/after every meal Floss the teeth you want to keep Visit your dentist Avoid food & drinks high in sugar Don t use your teeth as a tool

29 What about West Virginia? Decay index is 59% higher than national average for school-aged children -38% have untreated decay (66% have decay by age 8) 1 of 5 Medicaid covered children receive a single dental visit each year 84% of WV youth have dental cavities by high school graduation WV leads the nation in edentulous adults (adults with no natural teeth)

30 HISTORY OF ORAL HEALTH IN WV No State dental plan -No School Sealant Program -Limited Scope of Practice for RDH -Less than.5 FTE Dental Director - F on Report Card -Worst in the Nation No Data to Prove Otherwise 2007 Death of a Child in MD Legislative Study Examines OH Crisis in WV -WV Not Eligible for Federal Funds -Seed Money and Huge Oral Health Movement within WV ] ] WV Oral Health Advisory Created - SCOH School Project ARC/Benedum & Marshall Partnership -Public Health Supervision and General Practice State Oral Health Plan Development -Expansion of Oral Health Activities -1 st ever statewide Oral Health Surveillance -DHHR Leadership Supports Oral Health ] ] ] ] State Oral Health Plan -Schoolbased Sealant Program in 26 Counties -Oral Health Coalition -Fulltime Dental Director -DentaQuest Grant - C on Report Card Present -Expansion of OH Activities -Over 36 Grantees for Schoolbased OH -State Surveillance Plan -Funding HRSA, CDC, etc. -Mandate School OH Exam -Plethora of Positive OH Movement YOU!!!

31 QUESTIONS? DISCUSSIONS? COMMENTS?

32 3Targeted Best Practices Wendy Mosteller, RDH Regional Oral Health Coordinator Region II Gina Sharps, MPH, RDH Regional Oral Health Educator Marshall University

33 best practice Noun WHAT IS AN EBP? Definition of BEST PRACTICE a procedure that has been shown by research and experience to produce optimal results and that is established or proposed as a standard suitable for widespread adoption Examples Time

34 EVIDENCE BASED PRACTICES (EBP) Fluoridation Interventions Community Water Fluoridation (CWF) Fluoride Rinse Program (FRP) Fluoride Varnish Program (WV Cavity Free by 3) Age 1 Dental Visit Dental Sealants

35 WHO DECIDES ON EBP?

36 NATIONAL >>> STATE STRATEGIES TO ADDRESS EBP

37 COMMUNITY WATER FLUORIDATION IN WV

38 WHAT IS FLUORIDATION? Fluoridation is the adjustment of the fluoride in drinking water to the optimal level for reducing tooth decay

39 3 KEY MESSAGES Fluoridation is a community health measure that benefits people of all ages. Fluoridation is safe and is supported by credible scientific evidence. Fluoridation is both cost effective and cost effective.

40 FLUORIDE Fluorite (from which Fl is derived) is the 13 th most abundant element and is naturally released into water Small amounts of fluoride are found naturally in most foods and varying amounts in water. Not all communities have sufficient naturally occurring fluoride

41 One of ten great public health achievements of the twentieth century (CDC) Water fluoridation has nearly a 70 year history of success Water fluoridation has both topical and systemic benefits Fluoride is a vital mineral for proper bone and tooth formation

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43 AWWA POLICY STATEMENT

44 WV PUBLIC WATER SYSTEMS LEGISLATIVE RULE (64CSR3), SECTION 8.1 States: Average concentrations of fluoride present in the drinking water of a public water system which artificially adjusts fluoride levels shall be no less than 0.5 milligrams per liter and no higher than 0.9 milligrams per liter. The optimum level for artificially adjusted fluoride is 0.7 milligrams per liter.

