Mike Plunkett DDS MPH OHSU School of Dentistry
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1 Mike Plunkett DDS MPH OHSU School of Dentistry
2 Access and Policy Oral Health and Overall Health Addressing the Problem Community Level Programs Role of Education Discussion
3 We have come to recognize that the mouth is a mirror of the body, it is a sentinel of disease, and it is critical to overall health and wellbeing. The challenge facing us today to help all Americans achieve oral health demands the best efforts of public and private agencies as well as individuals. David Satcher, US Attorney General, May 2000
4 Issues of oral disease begins in pregnancy 49% of pregnant women visit a dentist in a year. Poor oral health during pregnancy increases the risk of early childhood cavities. Dental decay in the very young is the result of transmission of bacteria from mother to baby. Nutrition and parenting practices play a large role in early childhood cavities. 4
5 Percent Poor Near Poor Mid/High Family Income Source: NHANES III,
6 Poor Near Poor Mid/High Percent Age <6 Age 6-11 Age * includes prophylaxis, fluorides, or sealants Source: Medical Expenditure Panel
7 2007 Oregon Smile Survey of 1 st, 2 nd and 3 rd grade students: 63% have experienced tooth decay 35% have untreated tooth decay 20% have rampant tooth decay 4% have urgent treatment needs 7
8 According to the 2007 Oregon Smile Survey of 1 st, 2 nd and 3 rd grade students: 49% increase in untreated decay when compared to the 2002 Oregon Smile Survey. Oregon children s oral health is poorer than neighboring states of Washington, California, Idaho and Alaska. 8
9 According to 2005 data, 74% of 11 th grade students have experienced tooth decay. Adolescent behaviors contribute to poor oral health: Excess consumption of sugary foods Tobacco use Drug and alcohol use 9
10 Diabetes Heart disease Adverse pregnancy outcomes Respiratory infections Osteoporosis HIV infection Oral Health in America: A Report of the Surgeon General ~
11 Early Childhood Caries Prevention in Klamath County
12 Early Childhood Caries (ECC) Strong Dietary component Often called milk bottle caries Strongly associated with parental factors Caries in children 0-6 yrs
13 Primary Objective: Decrease Early Childhood Caries Targets : pregnant women Primary Referral Source: Any Department of Health Women, Children, Infants (WIC) provider (physicians, nurses, PAs etc.) Referral location: Local Participating Dentist
14 Each women will receive: 1) Complete Assessment 2) Assignment to a dental home Local public clinic or private office 3) All needed dental care 4) Extensive home care instructions addressed
15 Referrals sent daily to a central clearinghouse office Project staff at office refer to a dental home office Home visit are completed by a dental hygiene student from OIT hygiene school Home health instructions Childs oral health education Educational materials are provided
16 Participants are scheduled a visit at OIT Hygiene School for a complete oral evaluation. Follow up treatment is carried out at Klamath Open Door Community Health Center or by selected private dentists. Patients are followed up post-partum for 6 month visits after the 1 st tooth erupts.
17 Future Plans: Klamath Tribal Council for reservations Expand to other agencies Include larger insurers Make universal best practice if research shows significant result Contact: Marilynn Sutherland
18 CORE MISSION BEYOND CLINICAL COMPETENCE 1. Improve access to dental care. 2. Promote awareness of public health concepts. 3. Foster state and local collaborative relationships 4. Assist local communities in addressing their most pressing community health issues. 5. Team approach
19 Medical/Dental/Nursing/PA.. All have a role to play Educational environments shape professional culture and professional culture determines the priorities of a profession.
20 Studies have demonstrated a change in students views on: Ethics and the underserved Professionalism Willingness to practice in a public health setting.
21 Statewide Program Began Development in 2007 Current Status 12 Locations 25 Community Volunteer Faculty Still Elective but plan to make a fixture of the curricula
22 Students in 5 locations Students in 10 locations 4 students are now practicing in their rotation community Students in 13 locations
23 Increases access to dental care among underserved populations Professional development of students Promotes statewide collaboration Develops pipeline from education to practice
24 Are we developing solutions at the community level? Are we addressing the problem at its roots rather than putting out fires after they start? Are we giving the future health profession workforce the understanding and experiences necessary to address the problems?
25 Discussion
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