37
Critical Issues in School Health Conference May 5, 2011 Oral Health: Fighting the Number One Chronic Infectious Disease among Children
Critical Issues in School Health ConferenceMay 5, 2011
Oral Health: Fighting the Number One Chronic Infectious Disease among Children
Presenters
Dr. Donna Balaski, DMDManager, Medical Care AdministrationConnecticut Department of Social Services
Marty Milkovic, MSWDirector of Care Coordination & OutreachConnecticut Dental Health Partnership
2
Childhood Caries
• Caries is an infectious disease that can begin as early as the teeth begin to emerge (around 6 months), often progresses rapidly and can cause pain to the child
• Tooth decay is the single most common chronic childhood disease - 5 times more common than asthma, 4 times more common than early-childhood obesity, and 20 times more common than diabetes.
3
Source: American Academy of Pediatic Dentistry, Early Childhood Caries Statistics
Structure of a Healthy Tooth
Enamel – hard outer coatingDentin – hard tissue but has live nerves running through itCementum – slightly harder than dentin surrounds rootPulp – the tooth’s soft innerconnective tissue Periodontal Ligament – holds the tooth into the jaw bone
4
Dental Plaque
• Dental plaque is a biofilm, usually opaque that develops naturally on the teeth
• The microorganisms that form the biofilm are mainly Streptococcus mutans and anaerobes, with the composition varying by location in the mouth
• The extracellular matrix contains proteins, long chain polysaccharides and lipids
5
Plaque Progression
• Bacterial plaque tends to build up to an aggressive form every 20 to 28 hours
• Bacterial plaque hardens within 48 hours and is known as tartar
6
Etiology of Caries
Three Factors Must Be Present:
A TOOTH, BACTERIAL PLAQUE and FOOD for the bacteria
BACTERIAL PLAQUE + SUGAR = ACIDACID + TOOTH = TOOTH DECAY
7
Where does Tooth Decay Occur?
• Plaque accumulates on tooth surfaces:• Deeply grooved surfaces of the tooth• In between the teeth (interproximal areas)• Smooth surfaces of teeth
8
Stages of Tooth Decay
Demineralization – white spot lesion – acid begins to break down enamelPenetration – tooth is discolored and enamel is soft
-> Enamel collapsesPenetration into dentinPenetration into pulp
9
Quality of Health in the Oral Cavity
• Diet• Oral Hygiene - the quality and
quantity spent doing:•Brushing•Flossing
10
Quality of Health in the Oral Cavity
• DIET - Children who are frequently exposed to fermentable carbohydrates —for long periods of time run a great risk of suffering from Childhood Caries
• It is a multifactorial disease process initiated by bacteria (Strep. Mutans & lactiobaccilus). After food enters the
mouth, the bacteria in the plaque break down the carbohydrates, producing acids that result in mineral loss from teeth—a process left untreated results in cavities. » A Healthy Diet is Essential!
11
Quality of Health in the Oral Cavity
• Brushing all surfaces of the tooth at least twice a day (ideally after all snacks and meals) to remove plaque build up.
12
Quality of Health in the Oral Cavity
• Flossing – at least once a day to remove food debris and prevent plaque buildup
13
Childhood Caries
• Typically, Early Childhood Caries (ECC) that requires extensive dental repair (often in an operating room under general anesthesia) appears in children around 22 months
• Left untreated, it can destroy the child’s teeth, and have a strong, lasting effect on a child’s overall general health
• According to the 2007 Report by the Centers for Disease Control and Prevention (the most current report to date), cavities have increased for toddlers and preschoolers. Cavities in children ages 2 to 5 increased from 24 percent to 28 percent between 1988-1994 and 1999-2004
14
1 Dye BA, Tan S, Smith V, Lewis BG, Barker LK, Thorton-Evans G, et al. Trends in oral health status: United States, 1988-1994 and 1999-2004. National Center for Health Statistics. Vital Health Stat 11(248). 2007.
