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The Importance of Oral Health Across the Lifespan
AASC National Service
Coordinator Conference September 24-27, 2017
Jennifer Wahby, MPH Senior Health Services Analyst Public Health Dental Program 1
Objectives • Importance and Impact of Oral Health • National Objectives • Public Health Dental Program • Oral Health by Age Group including: oral health status,
key prevention focus areas, and state activities – Early Childhood – Childhood – Adults – Pregnant Women – Older Adults – All Ages
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Importance of Oral Health
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• Oral health is vitally important to overall health and well-being.
• Good oral health includes the ability to carry on basic human functions such as chewing, swallowing, speaking, smiling, and singing.
• Goal is to reduce oral disease and complications and eliminate oral health disparities.
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Oral Health Across the Lifespan
• Oral health should be maintained across the lifespan.
• Each stage of life has unique risk factors which impact oral health needs and status – Early Childhood
– Children and Adolescents
– Adult
– Pregnant Women
– Older Adults
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Impact of Oral Disease
• Societal – Diminished quality of life
– Sleep deprivation, depression, and multiple adverse psychosocial outcomes
– Individual identity
• Economic – Dental care paid out-of-
pocket by patients
– Emergency room spending
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National Objectives
• Oral Health in America Report (2000)
• Led to oral health objectives in:
– Healthy People 2010
– Healthy People 2020
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Florida Department of Health
Public Health Dental Program
– Provide a statewide direction for policy related to oral health issues
– Promote and administer oral health education and preventive dental programs
– Collect and analyze oral health data
– Support the provision of direct dental care services through the Department’s local health offices and other public and private organizations
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Early Childhood: 0-5 Years
• Focus on: – Reducing early childhood caries (dental decay)
– Improve oral health literacy
– Familiarize young children with routine preventive dental care
• State Activities: – Early Childhood Caries and Women, Infants and
Children (WIC) Pilot Project to improve access to preventive care
– Early Head Start/Head Start Screening Project
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Early Head Start and Head Start Oral Health Screening Project, 2014-2015
• 26 Head Start and 22 Early Head Start Centers
• Indicators:
1. Untreated decay
2. Treated decay
3. Caries experience
4. Early childhood caries
5. Urgency of need for dental care
• Early
• Urgent
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Florida Early Head Start/Head Start Oral Health Status Indicators
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Children: 5-18 Years
• Focus on: – Prevention of dental decay through sealants, fluoride
varnish, silver diamine fluoride – Reduce risk factors that impact oral health such as
sugar sweetened beverages and poor nutrition – Establish good oral health habits and a dental home – Lay the foundation for healthy teeth as an adult
• State activities:
– Third Grade Screening Project – School-Based Sealant Programs
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Children: 5-18 Years Oral Health Status
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• Tooth decay (caries) is the most prevalent chronic condition affecting children in the United States.
• Tooth decay affects:
– 1 in 5 (20%) of U.S. children aged 5 to 11 years
– 1 in 7 (14%) of U.S. adolescents aged 12 to 19 years
• The prevalence of untreated decay in children is higher among racial/ethnic minorities and among children from low-income families.
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Condition of Teeth as Reported by Parents, Florida and National Estimates 2011-2012
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[VALUE]%
[VALUE]%
7.6%
[VALUE]%
[VALUE]%
[VALUE]%
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
Excellent Good Fair
National Florida
Source: National Survey of Children’s Health
Third Grade Oral Health Screening Project, 2013-2014
• 41 Schools
• Indicators: 1. Untreated decay:
2. Treated decay
3. Caries experience
4. Dental sealants on permanent molars
5. Urgency of need for dental care • Early
• Urgent
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Tooth Decay in Florida • In 2013, approximately 1 in 4 Florida third graders
had untreated decay.