45 FLUORIDATION IS EFFECTIVE Fluoridation reduces tooth decay about %

46 FLUORIDATION IS EFFECTIVE Fluoridation reduces tooth decay about 25%

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

48 SCIENTIFIC ILLITERACY Alarming allegations/junk science can drive public policy Its really terrifying the scientific illiteracy that supports these suspicions - Dr. Marie McCormick, Institute of Medicine, 2004

49 Organized anti-fluoride activists Relatively small group with strong internet presence Distort research Misrepresent others views Ignore scientific evidence Spread fear and misinformation

50 CWF ROLLBACK CHALLENGES #1-Clarksburg Water Board (3 members), Sept 2013 *opposition led by 1 consumer/fan, based on junk science #2-New Cumberland, October 2013 *opposition based on cost savings #3-Martinsburg, December 2013 *opposition led by 1 consumer,based on junk science #4-Keyser Water Board, January 2014 *opposition led by Water Plant Supervisor, Mayor, City Administrator, based on cost savings and personal freedom #5-Beech Bottom, discontinued 2014 #6-Sugar Creek PSD in Braxton County, discontinued 2014

51 ANTI-FLUORIDATIONISTS CLAIM THAT FLUORIDE CAUSES ADVERSE HEALTH EFFECTS Kidney disease Down syndrome Cancer Reduces IQ Reduced cognitive function Immune disorders Acute Toxicity Skeletal Fluorosis Infertility Cardiovascular disease Anti-fluoride activists make many claims of adverse health effects Arthritis Endocrine disruption Fractures Diabetes Thyroid disease Alzheimer s disease Osteoporosis

52 FACT: THESE CLAIMS ARE UNFOUNDED Studies have repeatedly investigated potential adverse health impacts of fluoridation This research has found no evidence of a link between fluoride and any major negative health outcome

53 PROACTIVE/REACTIVE STRATEGIES: UNIFYING EFFORTS BEHIND THE SCIENCE 1. Educational initiatives -Information flier highlighting benefits of CWF 2. Statewide response plan >>>>Goal is to efficiently manage challenges 3. Utilizing state/federal oral health resources

54 Who s Missing???

55 Rapid Response Alert issued via WV Oral Health Coalition E-Blast

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57 GOOD WEBSITES TO DIRECT STAKEHOLDERS The Campaign for Dental Health is a coalition of organizations. The coalition and its website are managed by the American Academy of Pediatrics. This is the Centers for Disease Control and Prevention s resources related to community water fluoridation. There are a lot of helpful materials, including FAQs.

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59 AND HERE S A GOOD RESOURCE FOR YOU Fluoridation Facts A booklet produced by the American Dental Association It contains nearly 70 pages that provide detailed, science-based answers to questions that may be asked about community water fluoridation ashx

60 WV FLUORIDE MOUTHRINSE PROJECT

61 WHY IMPLEMENT A FLUORIDE RINSE PROJECT? Children who were at a higher risk of dental caries include those who have little exposure to fluoride, low income, poor diet FMR programs have been shown to reduce the number of cavities by 35% when implemented regularly

62 WV FLUORIDE MOUTHRINSE PROJECT FMR Project is for 30 weeks (rinsing 1x per week) and is voluntary Parental permission is needed All supplies are provided by the OHP free of charge No longer has to be sole responsibility of school nurse

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64 WHAT IS FLUORIDE VARNISH? Is a highly concentrated form of fluoride which is applied to the tooth's surface as a type of topical fluoride therapy. Applying fluoride varnish is to retard, arrest, or reverse the process of tooth decay in children at high to medium risk for dental caries. Studies have shown 25-45% reductions in the decay rate with the use of fluoride varnish. Suitable for infants and young children WV Cavity Free by Three: Fluoride Varnish Manual for Health

65 West Virginia Cavity Free by Three Goal of the program is to reduce Rates of Cavities (Early Childhood Caries)

66 PROGRAM GOALS Improve the oral health of children under 3 years old covered by Medicaid or CHIP Ensure medical health care providers are trained and reimbursed for providing care Ensure child is referred to a dentist to establish a Dental Home Increase the number of dentists willing to accept this age group for dental care

67 Why Primary Care Providers (PCP)? A child interacts w/their PCP an average of 11x by the age of 3 vs. 1x with their DDS by the age 3 Only 3% of 1-2 year old children in WV access preventive services provided by dentists/dental hygienists. 89% of infants and 1-year-olds had office-based physician visits annually, compared with only 1.5% who had dental visits.

