A MODEL FOR DENTAL CARE IN A SCHOOL BASED PROGRAM
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A MODEL FOR DENTAL CAREA MODEL FOR DENTAL CARE
IN A SCHOOL BASED PROGRAMIN A SCHOOL BASED PROGRAM
CHEMAWA INDIAN HEALTH CENTER CHEMAWA INDIAN HEALTH CENTER
DENTAL PROGRAMDENTAL PROGRAM
Beth Finnson, RDH, MPHBeth Finnson, RDH, MPH
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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
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World Health Organization
“Dental…disease is not eradicated,
but only controlled…”
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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
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Oral Health and General Health• Optimal oral health provides…
– Speaking– Smiling– Chewing– Tasting– Swallowing
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Oral Health and Learning• Early tooth loss results in…
– Failure to thrive– Impaired speech development– Malocclusion– Reduced self esteem
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Oral Health and Learning• Chronic Dental Pain causes…
– Anxiety– Fatigue– Irritability– Depression– Inability to concentrate– Poor nutrition
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OUR MISSION…
• To raise the physical, mental, social, and spiritual health of American Indians and Alaska Natives to the highest level.
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OUR GOAL…
• To assure that comprehensive, culturally acceptable personal and public health services are available and accessible to American Indian and Alaska Native People.
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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.
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IHS/Tribal Healthcare Systems
• 48 hospitals• 280 health centers• 147 health stations• 34 urban health projects• 9 residential treatment centers• 176 Alaska village clinics
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Chemawa Indian Health Center
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Indian Health Disparities
• 55% AI/AN rely only on IHS healthcare• Reduced life expectancy• Higher infant mortality rate• Safe/adequate water supplies• Waste disposal facilities
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Indian Population
• 1997-1999 Current Population Survey– Larger families– Less health insurance– Lower household median income– Lower educational levels– Higher unemployment rates– Young population
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Service Population Trends
• 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
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Indian Health Service
• Mobile Dental Van
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Challenges in IHS Dental Programs
• 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
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Oral Disease Trends
• 76% pre-school children with caries
• 68% adolescent children with caries
• Increased access for sealants
• 63% 8 year-olds with at least 1 sealant
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Chemawa Indian SchoolForest Grove
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Chemawa Indian SchoolIndian Boys
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Chemawa Indian SchoolSalem, OR
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Chemawa Indian SchoolTotem Pole
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Chemawa Health Center• Comprehensive health care facility
Medical Pharmacy
Dental Public Health
Optometry Behavioral Health
Lab School Nursing
Radiology Podiatry Registration/Billing/Coding
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Chemawa’s Model for A Dental SBHC Program– Collaboration
• School staff• Health facility staff• Dental students• Dental hygiene students• Volunteers
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Model for Dental SBHC• Screen process• Document, document, document…• Prioritize• Preventive care• Clinical care• Specialty care• Evaluation
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Documentation• Name Hygiene care• Chart Sealants• Home state Retention Rates• Screen date Extractions• Exam date Root canals• Number of caries PTC• Urgent needs Drop
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Screen Results 2007-2008• 462 students, aged 14-19
• 349 screened
• 99% have had dental caries
• 82% with untreated decay
• 15% reported oral pain
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Treatment Results 2007-2008
• 51% complete exams
• 9% extractions
• 99% oral hygiene education & cleaning
• 85% received 498 dental sealants
• 47% completed treatment
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Screen Results 2008-2009• 387 students, aged 14-19
• 387 screened
• 97% have had dental caries• 73% with untreated decay (1395 carious teeth)
• 14% reported oral pain
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31%
2010 Target = 57%
20%
1996 2000
Receipt of Preventive Services by Low Income Children
Obj. 21-12Note: 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.
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0
10
20
30
40
50
Total
2010Targets
6-11 Years 12-18 Years
Black MexicanAmerican
White Total Black MexicanAmerican
White
Dental Sealants: 1988-94 and 1999-2000
Obj. 21-8
1999-2000 1999-20001988-94 1988-94
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.
Percent
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Dental Sealants
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0
20
40
60
80
Obj. 21-1c
Adolescents 12-18 Years Who Ever Had Caries in Permanent Teeth, 1988-94 and
1999-2000
Note: Target is for adolescents 15 years old. 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.
Total Black MexicanAmerican
White MaleFemale
Percent2010 Target1988-94 1999-2000
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Oregon Smile Survey 2007
• 3,865 1st,2nd & 3rd graders• Oregon ranks 25/32 states • Disease disparities
– Geographic– Poverty– Dental insurance– Race/ethnicity
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Oregon Smile Survey 2007
• 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
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Oregon Smile Survey• Recommendations
– Community water fluoridation– Early-childhood cavities prevention – School based fluoride supplement program– School based dental sealant programs
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Resources• Oregon Dental Association
• Oregon Dental Hygienists’ Association
• Dental Foundation of Oregon
• Tooth Taxi• Medical Teams International Mobile Dental Van
• Boys and Girls Club
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Resources• 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
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Tooth Taxi
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Questions ?• Beth Finnson, RDH, MPH
• Chemawa Indian Health Center
• 3750 Chemawa RD NE
• Salem, OR 97305
• 503-304-7631