Tooth Talk: Strategies for Improving Oral
HealthEmployee Benefits Planning AssociationApril 3, 2014
2© 2013 Washington Dental Service Foundation
Washington Dental Service Foundation
Mission: To prevent oral disease and improve overall health. We do this through innovative programs and policies that produce permanent changes in the health environment so that over the long-term oral disease is prevented
Funding: Delta Dental of Washington - a non profit dental benefits company committed to improving oral health
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Why Oral Health?
HeartDisease
PhysicalActivity
Cancer
Children’s Development
Diabetes MentalHealth
CommunityEngagement
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The Opportunity
Oral disease is nearly 100% preventable
Oral disease is highly prevalent – opportunity toimprove health for a large # of people
Oral health impacts overall health and quality of life
Oral disease contributes to un necessary healthcarespending
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ChildrenIntense PainAnxietyFatigueWithdrawalDifficulty paying attention in school
51 million school hours lost nationally
Sleep Deprivation
Missed school days
Language development
Embarrassment
Nutrition problems
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Most Common Chronic Disease of Childhood
40% Start Kindergarten with toothdecay experience
15% of Kindergartener haverampant decay
Over 60% of 3rd graders havetooth decay experience
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Early Intervention Saves $
Children with severe dental decay often need to be treated in a hospital operating room, costing about $8,000 to $12,000 per child
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Adults
Employability and Productivity – Over164 million work hours/year lost
Linked with chronic health conditions:Diabetes, heart disease/stroke, pneumonia
Dry mouth (side effect of medications)can quickly lead to tooth decay
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Too Many Adults Have Oral Disease
Nationally:Nearly 1 in 4 adults in the U.S. has untreated tooth decayNearly 1 in 2 adults has periodontal disease (increases with age)
Washington:Nearly 40% of adults have had a tooth extracted due to disease1 in 5 adults over age 55 report a dental issue that needs treatment within the next monthAmong low-income seniors, this jumps to nearly 1 in 3.
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Poor Oral Health is Costly
One Cavity Costs $2,000 Over a lifetime(we have 32 teeth)
Dental pain is the number one reason uninsured adults visited Washington state emergency rooms – Dental-related Emergency room charges were
over $36 million in an 18 month period
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Oral Disease and Diabetes are Linked
Also, untreated gumdisease can increaserisk for developingtype II diabetes
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Cost Savings Opportunity
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Keys to Prevention
Good Home Care – Brushing and FlossingFluoride (can reverse early decay)Dental VisitsAddressing health issues (diabetes, dry mouth)Nutrition/Snacking habits
Time on Teeth mattersnormal meals vs. snacking/grazing
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Strategies
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Children
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Oral Health Partnerships
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Access to Baby and Child Dentistry
Goal: Improve young children’s oral health – more kids getting dental care
Medicaid-eligible children birth to 6years
Focused on prevention
Early intervention by age 1
Training for dental offices/clinics
Outreach & case management to families
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Early Learning: Cavity Free Kids
• Address oral health in places where children spend their time: Head Start, Child Care, Home Visiting
• Train early learning providers to educate children and families about oral health and connect them with dental care
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Pregnant WomenDid you know?
The bacteria that causes cavities can be spread from mother to child, usually in the first two years of life. GOAL: Improve pregnant women’s oral health to help prevent their babies from getting cavities
Prevent the spread of bacteria from mother to child
Engage mothers at a time they are especially receptive about caring for their babies
Strategies:Motivate and train dentists to serve pregnant women
Engage prenatal medical care providers in addressing oral health
Engage community based organizations in identifying and referring (WIC, home visiting)
Motivate pregnant women to demand services
– Education materials/media
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Baby Teeth Campaign
MEDIA CAMPAIGN:
Oral Health Screening by Age One• Paid Media: Parenting magazines (Seattle, Yakima, Centralia, Vancouver), Online
newspapers statewide, Spanish language newspapers, Spanish language radio, Ethnic Newspapers
• Earned Media: Articles in newspapers, parenting magazines, blogs, etc.
