Creating a Healthier Missouri: A Statewide Oral Health Plan 2009

2009·3.1 MB·English

by  Missouri Department of Health and Senior Services, Office of Primary Care and Rural Health

Creating a
Healthier
Missouri:
A Statewide Oral Health Plan
2009
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Creating a Healthier Missouri:
A Statewide Oral Health Plan 2009
Missouri Department of Health and Senior Services
Offi ce of Primary Care and Rural Health
Developed in cooperation with the Missouri Oral Health Task Force
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Letter to Missourians ..................................5
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Acknowledgements .....................................6
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Executive Summary ..................................... 8
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Background ..............................................12
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Focus Areas
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Education and Community Awareness ......................

ff Access to Care .........................................................20
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Workforce and Training ...........................................

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Public Policy ............................................................
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Implementation Plan ................................44
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References ...............................................52
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Fellow Missourians,
The Missouri Department of Health and Senior development and public policy issues. All of the
Services (DHSS) is excited to present “Creating identifi ed strategies emphasize integrating oral
a Healthier Missouri: A Statewide Oral Health health and overall health for the increased well-
Plan 2009.” The impact of oral health on being of Missourians.
overall health has been recognized in the health
care environment yet many still suffer from oral DHSS and its partners are committed to improve
disease. Evidence shows that gum disease or access to oral health care for all Missourians and
periodontal disease can lead to serious health to develop programs that educate citizens about
problems. Thousands of Missourians suffer from the connection between oral health and overall
tooth pain so severe that they miss days at school health.
or work.
Thank you for your interest in oral health. DHSS
Earlier this year, the Oral Health Task Force invites you to use this plan to address oral health
convened to develop a statewide oral health plan. in your community. It is through collaboration
This forty member group consists of oral health and dedication to improving oral health in our
professionals from the public and private sectors, communities that we will “Create a Healthier
plus representatives from dental schools, local Missouri.”
public health agencies, medical providers, oral
health coalitions, community health centers,
and agencies which work with community water Sincerely,
fl uoridation and special populations like the
disabled, elderly, and homeless. The oral health
plan identifi es Missouri’s most critical oral health
challenges and presents strategies for improving
oral health education, access to care, workforce
Margaret Donnelly
Director, Missouri Department of
Health & Senior Services
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This plan was developed by a diverse group of stakeholders from across Missouri who have extensive knowledge
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about oral health needs and share the common desire for all Missourians to have access to affordable oral
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health care. The following individuals and organizations took an active role in the Oral Health Task Force
which is responsible for the creation of this document. We are sincerely grateful for the time and expertise they
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Steven Bacon – Missouri Department of Health and Senior Services, HIV/AIDS Program, Ryan White &
HOPWA Services Manager
Jennifer Bauer, Executive Director – Missouri Academy of Family Physicians
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Mamie Benson, Family Partner – Missouri Bureau of Special Health Care Needs
Craig Biele, MSW – Missouri Foundation for Health
