SMILE, CALIFORNIA! WIC s Role in the Oral Health Plan Jennifer Byrne, CCPH Project Manager Perinatal and Infant Oral Health Quality Improvement Project California Department of Public Health If you don t give a smile, you won t get a smile. Dr. Susan Cooper April 12, 2017 1
Oral Disease Nationally Tooth decay is the leading chronic disease in children far more common than asthma and hay fever but it can be prevented! Mild Moderate Severe 2
How Do Teeth Decay? If Bacteria + Carbohydrates = Acid (Germs) (Food!) Then Acid + Tooth = Decay 3
Prevalence (%) 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Americans with Tooth Decay 2-5 6-8 9-11 12-15 16-19 20-64 65+ Age Primary Teeth Permenant Teeth Sources: NHANES, CDC 4
Oral Health Care Utilization Disparities Amongst Pregnant Women in California 70% 60% White Prevalence (%) 50% 40% 30% 20% Asian/Pacific Islander Latina 10% Black 0% All Women Private Insurance Medi-Cal Sources: MIHA, CDPH 5
Infants and Children are at Risk for Tooth Decay if they Live in communities without fluoridated water Are from families with low incomes Are from certain racial and ethnic minority groups In California: Latinos, African-Americans, American Indian, and Alaska-Native Have limited or no dental insurance Are from families whose parents have less than a high school education Have special health care needs Have individual conditions that increase risk Experience Adverse Childhood Experiences Experience poor oral hygiene History of tooth decay in primary teeth or amongst family members This slide is based on the curriculum Open Wide: Oral Health Training for Health Professionals prepared by Katrina Holt and Ruth Barzel, National Maternal and Child Oral Health Resource Center, Georgetown University.
Tooth Decay and Gum Disease Lead to Other Problems Spread to other organs Cause destruction of teeth Cause pain and difficulty chewing Result in poor nutrition Impair performance in school Impair psychological and social development Cause speech problems Increase oral health risk in adulthood Increase risk of diabetes and cardiovascular disease Increase risk of low-birth weights and premature births, if pregnant Death This slide is based on the curriculum Open Wide: Oral Health Training for Health Professionals prepared by Katrina Holt and Ruth Barzel, National Maternal and Child Oral Health Resource Center, Georgetown University. 7
California Department of Public Health Oral Health Program Improve the Oral Health of All Californians through Prevention, Education, and Organized Community Efforts 8
Developing the State Oral Health Plan CDPH AC Disease Burden Document Environmental Scan Framework Define the Problems Workgroups Goals, Objectives, Strategies Work Plan Partnership Implementation
Opportunities Provide evidence-based and demonstrable models of prevention and treatment interventions Address the needs of Californians with poor oral health Develop infrastructure and capacity Create visible, consistent and effective messaging Conduct ongoing surveillance and evaluation
Proposed Strategies Develop infrastructure and capacity Support proven prevention and early detection programs Link people to sources of care Strengthen knowledge and skills to engage in healthy behavior Improve health systems Provide training and technical assistance to enhance capacity for vulnerable populations Develop partnerships, coalitions and collaborations for improving oral health Gather data to support ongoing surveillance, planning, and evaluation
Desired Impact Year 1 Pregnancy School Early Entrance Childhood 3 rd Grade K 3 rd 54% 71% 43% 56% Promote Healthy Habits Brushing Reducing Sugar Increase Dental Visits by Supporting Community Clinical Linkages Dental Care Delivery System Inter-professional Collaboration Address Determinants of Oral Health Health Literacy Insurance Coverage Water Fluoridation Engaged community Informed, activated patient Prepared and proactive clinicians
Collective Impact Common agenda Shared measurement systems and approaches to evaluating progress Mutually reinforcing activities Continuous, consistent, and open communication Backbone support organization(s) to convene and coordinate
Moving from Planning to Action: Using Tobacco Tax Funds State Oral Health Program Local Oral Health Program Communication & Health Literacy Surveillance & Evaluation Training & Technical Assistance
WIC s Role in Implementation If not for the WIC program, my child would not have received dental care. Sonoma County WIC Dental Days beneficiary 15
WIC, A Likely Partner Promotes nutrition and dietary practices essential to overall health and to the prevention of dental disease Participants at high-risk for disease Trusted and safe environment A familiar location Slide adapted from Dr. Susan Cooper. 16
Participate in Local Action Provide expertise Plan Development Identify needs and determinants Determine the assets and resources Offer solutions Help identify evaluation questions
Promote Kindergarten Assessment Policy Become a champion Inform decision makers Educate the community Earn media coverage Use the data to explain trends and variation
Support Integration of Oral Health into Primary Care Be a supportive referral provider Establish a medicaldental partnership Activate and support patients and families Serve as an education resource and training partner Source: Qualis Health. Oral Health: An Essential Component of Primary Care. June 2015. 19
Promote Oral Health Literacy Create a shame-less environment* Use plain language* Visuals and drawings Use teach-back method* Strengthen school health curricula *Source: Nicole Holland, Lois Wessel. Health Literacy: Implications for the Dental Setting. NNOHA Webinar, April 5, 2013. Association of Clinicians for the Underserved.