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Percent of Untreated Decay and Dental Sealants among Florida's Third Grade Children 2013-2014, by FRL Status
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33.5%
30.3%
23.4%
38.5%
15.3%
38.4%
9.0%
49.3%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
Untreated Decay Dental Sealants
>75% FRL 50-75% FRL 25-50% FRL <25% FRL
Percent of Third Graders with Caries Experience by State
Healthy People 2020 Goal: 49.0%
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75
.0
70
.6
66
.8
65
.7
64
.9
64
.8
64
.0
62
.8
61
.8
61
.6
59
.7
59
.3
57
.9
57
.6
57
.5
56
.0
55
.9
55
.9
55
.2
54
.9
54
.7
54
.6
52
.5
52
.4
52
.0
51
.2
51
.0
50
.5
48
.6
48
.4
47
.4
47
.3
47
.2
44
.1
43
.1
41
.9
41
.8
36
.7
39
.6
35
.4
34
.5
32
.7
Percent of Third Graders with Dental Sealants, by State
Healthy People 2020 Goal: 28.1%
18
68
.5
64
.1
62
.7
61
60
.9
60
.4
56
.6
55
.2
53
.6
52
.4
51
.6
51
.2
51
.2
50
.4
49
.8
49
.4
47
.1
46
.8
45
.6
45
.3
44
.9
42
.6
41
.9
40
.5
40
.1
37
.6
37
.5
37
.4
36
.9
36
.8
35
.7
35
.4
34
.2
33
.2
32
.3
30
.2
29
27
26
.4
23
.5
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Dental Sealants • Dental sealants are thin plastic coatings that
are applied to the grooves on the chewing surfaces on the back teeth to protect them from more than 80% of decay.
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Unsealed Tooth Sealed Tooth
School Based Sealant Programs in Florida
• Department of Health (DOH) S-BSPs have expanded over the past five years
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Adults: 18-64 Years • Focus on:
– Routine preventive and restorative care when appropriate
– Reducing dental disease particularly related to individuals with chronic disease
– Making sure pregnant women seek preventive dental care for healthy pregnancies
• State Activities: – Referrals for low-income, underinsured or insured
adults – Surveillance activities
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Oral Health Status of Florida Adults Prevalence of Adults Who Have Lost a Permanent
Tooth, by Race/Ethnicity, 2014
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[VALUE]% [VALUE]%
[VALUE]%
[VALUE]%
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
Total50.4% (49.1-51.8)
Non-Hispanic White50.6% (49.0-52.2)
Non-Hispanic Black58.5% (54.2-62.8)
Hispanic47.2% (43.7-50.8)
Source: Florida Behavioral Risk Factors Surveillance System, 2014
Preventive Visits
• Daily oral hygiene routines and healthy lifestyle behaviors play an important role in preventing oral disease
• Routine teeth cleaning, exams and x-rays
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Prevalence of Florida Adults Aged 18 Years and Older With a Teeth Cleaning
Characteristic Prevalence (95% CI)
Total 60.9% (59.6-62.1)
Gender
Male 59.5% (57.5-61.5)
Female 62.2% (60.7-63.7)
Race/Ethnicity
Non-Hispanic White 64.2% (63.0-65.4)
Non-Hispanic Black 49.6% (45.1-54.2)
Hispanic 57.0% (52.4-61.5)
Age
18-44 57.3% (54.9-59.7)
45-64 62.0% (60.1-63.9)
65 and older 64.3% (62.6-65.9)
Income
Less than $25,000 35.7% (33.2-38.2)
$25,000-49,999 58.2% (55.6-60.8)
$50,000 or more 76.7% (75.0-78.5)
Education
Less than High School 28.3% (23.8-32.8)
High School or G.E.D. 49.4% (47.0-51.8)
More than High School 69.3% (67.8-70.7)
24 Source: Florida Behavioral Risk Factors Surveillance System, 2010
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Pregnant Women
• Focus on: – Continuing routine dental care during pregnancy
– Educating pregnant woman on the importance of oral health for themselves, their family and their new baby
• State Activities: – Expanding dental services to Women, Infant, and
Children (WIC) offices
– Providing funding to county health departments for direct services provided to pregnant women in their dental clinics
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Oral Health During Pregnancy • Regular preventive dental care should
be maintained during pregnancy.
• The American College of Obstetricians and Gynecologists (ACOG) recommends that women be routinely counseled about the maintenance of good oral health habits across the lifespan as well as the safety and importance of oral health care during pregnancy.
Oral health care during pregnancy and through the lifespan. Committee Opinion No. 569. American College of Obstetricians and Gynecologists. Obstet Gynecol 2013; 417-22.