Childhood Caries
• For children ages 2 to 5, 70% of the caries is found in 8% of the population.2 ECC is disproportionately concentrated among socially disadvantaged children, especially those who qualify for Medicaid coverage
• Children between the ages of 2 and 5 who have not visited a dentist within the past 12 months are more likely to have caries in their primary teeth 3
15
2 Macek MD, Heller KE, Selwitz RH, Manz MC. 2004. Is 75 percent of dental caries really found in 25 percent of the population? Journal of Public Health Dentistry 64(1):20-25.3 Dye BA, Tan S, Smith V, Lewis BG, Barker LK, Thorton-Evans G, et al. Trends in oral health status: United States, 1988-1994 and 1999-2004. National Center for Health Statistics. Vital Health Stat 11(248). 2007.
Costs of Childhood Caries
• Goes beyond pain and infection; it can affect speech and communication, eating and dietary nutrition, sleeping, learning, playing and quality of life, even into adulthood
• Many children with childhood caries require costly, restorative treatment in an operating room under general anesthesia. Under Medicaid expenditures, such operations can cost thousands of dollars
16
Consequences of CC
• Higher risk of new carious lesions in both the permanent dentition
• Greater number of hospitalization and Emergency Room visits• Increased treatment costs and time• Insufficient physical development (especially in height/weight). • Loss of school days and increased days
with restrictive activity• Diminished ability to learn• Diminished oral health-related quality
of life
17
What You Can Do
• Make it ImportantStudents (and parents!) need to know that the Mouth is Part of the Body. Oral health is an important component of overall health
• EducatePromote use of the oral health curriculum:
Connecticut Cares – About Oral HealthGet a local dentist to come and volunteer!
• Get Them Into CareRefer them to local providers, bring qualified school-based and mobile program to your school
18
What You Can DoMake it Important
• The biggest barrier to good oral health is a lack of understanding of its importance– Poor oral health is associated with a number of
systemic diseases: Diabetes, Pre-term Births, Heart Disease, Poor Nutrition and more.
– Particularly in Children, an unhealthy mouth can have severe behavioral health outcomes
– In essence, it is a problem of knowledge and attitude
19
What You Can DoEducate
• The State Oral Health Curriculum is an excellent tool to educate children K-12 in good oral hygiene:
Connecticut Cares – About Oral Health– Developed by the Connecticut State Dental Association (CSDA),
Connecticut Association of School Based Health Centers and other stakeholders.
– Available on the CSDA and SDE websites• www.csda-public.com/Kids/OralHealthCurriculumFinal.pdf
– Available Today at the CTDHP Table or by Contacting CTDHP
20
What You Can DoGet Them into Care
• For Children on HUSKY or Medicaid– CTDHP has nearly 1,300 dentists statewide.– Our toll-free Call Center has answered 180,000 calls
and never failed to find a dentist for a caller.– More to Follow.
• Bring a Qualified School-based or Mobile DentalProgram to Your School.
