Transcript Document

Oral Health Surveillance in Texas
David P. Cappelli, DMD, MPH, PhD
Associate Professor
Department of Community Dentistry
University of Texas Health Science Center at San Antonio
Texas Oral Health Summit: Advocacy, Equity & Access
Austin, Texas
September 9-10, 2004
Components of a State Oral
Health Surveillance System
Clear purpose and objectives
Core set of measures
Analyze trends
Communicate data and information
to decision-makers and to the public
CDC, Division of Oral Health, May, 2003
CDC Surveillance Data
National Oral Health Surveillance System (NOHSS)
Behavioral Risk Factor Surveillance System (BRFSS)
Water Fluoridation Reporting System (WFRS)
Pregnancy Risk Assessment Monitoring System (PRAMS)
Youth Risk Behavior Survey (YRBS)
Surveillance, Epidemiology & End Result (SEER)
Basic Screening Survey (BSS)
National Health and Nutrition Survey (NHANES)
National Health Interview Survey (NHIS)
National Oral Health
Surveillance System
Capture data from four questions
listed on BRFSS and WFRS
Last dental visit within the past year
Teeth cleaned by a dentist/dental
hygienist in the past year
Population over the age of 65 years who
have lost all of their teeth
Population on public water systems
receiving fluoridated water
Last Dental Visit within the
Past Year
70
64.1
60
60
50
40
30
20
10
0
1995
1996
1997
Yes
CDC, BRFSS
No
1999
2002
Teeth Cleaned within Past Year
70
60
50
40
30
20
10
0
1999
2002
Yes
CDC, BRFSS
No
Lost 6+ Teeth Due to Tooth
Decay or Gum Disease
90
80
70
60
50
40
30
20
10
0
19.1
1995
14.2
1996
1997
Yes
CDC, BRFSS
No
1999
2002
Water Fluoridation Reporting
System (WFRS)
34%
66%
Fluoridated
CDC, Oral Health Resources, 2003
Nonfluoridated
SMART BRFSS Data
Dallas and Houston Metropolitan Areas
Contains data on 7 health indicators
None directly relate to oral health
Smoking status
Diabetes
Obesity
National Data Collection
Opportunities
PRAMS: Four questions that could be
asked directly related to oral health
SEER: Forty-one states + DC analyze
for state-specific data on oral cancer
YRBS: Oral health related questions
could be included
Statewide Data Collection
Opportunities
Texas State Board of Dental Examiners
Collects annual data on workforce of dentists
and dental hygienists
Age and practice location
Number of auxiliaries utilized
Obtains information on location of practice and
practice activity (hours/weeks worked)
Medicaid/Insurance Provider
Accessibility for persons with disabilities
Statewide and Regional Data
Collection Opportunities
‘Statewideness’ Assessment of Oral
Health
Data by county available on:
Number of Medicaid eligible children age one year
and older
Number of Medicaid eligible children who received
at least one dental service
Number of Medicaid eligible providers who provided
at least one dental service
Statewide and Regional
Efforts
Multiple statewide and regional
projects and groups that obtain data
on:
Prevalence of oral disease
Untreated dental caries
Urgent dental care needs
Sealant prevalence
Statewide and Regional
Efforts
Texas Dental Health Survey, “Make Your
Smile Count”, 1998
TDH in cooperation with UTHSCSA, Community
Dentistry
State survey of Preschool, 2nd and 8th grade
students
Parental Questionnaire and Direct Screening
16 elementary/16 adjacent middle schools
110 Preschoolers/1124 2nd graders/802 8th graders
Statewide and Regional
Efforts
Texas Dental Health Survey, “Make Your
Smile Count” Findings:
66% (2nd)/53% (8th) had a dental caries
experience
44% (2nd)/22% (8th) had untreated tooth decay
16% (2nd)/24% (8th) received dental sealants
Medicaid Enrollment was associated with:
Positive parental perception of good oral health
Greater likelihood of dental visit in past year
Lower likelihood of never having a dental visit
Greater likelihood of having a dental home
Statewide and Regional
Efforts - El Paso
El Paso Oral Health Care Community
Plan, 2000
Statewide evaluation of the oral health status of
children (6-8 years)
Students on free and reduced lunch program
(4,012 Medicaid/10,104 Non-Medicaid)
Findings:
Non-Medicaid children had more active caries and
received fewer preventive services
Non-Medicaid children had more urgent care
needs
Statewide and Regional
Efforts - El Paso
TEXAS
EL PASO REGION
Medicaid
(%)
Non-Medicaid
(%)
Medicaid
(%)
Non-Medicaid
(%)
Caries History
58.7
58
65.9
65.4
Active Caries
36.0
46.2
46.6
48.3
Sealants Present
21.8
13.8
12.9
14.1
Urgent Care
Needed
9.7
14.3
38.8
40.7
Routine Referral
Needed
29.3
35.5
9.7
10.8
Sealants Needed
38.2
32.9
34.8
34.4
No Treatment
Needed
22.8
17.3
16.7
14.0
Statewide and Regional
Efforts -El Paso
Dr. Michael Najera
How to best provide needed dental health education
message to low-income children
Administered 80-question oral health survey to 400
mothers enrolled in WIC clinics in El Paso, TX
Findings:
Oral health knowledge was less in mothers born in Mexico, with
less than HS education, and low ability to read English
Oral health of the child was significantly adversely affected by
having a younger mother (under age 25), mother born in
Mexico, Spanish is principal language and low English literacy
Oral health of the mother and dental practices of both mother
and child were affected by low English literacy
Statewide and Regional Efforts
Lower Rio Grande Valley
Lower Rio Grande Valley: Dr.