Percent of Florida New Mothers with Preventive Dental Visit, 2014
35.51%
42.34%
29.08% 29.26%
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
30.00%
35.00%
40.00%
45.00%
2014
Overall Non-Hispanic White Non-Hispanic Black Hispanic
27 Source: Florida Pregnancy Risk Assessment Monitoring System (PRAMS), 2014
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Older Adults: 65 and Older
• Focus on: – Age-appropriate care include access to denture and
implants
– Oral cancer screening
– Reducing dental disease particularly related to individuals with chronic disease
• State Activities: – Referrals for low-income, underinsured or insured adults
– Monitoring Senior Smiles Pilot Project through NOVA School of Dentistry
– Older Adult Screening Project
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Oral Health in Older Adults-Florida
• During 2014, among Florida adults age 65 and older*:
– Two in three (66%) had visited the dentist in the past year
• Highest among non-Hispanic White adults
– Three in four had at least one permanent tooth removed because of tooth decay or gum disease
• Highest among non-Hispanic Black adults
*2014 Florida BRFSS
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Oral Cancer
• Can occur in any part of the mouth or throat, including the lips, tongue, cheek, floor, hard and soft palate, and sinuses.
• Has a historically high death rate due to late stage diagnosis.
• Incidence of oral cancer was highest among non-Hispanic White persons when compared to non-Hispanic Black and Hispanic persons.
• The incidence of oral cancer is much higher among males than females.
• Risk factors for oral cancer include: smoking, smokeless tobacco use, excessive consumption of alcohol, excessive sun exposure, and human papillomavirus.
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Oral Cancer Health Screenings
• Oral cancer is more common in adults aged 60 years and older
• Recent trends identified increasing in adults younger than 40 years
• Risk factors – Use of tobacco (cigarettes and smokeless)
– Alcohol,
– Marijuana
– Genetic and biologic factors
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Oral Health and Chronic Disease
• There is a growing body of evidence that shows treating oral health conditions can improve overall health status among those with various chronic conditions including diabetes, heart disease, and stroke* – Cost savings component of preventing and treating
oral disease
• There may be a pathological link between oral disease (particularly periodontal disease) and poor health outcomes such as preterm birth and stroke *Jeffcoat, M. K., Jeffcoat, R. L., Gladowski, P. A., Bramson, J. B., & Blum, J. J. (2014). Impact of periodontal therapy on
general health: Evidence from insurance data for five systemic conditions. American journal of preventive medicine, 47(2), 166-174. 32
Older Adult Oral Health Screening Project, 2015-2016
• Growing vulnerable population with unique oral health needs
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Basic Screening Survey (BSS) Oral Health Indicators for Older Adults
1. Dentures and denture use
2. Number of natural teeth
3. Untreated decay
4. Root fragments
5. Need for periodontal care
6. Suspicious soft tissue lesions
7. Urgency of need for dental care
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Methodology
• 3,288 adults were enrolled in all the congregate meal sites in the selected 35 centers from 2015-2016
– 21.6% of consent forms returned (709/3,288)
– 95.6% of consent forms returned with positive consent (678/709)
– 20.5% of sampled adults screened (674/3,288)
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Demographic Characteristics
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Demographic Characteristics of Adults Screened during the Florida
Older Adult Oral Health Screening Project 2015-2016, n=668
Characteristic N (%)
Age
60-69 years 176 (26.4%)
70-79 years 269 (40.3%)
80-89 years 195 (29.2%)
90 years and older 28 (4.2%)
Gender
Male 224 (33.5%)
Female 442 (66.2%)
Missing 2 (0.3%)
Race/Ethnicity
White 237 (35.5%)
Black 60 (9.0 %)
Hispanic 278 (41.6%)
Multi-Racial 66 (9.9%)
Other Race 20 (3.0%)
Missing 7 (1.1%)
Key Findings
• Florida’s edentate older adults ages 60 and older (19.2%):
– Average number of natural teeth: 15.2
– Suspicious soft tissue lesions: 5.5%
– Early dental treatment need: 28.6%
– Urgent dental treatment need: 5.0%
– No insurance coverage: 58.5%
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Overall Oral Health Indicators of Florida's Older Adults, 2015-2016
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22.9% 21.3%
17.1%
5.5%
28.8%
5.0%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
Untreated Decay Root Fragments Need for Periodontal
Care
Soft Tissue Lesions* Early Dental Care* Urgent Dental Care*
*Per the 2010 Older Adult BSS Manual, soft tissue lesions, early dental care, and urgent dental care indicators are inclusive of all participants, including the edentate population. All other indicators in figure are reported for dentate population only.