• New Media: Facebook ads
• KidsOralHealth.org website
• WA State Dept of Health—Child Profile mailing to families with 9 month olds
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Baby Teeth Campaign: Earned Media
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Educational Resources
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School Based Health Centers
• WHAT: Address the oral health of • school age children (6–18) in • School Based Health Centers (SBHC)
• WHY: As children age they:• Access dental care less often; • Have increased rates of decay.• In-school clinics remove barriers to care – children missing school or parents missing
work to attend appointments• ACA funds expansion; number of schools with on-site clinics growing
• HOW: Teach medical providers in school clinics to address oral health - educate, screen, and refer.
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SealantsWHAT: Improve the oral health of school-age children by increasing the number who have sealants
WHY: Sealants:• Reduce decay by up to 70%• Evidence-based, cost-effective• 50% of Washington’s school-age children do not have sealants
HOW: • Partner with dental providers and schools with over 50% free/reduced lunch to
deliver sealants• Motivate dentists to apply sealants• Educate parents, and motivate to request sealants
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Seniors
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Healthy Aging Includes Oral Health
People are living longer and more are keeping their teeth throughout life.
Ensuring older adults and their providers understand the connection between oral health and healthy aging:
• Medicare does not include dental –need to plan ahead
• Those with chronic health issues and on medications should talk with their medical and dental providers
• Some lower-cost dental care options exist
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Oral Health for Caregivers
Goal: Train caregivers to improve the oral health of their clients/residents to prevent disease
Home Care AidesAdult Family Home ProvidersCaregivers for Individuals with Developmental DisabilitiesFamily Caregivers
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Special Populations
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Latinos
A growing population:• Between 2000 – 2010, WA’s Latino population grew 71%
• By 2060, the population of Latinos will double – from 1 in 6 today to 1 in 3 (nationally)
Children have high rates of disease:
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Tribes
FluoridationOperating Room DiversionFoundation Strategies for Young Children, Pregnant Women, Seniors
Partnerships:Northwest Tribal Dental Support CenterLummi TribeKalispel TribePuyallup TribeHoh TribeMakah Tribe
The Issue: • 79% of 5 year old Native American children have tooth
decay;• 98% of elders had lost teeth because of dental disease or
oral trauma
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Community Health Workers
• WHAT: Improve the oral health of “hard-to-reach” populations by training community health workers (CHW) to address oral health
• WHY: An evidence-based approach that improves health outcomes of “hard-to-reach” groups with poor oral health outcomes; ACA funds and numbers expanding
• HOW: Train Community Health Workers • to address oral health with the communities• they serve
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Engaging Primary Care
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Putting the Mouth back in the BodyGOAL: Train medical providers to address oral health with
all their patients:- screening- risk assessment- oral health education- fluoride varnish- referral if needed
WHY?
– Already doing prevention & chronic disease management for rest of body
– Already looking in the mouth
– Oral health—related to nutrition and medications
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Oral Health in Medical Settings
BenefitsCatch disease early, early treatment = reduced cost of care, improved outcomesHelp patients understand the connection between poor oral health and other chronic diseases
Reduce dental-related ER visits Reduce medical costs (e.g. savings from reduced diabetes care)Increase access to preventive oral health care for those not receiving dental care
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Primary Care Trainings: 2002-2013
Trained:2,483 Primary CareProviders
3,191 clinic staff
Approximately 1/3of practicing primarycare MDs have beentrained
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Increasing Access
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Community Health Centers
Whatcom
Snohomish
Okanogan
Chelan
Douglas
Franklin
BentonYakima
Lewis
Thurston
Island
MasonSpokane
Whitman
Columbia
Garfield
King
SkagitStevens
Klickitat
SkamaniaCowlitz
Wahkiakum
Kittitas Grant
Pierce
Clark
FerryPendOreille
Lincoln
Adams
WallaWalla
Asotin
Clallam
Jefferson
Grays Harbor
Pacific
San Juan
Kitsap
WDSF has provided funding within the last seven years
$6.4 million infunding since 2005
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Community Health Centers
Expanding Capacity –In 2013, funded expansion grants totaling $1,098,000 – enabling over 33,000 additional patient visits annually
Northeast Washington Health ProgramsChewelah, WA
SonBridge Clinic Walla Walla, WA
International Community Health Services
Seattle, WA
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Impact
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Impact: Statewide Medicaid Dental UtilizationChildren Under Age Six
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Impact: Young Medicaid Insured Children Receiving Care
WA
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Increase in Medical Providers delivering Oral Health Preventive Services
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Recent decline in untreated decay
20.7
26.7 26.2
13
16.9
21.6
20.5
14.9
0
5
10
15
20
25
30
1994 2000 2005 2010
Low Income Preschool2nd/3rd Grade
*
*
*
* Statistically significant change from prior surveyWA Smile Survey
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Impact: Older Adult Oral Health Survey
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The Mighty Mouth Campaign
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The Challenge:
We are not the onlyones talking abouthealth risks.