21
CTDHP
About the Connecticut Dental Health Partnership
22
History
• Started on September 1, 2008
• Replaced Several Separate Programs Operated by Managed Care Organizations and the State
• Administered by BeneCare Dental Plans
• Office located in Farmington
• Includes more than 580,000 Children and Adults! – More than 1 in 4 of Connecticut’s Children– Largest Dental Program in the State
23
‘Carved-out’ all of the old dental programs in:
• HUSKY A(Medicaid for children & caregivers)
• HUSKY B(CHIP for children)
• Title XIX / Fee-for-Service (FFS Medicaid)
• Medicaid for Low Income Adults (M-LIA)(Formerly SAGA - Assistance program for single adults)
24
History
Successes
• Historical Perceptions of the Older Program o Multiple Managed Care Organizations (MCOs)
- 3+ Dental Benefit Management Companieso State Operated Program in Fee-for-Service Medicaido Smaller number of dentists, Closed panelso Long wait times for appointments
• Today’s CTDHP Reality - Successo Network has over 1,200 unique providerso Dental Utilization Increasingo Single , Responsive Call Centero Care Coordination and Outreach for Target Groupso Focus is on promoting the Dental Home Concept
25
Provider Relations
Improved Provider Relations• Increased Focus on Recruitment & Retention• Dedicated, Responsive Staff• Toll-free Number• In-office assistance
Good Results• More Than 1,200 Providers Enrolled• Excellent Retention
26
2727
Participating Dental Practitionersas of March 31, 2011
111 Applications Pending
Client Call Center
Our Call Center is Responsive• Primary Focus is on the Client’s Needs• Scheduling Assistance
– Referrals to Providers– 3 way Conference Call to Schedule Appointments– Translation Services
• Transportation CoordinationAssistance(For most clients)
• Benefit Information• More …
28
• Over 90% of Calls Answered within 45 seconds
• Average time on phone with each client is over 5 minutes
• Nearly All Call Issues Are Resolved First Time• Mystery Shopper Survey Performed in 2010
– Conducted by United Way 211 – 93% of ‘clients’ were able to secure a routine dental
appointment (For offices reached - 95% of 418 called!)– Average time for a routine appointment was 11.2 days
29
Client Call Center
Care Coordination
Seven ‘Dental Health Care Specialists’ (DHCS)• Cover Six Regions of the State, One DHCS Focused on
Special Health Care Needs• Work with Clients to Overcome Barriers to Care
– 4,468 Cases Opened in 2010
• Work with Providers to Facilitate Referrals• Work with Community Agencies to
Facilitate Outreach Activities– 1,400 visits between 7/1/09 & 12/31/10– More than 5,000 posters distributed
30
Outreach
• Informational for Clients & Providers• Increase Dental Health
Awareness &Knowledge– Importance of Dental Health– Client Rights & Responsibilities
• Reach Out to Specific Groups– Special Health Care Needs (Care
Coordination & Case Management)– Non-utilizers of Services– Pregnant Women (Targeted Outreach)
31
32
Brochures mailed to all prenatal clients (English & Spanish versions)
Outreach
Care Coordination & OutreachOutreach Visits and Posters
33
Outreach Posters
Six Versions of oral health posters that focused on elementary & middle school children and their parents
More Than 4,000 Outreach Posters Distributed to Schools and Community Agencies since the program started.
Care Coordination & OutreachTargeted Outreach
Using Specialized ‘Prescription Pads’• Hospital Emergency Departments
– To Facilitate Referrals for UnnecessaryVisits to the ED for Dental Pain
– Visited and Provided Pads, Postersand Information to all ED’s in State
• Primary Care Physicians– Visiting all PCP’s in HUSKY Primary
Care (HPC/PCCM)– Will Expand to Other PCP’s– Providing Pads, Posters, Other
Materials and Training
• Community Agencies
34
Results
Connecticut One of Only Six States to Receive Top Grade from Pew
• The Pew Center on the States Pew assessed andgraded states and the District of Columbia on eight proven policy solutions that ensure dental health and access to care. A 50-state report card shows that just six states earned an “A” and that 36 states received a “C” or lower.
• Only six states merited A grades: Connecticut, Iowa, Maryland, New Mexico, Rhode Island and South Carolina.
35
Phone Numbers
Client Call Center866 - 420 - 2924
(M-F, 8 AM - 5 PM)
Provider Relations888 - 445 - 6665
(M-F, 8 AM - 5 PM)
36
Questions?
Marty Milkovic, MSWDirector of Care Coordination & OutreachConnecticut Dental Health Partnership195 Scott Swamp RoadFarmington, CT [email protected]
Donna Balaski, DMDHealth Management Administrator
Connecticut Department of Social Services25 Sigourney StreetHartford, CT 06106
37