Oral Health in Community Settings Recruit an Oral Health Champion! Perform an oral health risk assessment Conduct a basic oral health screening, if qualified Initiate appropriate preventive interventions, if qualified Provide anticipatory guidance Refer to a dentist WIC Oral Health Lesson Plans on CDPH website: First Smiles and Healthy Teeth
Oral Health Risk Assessment An approach to identify the risks and/or protective factors that may impact a child s oral health A referral is made if more than one box in the Risk Factors for Oral Disease column is checked This slide is based on the curriculum Open Wide: Oral Health Training for Health Professionals prepared by Katrina Holt and Ruth Barzel, National Maternal and Child Oral Health Resource Center, Georgetown University.
Anticipatory Guidance Visit your dentist twice a year Drink fluoridated water Brush your teeth for two minutes two times a day Infants: Wipe the gums with a clean, moist gauze pad or washcloth Toddlers (or the eruption of the first tooth): Brush teeth with a smear of fluoride toothpaste Young Children: Help them until they are 6 years old Images : Wiki How and Healthy Children.Org 23
Diet s Impact on Oral Health Sugar causes tooth decay Drink fluoridated water, not soda or juice Eat foods you can pronounce Fruits, vegetables and whole grains Lean sources of protein such as poultry, fish and beans Offer snacks at regular times between meals only 24
Oral Health Education for Caregivers Brush child s teeth for 2 minutes twice a day beginning with the first tooth and until age 6 (or when the child can brush on their own) Take you child to the dentist by age 1 and every 6 months thereafter Do not engage in saliva sharing habits Limit sugar intake Do not dip pacifiers in sweetened foods like sugar or honey Do not use a bottle to calm a child or to put a child to bed If the child is accustomed to a bottle offer a bottle with plain water instead
Preparing Parents for their Child s First Dental Visit Parents will learn what to expect with their child s oral health and development Dental visit goals: Assess risk for tooth decay Provide anticipatory guidance Answer parent questions Initiate prevention practices Parents learn how to care for their child s teeth Early identification of potential problems with tooth and jaw development 26
Referring Families to Oral Health Care Services InsureKidsNow.Gov: Find a dentist plugin - www.insurekidsnow.gov/state/ca/find-a-dentist/index.html The California Department of Health Care Services (DHCS) Denti- Cal provider referral list - www.denti-cal.ca.gov/wsi/ Bene.jsp?fname=ProvReferral Welltopia by DHCS, free and low-cost resources - www.mywelltopia.com For assistance locating a dentist, you can also contact: Local Health Departments Local or state dental societies American Academy of Pediatric Dentistry American Dental Association
Acknowledgements Association of State and Territorial Dental Directors Association of Clinicians for the Underserved American Dental Association California Dental Association California Home Visiting Program, California Department of Public Health California Department of Health Care Services Center for Oral Health Children s Dental Health Project Children Now The Children s Partnership Early Head Start and Head Start First 5 Association of California Health Resources and Services Administration, Maternal and Child Health Bureau Maternal and Child Health Access Maternal and Infant Health Assessment Survey Open Wide: Oral Health Training for Health Professionals prepared by National Maternal and Child Oral Health Resource Center Qualis Health Sonoma County Community Action Partnership 28
Jennifer Byrne Jennifer.Byrne@cdph.ca.gov (916) 955-1023 Jayanth Kumar Jayanth.Kumar@cdph.ca.gov (916) 324-1715 Rosanna Jackson Rosanna.Jackson@cdph.ca.gov (916) 552-9896 29