Ramon Baez, UTHSCSA
Conducted between 1990-1995
3,450 individuals were examined
Findings:
85% of the population was in need of dental
care
Need for emergency dental care increased with
age (69% of persons over age 55 needed care)
Statewide and Regional Efforts
Lower Rio Grande Valley
South Texas Health Status Assessment,
Community Health Development Program,
2003
Household survey of adults and children living five
South Texas counties (Cameron, Hidalgo, Starr,
Webb, Willacy) to look at oral health services for
colonia residents
Supported by funds from RWJ Foundation for the
Integrated Health Outreach Services Project (IHOS)
and HRSA
Statewide and Regional Efforts
Lower Rio Grande Valley
South Texas Health Status Assessment,
Community Health Development Program, 2003
Findings:
Dentists per 100,000 Population: 9.6-16.2 (Texas: 36.4)
Over 65% of all respondents stated that cost was a
consideration in seeking dental care, even if insured
55% of adults traveled to Mexico for dental/medical care
Over 25% of adults never had a dental exam (14% of children)
Over 30% of adults (25% of children) had tooth or gum
problems at the time of the survey
Statewide and Regional
Efforts - Houston
Innovative Method to Improve the Impact of
the Texas Oral Health Program
Collaboration between UT-Houston Dental Branch and
Dental Health Task Force of Greater Houston
Funded by TDH-Innovations Grant
Goals and Objectives
Develop and test a cost-effective method to generate data
for development of evidence-driven oral health policies
Utilize data to develop a strategy to improve the oral health
of Texas children
Statewide and Regional
Efforts - Houston
Used direct screening
dft/DMFT
Untreated caries
Sealant prevalence
Questionnaire to collect data
Perceptions of health
Oral health promoting practices
Exposure to sugar-containing foods
History of dental experiences
Statewide and Regional
Efforts - Houston
Selected 7 counties in TDH region 6 (total
of 13 counties) based on SES variables
2,781 children in Pre-K, Grades 2, 7 and
10 were included
Conclusions:
Prevalence of untreated decay 13.5%-54.3%
Sealant prevalence 27.8%-51%
Based on findings, provided strategic
recommendations for both individual and community
measures
Statewide and Regional
Efforts - San Antonio
Behavioral Risk Factor Survey of Bexar County,
Texas, 2002
Collaboration with Bexar County Community Health Collaborative
and UTHSCSA, Community Dentistry
Component of a community health assessment to guide efforts
toward prevention and health improvement
Telephone survey of 1,010 adults
Findings:
66% of adults had a dental visit in the past year
Persons at greater risk or lower SES were less likely to have had
a dental examination in the past year
78% of children had a dental visit in the past year
Statewide and Regional
Efforts - Dallas
Children’s Oral Health Coalition, 2002
Screened 5,000 children in 13 Fort Worth ISD
elementary schools
Findings:
16% require urgent care
18% have dental caries
Survey to 612 dentists, 16 school district nurse
administrators, 421 families who received care at lowincome clinics
Assess perceptions of the extent of oral health
problems and availability of dental services for children
Statewide and Regional
Efforts - Dallas
Children’s Oral Health Coalition, 2002 Findings:
53% of nurse administrators reported that dental problems
presented to schools daily/weekly
85% reported that services are inadequate and 77% noted
that the service were not easily accessible
58% of families were enrolled in Medicaid, and 44% did not
have a dentist
20% of families had a child with dental pain that was not
being treated
16% of dentists responding were Medicaid providers
Of those accepting Medicaid, only half of those were accepting
new patients
Statewide and Regional
Efforts - Dallas
Dental Health Arlington: Sealant
Program, “SMILES”
Non-profit, full service dental clinic, serving
low income residents of Tarrant County
SMILES: School-based sealant program in
operation for 9 years
Collect data for the nine years of the
programs existence
LOGIC MODEL
Inputs
•Staff (contract and in-kind) for:
 Epidemiological support
 Data management
 Information Technology (IT)
 Oral health policy leadership
 Data collection
•Data Sources:
 National data sources
 State data sources
 Community data sources
SURVEILLANCE
Activities
•Develop a surveillance plan
•Establish surveillance objectives
•Select and develop case definitions and
indicators using standard health indicators
whenever possible
•Link existing data sources
•Identify gaps in data
•Obtain community IRB approval
•Collect data to obtain community-level
indicators and meet other needs
Intermediate
Outcomes
•Ongoing monitoring of
trends in oral health
indicators
•Increase in evidencebased interventions,
planning, and evaluation
•Increase in programs for
populations most in need
•Analyze data and interpret findings
•Equipment:
 IT hardware/software
•Other:
 Funding
 Community Support
 Support for Partners
CDC, Division of Oral Health, May, 2003
•Develop and write surveillance report
•Disseminate surveillance results
•Ensure data security and confidentiality
•Develop strategies for sustaining
surveillance system
•Evaluate state surveillance system
Long-term (Distal)
Outcomes
•Improved Oral Health
Recommendations for
Future Action
Develop a coalition of statewide partners to
establish objectives and identify core measures
Create a statewide plan for continued
surveillance of oral health
Leverage funds to participate in national
surveillance programs
Make surveillance a priority in the state oral health
program
Recommendations for
Future Action
Coordinate regional efforts at a statewide
level to standardize information and to
serve as a repository for findings
Recommend standardized system for all surveillance
efforts (i.e., ASTDD Basic Screening Survey or BRFSS)
Support existing regional surveillance at
the statewide level by providing technical
assistance on design, collection, and
analysis
Thank You