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We need to offer more than this
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BEHAVIORAL FRAMEWORK (simplified)
Action!
You could get something pretty cool
All the cool kids are doing it
Let me help you make it happen
REWARD
NORMS
EFFICACY
People’s actions influence attitudes that influence future actions.
This is important.
I’m the kind of person that does
this.
Theory of Change
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OUR GOALSKnowledge:
Fewer than 1 in 5 participants knew that:• Most children in Washington start kindergarten without any cavities• A parent can pass bacteria to their children by sharing eating utensils.
Just over half knew:• Tooth decay can be reversed if it is caught early.• An oral health check up can reveal broader health problems such as
diabetes, cancer, and immune disorders.• Gum disease increases your risk for diabetes & that it’s linked to heart
disease, stroke, and pneumonia.
Focus Group Findings
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OUR GOALSKnowledge:
Fewer than 1 in 5 participants knew that:• Most children in Washington start kindergarten without any cavities• A parent can pass bacteria to their children by sharing eating utensils.
Just over half knew:• Tooth decay can be reversed if it is caught early.• An oral health check up can reveal broader health problems such as
diabetes, cancer, and immune disorders.• Gum disease increases your risk for diabetes & that it’s linked to heart
disease, stroke, and pneumonia.
Focus Group Findings
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Dental Visits: Valued for Kids, But Not Always Adults• Nearly everyone expressed strong agreement that it is important
for children to see a dentist regularly, even if parents didn’tregularly get dental care.
• Adults who get regular dental care universally saw their owndental visits as important. Non doers were mixed: Some agreed itis important but faced barriers, while others downplayed itsimportance for them.“As long as I can take care of my kids, it’sreally all I care about at the moment. I knoweventually I’ll have to take care of myself, butI can’t afford to do it right now.”
Non doer/Uninsured
“I don’t have any problems with myteeth… I went to the dentist in themilitary, and then 15 years later when Ihad my son and I’m good.”
Non doer/Insured
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Other Key Findings
• Information about new science (transmitting bacteria& connection to overall health) was of interest toparticipants.
• The concept of physicians conducting oral healthscreenings during patient visits was of interest toparticipants.
• Desire for health, fitness & youth.
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The Mighty Mouth Campaign
Increase public awareness of the value of oral health
Target Audience: Adults 25+
Position oral health as essential part of overall healthConnect oral health with issues people care about: fitness, beauty, saving moneyFrame it as easy, important and cost-effectivePresent new, surprising information Be fun and informative, not “preachy”
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Mighty Mouth Campaign - Tactics
Paid Media– TV/radio/cable/online
Earned/Social Media– Print articles, broadcast, – Facebook, Twitter
Partnerships– Commercial/retail– Non-profit/community-based
Promotional event (Teeth Week pilot)
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Resources for Partners
Website: TheMightyMouth.orgFloss kitsSample articles (Mighty Mouth Minutes)Social media postsInfographicsPostersOthers as requested