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Bonnie Branson, RDH, PhD – University of Missouri-Kansas City School of Dentistry
Myrna Bruning, RN, MS – Missouri Rural Health Association
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Lisa Bush, DMD, MPH – Family Care Health Center Dental Clinic
Susan Centner, Digital Library Project Director – Missouri Area Health Education Centers
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Donnell Cox, Executive Director – Doral Dental
John Dane, DDS – Elks Mobile Unit
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Karen Dent, Director – Oral Health Network
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Catherine Edwards, PhD – Missouri Department of Health and Senior Services, Oral Health Program
Julie Enboden, Service Coordinator – Children with Special Health Care Needs Program (CSHCN)
oo Michael French, Co-Director, ATSU-KCOM Program Offi ce, Missouri Area Health Education Centers
Bonnie Glass, Administrator – Henry County Health Center
nn Sarah Grim, MSPH, CHE, Executive Director – Missouri Coalition for Oral Health
Linda Grgurich, MA, MBA – Pathways Community Behavioral Healthcare
kk Jessica Hembree, MPA – Health Care Foundation of Greater Kansas City
Rhonda Holman, Vice President – Health Care Foundation of Greater Kansas City
cc Debra Howenstine, MD – University of Missouri-Columbia, Department of Family and Community Medicine
Barbara Huddleston, Nutritionist III – Missouri Department of Health and Senior Services,
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Bureau of Senior Programs
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Amy Kessel, Medicaid Unit Supervisor – Missouri Department of Social Services, MO HealthNet Division
Carolyn Link, JD, MPA, BS – Missouri Department of Health and Senior Services, Oral Health Program
Darren Mahaffey, DDS – private dentist
Michael McCunniff, DDS – University of Missouri-Kansas City School of Dentistry
Julie Nice, RDH, BS – Community Health Center of Central Missouri & Westside Dental Practice
Stacy Owsley, Director – Missouri Head Start, State Collaboration Offi ce
Claudia Preuschoff, MD, FAAP – Missouri Chapter, American Academy of Pediatricians
Marie Peoples, MA, MPH, CSACII – Missouri Department of Health and Senior Services,
Offi ce of Primary Care and Rural Health
Robin Rust, Project Director – Missouri Department of Mental Health, Division of Developmental Disabilities
Lois Sandbothe, LPN – Missouri Department of Social Services, MO HealthNet Division
Cheryl Spiller, RDH – Greater Columbia Dental Hygienists’ Association
Jim Spring, DDS – private dentist
Beth Vossler, Assistant Director – Central Missouri Community Action
Aaron Washburn, Assistant Executive Director – Missouri Dental Association
Vicki Wilbers, Executive Director – Missouri Dental Association
Pam Wittmeyer, RDH, BHS – Clay County Public Health Center, Missouri Dental Hygienists’ Association
Doug Wyckoff, DDS – private dentist
Brenda Myers, Oral Health Task Force Facilitator – Missouri Department of Health and Senior Services
Co-writers
Bonnie Branson, RDH, PhD – University of Missouri-Kansas City School of Dentistry Creating a
Catherine Edwards, PhD – Missouri Department of Health and Senior Services, Oral Health Program
Brenda Myers, Oral Health Task Force Facilitator – Missouri Department of Health and Senior Services
Healthier
Design & Layout
John C. Davis, Public Information Coordinator – Missouri Department of Health and Senior Services
Missouri:
A Statewide Oral Health Plan
2009 7
The numbers are astounding…
• Dental caries, or tooth decay, is the single pain that is severe enough to cause a loss of time at
most common chronic childhood disease. It is work or school.5
fi ve times more common than asthma and
results in an estimated 51 million school hours Rank Percent Who Visited the Dentist/Clinic
(1=high | 51=low)
being missed each year.1
United States 71.3%
• Nearly 25 percent of American adults over age
1. Connecticut 80.2%
60 have lost all of their teeth, primarily
2. Massachusetts 79.3%
because of tooth decay.2
3. Rhode Island 79.0%
• Tooth decay affects more than 90 percent of 4. Delaware 76.8%
eeyy adults over age 40, and advanced gum disease 5. New Hampshire 76.7%
affects 5 – 15 percent of adults.3 6. Michigan 76.0%
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vv 7. New Jersey 75.9%
• Gum disease, otherwise known as periodontal
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disease, can lead to serious health problems
ttmm such as heart disease, stroke, diabetic 45. Nevada 63.7%
uu complications, and pre-term, low birth weight
46. Arkansas 63.5%