68 PROGRAM DETAILS Providers Primary care MDs and NP Ancillaries- PA, RN, LPN, MCA under direct supervision Care oral health evaluation, caries risk assessment, anticipatory guidance, fluoride varnish application,dental referral Ages- under 3 years old Frequency twice per year (1 at EPSTD) Online training CE program with CME credit. Must pass test. For all medical/dental professionals in program. Recertification by online training done every 3 yrs

69 WHAT DOES THE PROGRAM LOOK LIKE? Care Oral health evaluation Caries risk assessment, anticipatory guidance Fluoride varnish application Dental referral

70 TARGET GROUP Suitable for infants and young children Apply to children at-risk of tooth decay, beginning with first tooth. Apply 2-4 times/year for maximum benefit. Can apply varnish on the same schedule as childhood immunizations. WV Cavity Free by Three: Fluoride Varnish Manual for Health

71 BARRIERS How to deliver this product to infants and preschool children before they develop ECC. Lack of education with parents and both medical/dental personnel Insurance reimbursement WV Cavity Free by Three: Fluoride Varnish Manual for Health

72 Early intervention to provide examination, risk assessment, and guidance to prevent disease. AGE 1 DENTAL VISIT

73 AGE 1 DENTAL VISIT The academies of the American Dental Association (ADA), the American Academy of Pediatric Dentistry (AAPD), and the American Association of Pediatrics (AAP) all recommend that a child visit the dentist for the first time 6 months after the eruption of the first tooth or by age one, whichever comes first.

74 IMPORTANCE OF AGE 1 DENTAL VISIT The single most common chronic childhood disease is dental caries. Social/economic impact -51 million school hours are lost each year to dental-related illness. One of the single most expensive uncontrolled diseases of childhood exceeding 12 billion dollars Dental cost 40% lower in the 1stfive years of life for those children who have had an age 1 dental visit

75 Knee-to-Knee Technique

76 BARRIERS All of the dental community not on board with Age 1 visit Lack of dental insurance Lack of Age 1 dental visit education with the parents Unwillingness of guardians to transport children

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78 DENTAL SEALANTS

79 PROJECT GOAL ARC/Benedum School-Community Partnerships for Children s Oral Health Award grants to support collaborative efforts for improving the oral health of youth through school-based/linked dental services

80 COMPONENTS Sealants

81 QUESTIONS OR COMMENTS?

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87 WORKING LUNCH YOUR SUPPORT STAFF PARTNERSHIP FOR ELDER LIVING-MARSHA DELANCEY WV DENTAL HYGIENE ASSOCIATION- BARBARA THAXTON FAMILY RESOURCE NETWORK- WENDY MOSTELLER HEAD START- GINA SHARPS Over lunch you will work in your organization along with the assigned MU staff to develop a work plan. Thinking about- What role the organization can play Resources Needed Timeframes Partners Measures of Success

88 NEXT STEPS- EACH GROUP WILL SHARE WITH THEY DEVELOPED

89 BREAK Return at 3:30pm Food & Drinks out in the hallway

90 WELCOME BACK & WELCOME to Oral Health Boot Camp II

91 ICE BREAKER - RULES Tower must be 5 feet high Must be freestanding Can t be attached to the floor or table Everyone must participate Can only use items in the bag and 1 sheet of paper Don t have to use every item Withstand light wind test 15 min time limit

92 YEAR 1 GRASSROOTS ORGANIZATION Who you are Your organization Where you are located & county(ies) you serve A few highlights from this past year

93 NEW GRASSMIDDLE GRANTEES Who you are Your Organization Target Population/Special Interest Group/Demographic Brief Summary of Work Plan

94 BREAK TIME!!!! CHECK-IN CHECK S, KAYAK, NAP, WHATEVER YOU WANT TO DO! RETURN TO THE PATIO FOR DINNER AT 6:00PM