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Upper and Lower Denture Use of Florida's Older
Adults, Total and by Education Status, 2015-2016
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53.3%
32.1%
27.3%
22.4%
34.4%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
Less than HS Degree HS Degree Some College Advanced Degree Total
Oral Health Indicators for Florida's Older Adults, by
Education Status, 2015-2016
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20.8%
17.5%
14.4%
5.8%
25.0%
3.3%
25.2%
26.8%
18.1%
3.6%
26.5%
5.5%
22.7%
17.1%
13.3%
5.3%
30.5%
6.4%
28.6%
24.8% 26.3%
5.2%
38.8%
2.7%
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
30.00%
35.00%
40.00%
45.00%
Untreated Decay Root Fragments Need for Periodontal
Care
Soft Tissue Lesions* Early Dental Care* Urgent Dental Care*
Less than HS Diploma High School Diploma Some College Advanced
*Per the 2010 Older Adult BSS Manual, soft tissue lesions, early dental care, and urgent dental care indicators are inclusive of all participants, including the edentate population. All other indicators in figure are reported for dentate population only.
Oral Health Indicators of Florida's Older Adults, by
Race/Ethnicity, 2015-2016
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24.6% 25.5%
18.1%
5.7%
30.0%
6.1%
32.2%
44.4%
12.9%
1.6%
32.0%
7.4%
18.6%
14.2%
16.8%
6.6%
26.2%
4.5%
23.1%
3.4%
25.0%
5.2%
37.3%
0.8%
15.7%
24.8%
3.2%
10.3%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
45.0%
50.0%
Untreated Decay Root Fragments Need for Periodontal
Care
Soft Tissue Lesions* Early Dental Care* Urgent Dental Care*
White Black Hispanic Multi-Racial Other
*Per the 2010 Older Adult BSS Manual, soft tissue lesions, early dental care, and urgent dental care indicators are inclusive of all participants, including the edentate population. All other indicators in figure are reported for dentate population only.
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Dental Insurance Status of Florida's Older Adult
Population, 2015-2016
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10.2%
23.9%
30.2%
28.3%
3.3% 4.1%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
Private Medicaid Medicare None Don't Know Other
Chronic Conditions among Florida's Older Adult
Population, 2015-2016
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45.6%
8.8% 10.7%
28.7%
23.3%
41.2%
9.7%
15.2%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
45.0%
50.0%
Arthritis Asthma Cancer Diabetes Heart Disease Hypertension Obesity Osteoporosis
Oral Health for All Ages
• Focus on:
– Access to Community Water Fluoridation
– Routine preventive and restorative dental care
– Oral health literacy and oral health education
– Diet (nutrition and sugary beverages)
– Tobacco Control
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Community Water Fluoridation (CWF)
• Most cost-effective method for preventing dental caries
• Benefits all citizens regardless of age or socioeconomic status
• Return of investment
• 77% of Florida have access to CWF
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Oral Health Education
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Oral Health Literacy
Florida Department
of Health Agency for Health Care Administrati
on
Florida Dental
Hygienists’ Association
Florida Dental
Association
Volunteer Health
Network
Oral Health Florida
Federally Qualified
Health Centers
Dental/ Hygiene Schools
School-Based
Sealant Programs
Community/Outreach Groups
Sugar-Sweetened Beverage Consumption
• Consumption of sugar-sweetened beverages linked to several adverse health outcomes
– Obesity
– Diabetes
– Cardiovascular disease
– Dental caries
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Tobacco Use and Control
• Tobacco use linked to several chronic diseases such as cancer and heart disease.
• Primary cause of many adverse oral conditions such as oral cancer, periodontal disease, and congenital defects in children whose mothers smoked during pregnancy.
• Comprehensive tobacco control can have a large impact on oral health status, and the dental office provides an excellent venue for providing tobacco education and intervention services
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Conclusions
• The PHDP continues to promote cost efficient workforce models, increase access to care though School-Based Sealant Programs and innovative collaborations, increase communities receiving water fluoridation, and conduct oral health surveillance activities for various populations statewide. Through these oral health promotion initiatives and activities, the PHDP will continue to improve, promote, and protect the oral health status of all Floridians.
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Thank You!
Jennifer Wahby, MPH
(850) 617-1434
www.flhealth.gov/dental
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