Statement of the Problem why is oral health important and what role does health literacy play in the etiology of dental/oral diseases?

Statement of the Problem why is oral health important and what role does health literacy play in the etiology of dental/oral diseases?

Amid Ismail, BDS, MPH, MBA, DrPH Laura H. Carnell and Dean, Kornberg School of Dentistry Temple University ismailai@temple.edu

Agenda Oral health literacy Burden of oral health Expanding the vision If I d asked customers what they wanted, they would have told me, A faster horse! Henry Ford

Oral Health Literacy

Oral Health Literacy The degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate oral health decisions. American Dental Association

Oral Health Literacy Individuals Health care providers Community Policy and decision makers

Oral Health Literacy Individuals Health care providers Community Policy and decision makers

Access and quality of care cluster Social, economic behavioral cluster Social, economic, cultural factors Biological risk factors Oral health knowledge Oral health behaviors Oral Health Self-efficacy Oral Health Literacy Educational attainment Self- efficacy is the belief in one s capabilities to organize and execute the courses of action required to manage prospective situations Bandura

Health Promotion Access and quality of care cluster Social, economic behavioral cluster Social, economic, cultural factors Biological risk factors Oral health knowledge text Oral health behaviors Oral Health Self-efficacy Oral Health Literacy Educational attainment Self- efficacy is the belief in one s capabilities to organize and execute the courses of action required to manage prospective situations Bandura

Untreated Decay in the US

Deprivation, Fluoridated Toothpaste, and Caries Ellwood RP, et al. Community Dent Oral Epidemiol 2004;32:159-64.

Oral Health Literacy in the USA Lee JY et al. J Public Health Dent 2011;71:152-160.

Percentage of public school students in Kindergarten through grade 12 who have ever repeated a grade, 2007 (US Department of Education) Race/Ethnicity Total Male Female White 8.7% 11.2% 6.1% Black 20.9% 25.6% 15.3% Hispanic 11.8% 12.4% 11.1% Asian 3.5% 6.5%.. AI/AN 13.0%....

Systematic Review: Health Literacy and Child Health Outcomes Health Literacy: Parents literacy levels impact on children behaviors and health outcomes but not on the use of health care services. Improving written materials can increase health knowledge, and combining good written materials with brief counseling can improve behaviors including adherence. The average quality of the studies was fair to good. DeWalt DA and Hink A. Pediatrics 2009;124:S265-74.

Systematic Review on Health Literacy and Health Outcomes, 2011 Outcome Type of studies Low vs Adequate Health Literacy Strength of evidence in 2011 Access to care Cohort Inconsistent Insufficient Colon cancer screening Cross-sectional Decrease Insufficient Dental diseases Cross-sectional Inconsistent Insufficient Emergency care visits Cohort Increase Moderate Self-efficacy Cross-sectional Inconsistent Insufficient Mammography Cross-sectional Decrease Moderate Berkman ND, et al. Ann Intern Med. 2011;155:97-107.

Agenda Oral health literacy Burden of oral health Expanding the vision

The US Population Responses Selected OHIP-7 Questions, NHANES III (n = 6,183) Oral Health Impact How often during last year have you had painful aching anywhere in your mouth? (Physical Pain) How often during last year have you felt life in general was less satisfying because of problems with your teeth, mouth, or dentures? (Handicap) How often during last year have you avoided particular food because of problems with your teeth, mouth, or dentures? (Physical Disability) How often during last year have you been self-conscious or embarrassed because of your teeth, mouth, or dentures? (Psychological Disability, Psychological Discomfort) Often-Occasionally 19.9% 10.1% 15.3% 12.6% Seirawan H, el al. J Public Health Dent 2011; 71:194 201

Burden of Dental Caries in Alaska 65% of preschool children had early childhood caries; 60% of young Alaska Native children had extensive dental disease Riedy C. Int Dent J 2010;50 (Supplement 2) :241-4.

Cost of Care of Children with ECC in Philadelphia under GA and IV Sedation $11 M in 2011 Recidivism: 20% a year

Impact of Early Childhood Caries (7 Yearold British Children Treated under GA) Olley RC, et al. Brit Dent J 2011;201: 1-8

Burden of Caries by Socioeconomic Status of 100 Children who Received Extractions under General Anesthesia Olley RC et al. Brit Dent J 2011;201: 1-8

Support Requested by Parents of Children who Received Extractions under GA Olley RC et al. Brit Dent J 2011;201: 1-8

We pay for procedures, not OUTCOMES We focus on dental care by professional providers rather than on a system for promoting health

Health Systems and Oral Health Ismail AI, Sohn W. JADA 2001;132:295-303.

Untreated Decay in New Zealand, 2009 New Zealand Ministry of Health, December 2010 Most Deprived

Trends in Untreated Decay in the US

Trends in Dental Caries in the Primary Dentition (dft). United States, from 1970s to 1980s Mean dft There has been no change since mid 1980s

Prevalence of Dental Caries, United States, 1988-1994 and 1999-2004 Primary Permanent Source: Dye et al. Vital and Health Statistics 2007;11(248)

There are still major disparities in oral health We do not have a plan!

A new strategy EXPANDING THE VISION 32

Health Promotion Access and quality of care cluster Social, economic behavioral cluster Social, economic, cultural factors Biological risk factors Oral health knowledge text Oral health behaviors Oral Health Self-efficacy Oral Health Literacy Educational attainment Self- efficacy is the belief in one s capabilities to organize and execute the courses of action required to manage prospective situations Bandura

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