Transcript A MODEL FOR DENTAL CARE IN A SBHC

A MODEL FOR DENTAL CARE
IN A SCHOOL BASED PROGRAM
CHEMAWA INDIAN HEALTH CENTER
DENTAL PROGRAM
Beth Finnson, RDH, MPH
Oral Health in America
• A Report of the Surgeon General
– David Satcher, MD, 2003
• Silent epidemic affecting…
– Poor children
– Elderly
– Racial and ethnic minority groups
World Health Organization
“Dental…disease is not eradicated,
but only controlled…”
Dental Caries
– Chronic childhood disease
– 51 million school hours lost yearly
– 164 million work hours lost yearly
– 16,000 school hours lost yearly in Oregon
Oral Health and General Health
• Optimal oral health provides…
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Speaking
Smiling
Chewing
Tasting
Swallowing
Oral Health and Learning
• Early tooth loss results in…
– Failure to thrive
– Impaired speech development
– Malocclusion
– Reduced self esteem
Oral Health and Learning
• Chronic Dental Pain causes…
– Anxiety
– Fatigue
– Irritability
– Depression
– Inability to concentrate
– Poor nutrition
OUR MISSION…
• To raise the physical, mental,
social, and spiritual health of
American Indians and Alaska
Natives to the highest level.
OUR GOAL…
• To assure that comprehensive,
culturally acceptable personal
and public health services are
available and accessible to
American Indian and Alaska
Native People.
OUR FOUNDATION…
• To uphold the Federal Government’s
obligation to promote health
American Indian and Alaska Native
people, communities, and cultures
and to honor and protect the inherent
sovereign rights of Tribes.
IHS/Tribal Healthcare
Systems
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48 hospitals
280 health centers
147 health stations
34 urban health projects
9 residential treatment centers
176 Alaska village clinics
Chemawa Indian Health Center
Indian Health Disparities
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55% AI/AN rely only on IHS healthcare
Reduced life expectancy
Higher infant mortality rate
Safe/adequate water supplies
Waste disposal facilities
Indian Population
• 1997-1999 Current Population Survey
– Larger families
– Less health insurance
– Lower household median income
– Lower educational levels
– Higher unemployment rates
– Young population
Service Population Trends
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65% population increase (1990-2006)
Increase in life expectancy (64-73)
Federal recognition for more tribes
56% urban
44% reservation or rural areas
Inadequate IHS budget
Indian Health Service
• Mobile Dental Van
Challenges in IHS Dental
Programs
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2,800 patients per IHS dentist
1,500 patients per U.S. dentist
$50 average IHS expenditure per patient
$300 average U.S. per patient
25% dental access for Indian people
Oral Disease Trends
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76% pre-school children with caries
68% adolescent children with caries
Increased access for sealants
63% 8 year-olds with at least 1 sealant
Chemawa Indian School
Forest Grove
Chemawa Indian School
Indian Boys
Chemawa Indian School
Salem, OR
Chemawa Indian School
Totem Pole
Chemawa Health Center
• Comprehensive health care facility
Medical
Pharmacy
Dental
Public Health
Optometry
Behavioral Health
Lab
School Nursing
Radiology
Podiatry
Registration/Billing/Coding
Chemawa’s Model for
A Dental SBHC Program
– Collaboration
• School staff
• Health facility staff
• Dental students
• Dental hygiene students
• Volunteers
Model for Dental SBHC
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Screen process
Document, document, document…
Prioritize
Preventive care
Clinical care
Specialty care
Evaluation
Documentation
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Name
Chart
Home state
Screen date
Exam date
Number of caries
Urgent needs
Hygiene care
Sealants
Retention Rates
Extractions
Root canals
PTC
Drop
Screen Results 2007-2008
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462 students, aged 14-19
349 screened
99% have had dental caries
82% with untreated decay
15% reported oral pain
Treatment Results
2007-2008
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51% complete exams
9% extractions
99% oral hygiene education & cleaning
85% received 498 dental sealants
47% completed treatment
Screen Results 2008-2009
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387 students, aged 14-19
387 screened
97% have had dental caries
73% with untreated decay (1395 carious teeth)
14% reported oral pain
Receipt of Preventive Services by Low
Income Children
31%
20%
1996
2000
2010 Target = 57%
Note: Data are for children under 19 years. Low income is less than 200% of poverty level. Preventive services include
examinations, cleaning, x-rays, fluoride treatments and sealant applications.
Source: Medical Expenditure Panel Survey, AHRQ.
Obj. 21-12
Dental Sealants: 1988-94 and 1999-2000
Percent
50
1988-94
1999-2000
1988-94
1999-2000
2010
Targets
40
30
20
10
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Total
White Black Mexican
American
6-11 Years
Total
White Black Mexican
American
12-18 Years
Unreliable estimate, relative standard error >30%.
Note: Targets are for children 8 years and 14 years. Black and white exclude persons of Hispanic origin. Persons of
Mexican-American origin may be any race.
Source: National Health and Nutrition Examination Survey, NCHS, CDC.
Obj. 21-8
Dental Sealants
Adolescents 12-18 Years Who Ever Had Caries in
Permanent Teeth, 1988-94 and 1999-2000
Percent
1988-94
80
1999-2000
2010 Target
60
40
20
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Total
White
Black
Mexican
American
Female
Note: Target is for adolescents 15 years old. Black and white exclude persons of Hispanic origin. Persons of MexicanAmerican origin may be any race.
Source: National Health and Nutrition Examination Survey, NCHS, CDC.
Male
Obj. 21-1c
Oregon Smile Survey
2007
• 3,865 1st,2nd & 3rd graders
• Oregon ranks 25/32 states
• Disease disparities
– Geographic
– Poverty
– Dental insurance
– Race/ethnicity
Oregon Smile Survey
2007
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64% of children have had dental caries
20% of children with rampant decay (7+)
35% of children with untreated decay
25% with no dental insurance
9% with no dental home
20% need urgent care due to pain/infection
43% with dental sealants
Oregon Smile Survey
• Recommendations
– Community water fluoridation
– Early-childhood cavities prevention
– School based fluoride supplement program
– School based dental sealant programs
Resources
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Oregon Dental Association
Oregon Dental Hygienists’ Association
Dental Foundation of Oregon
Tooth Taxi
• Medical Teams International Mobile Dental Van
• Boys and Girls Club
Resources
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Oregon Smile Survey
Burden of Disease in Oregon
Oral Health Data Book
King Fluoride
Dental Sealants Protect Oregon Teeth:
A Guide…
• http://www.oregon.gov/DHS/ph/oralhealth
Tooth Taxi
Questions ?
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Beth Finnson, RDH, MPH
Chemawa Indian Health Center
3750 Chemawa RD NE
Salem, OR 97305
503-304-7631
[email protected]