babies. But unlike many health problems,
47. Missouri 62.6%
ccmm periodontal disease and other oral health
47. Texas 62.6%
complications can be prevented.4
ee 49. West Virginia 60.6%
Oral disease is a serious problem in our state 50. Mississippi 59.4%
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xx and across the nation, and yet it is 100 percent 51. Oklahoma 57.9%
preventable. Daily brushing and fl ossing along
EESS Recreated with permission of the Henry J. Kaiser Family Foundation
with regular dental visits can deter tooth decay,
gum disease, and other dental problems. Still, it is
estimated that 11 percent of the population has never
seen a dentist. Millions more are affected by tooth
“Oral disease is a serious problem in our state...
8 yet it is 100 percent preventable.”
The problem in Missouri...
Missourians do not visit the dentist as often as citizens likely to be for that population. In rural Missouri,
of other states. Sixty-three percent of Missourians the lack of education, as measured by the percent
reported visiting a dentist within the past year while of population without high school education, is a
the national average is 71.3 percent. Furthermore, very serious issue. Sixteen counties in the state have
more than 26 percent of Missouri’s residents age 65 a percent of the population over 18 without a high
or older have had all of their teeth extracted. The school education that ranges from 31 percent to more
national average is 18.5 percent.6 than 42 percent. All of the counties are rural. Of
the 75 counties with more than 20 percent of adults
These fi gures point to a need for oral health education without a high school education, only one (St. Louis Percentage of Population with
that emphasizes: City) was not rural. Of all rural counties, almost 85 No High School Education
Oral disease can be prevented percent have a percent of adults without a high school
with basic dental hygiene and annual visits education greater than the state rate. This is a critical Atchison Nodaway Worth Harrison Mercer Putnam SchuylerScotland Clark
Sullivan No High School
to an oral health provider. factor in developing education and intervention Holt Andrew Gentry Grundy Adair Knox Lewis 10% or Less
Mto icsasoreu rfoi rm uirnrionrssu trhede nanatdio unn’sd neerseedr vfoedr ipmoppruolvaetido nacs cess sBterasitdegesie esd tuoc iamtiponac at nodra iln hceoamlteh iisnsu Mesi sinso Muriis.7s o uri’s BuchPalantatenCDCleilnaKtyoanlbCDaRaldvawiyeeslslLiCvianrgrsotloln LCinhnaritonRMaancdoonlphSMhoenlbryoeMarRioanlls Pike 123111%%% tttooo 243020%%%
Audrain
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St. Clair Hickory Camden CrawfordWashington Ste.
provider. A number of barriers impact access and reimbursement rates of public-funded programs, Vernon Pulaski Phelps St. Genevieve
health status, particularly for vulnerable populations, such as MO HealthNet, access to care for many Barton Cedar Polk Dallas Laclede Dent ReynolIdrosn FraMnacdoiisson PerCGryairpaerdeau
including young children, low-income families, Missourians is problematic. In addition, Missouri’s Jasper Dade Greene Webster Wright Texas Shannon Wayne Bollinger Scott
individuals with chronic physical or mental illnesses, one dental school is challenged with graduating Lawrence
Newton Christian Douglas Carter Stoddard Mississippi
and developmental disabilities. enough dentists to serve the nearly 6 million Missouri Butler
McDonald Barry Stone Taney Ozark Howell Oregon Ripley New
residents and to keep up with the growing number of Data Source: MU Extension Offi ce of Social & Economic Madrid
Pemiscot
Education and income are highly correlated with dentists who will reach the average retirement age of Data Analysis
Missouri Department of Health and Senior Services Dunklin
health status. The higher the education and income 65 in the next 10 – 15 years.
levels of a population, the better the health status is
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Practical, effective solutions are critical…
The 40-member Oral Health Task Force, convened
In developing this Statewide Oral Health Plan, the by the Missouri Department of Health and Senior
overarching principle that guided the efforts of the Services, identifi ed four areas of focus where
task force who determined the state’s oral health improvements in oral health are especially critical.
priorities was that: Within the four focus areas, goals and strategies have
Oral health is integral to the general health and been developed and recommended for implementation
well-being of all Missourians. in this Statewide Oral Health Plan. Following is a
summary of the focus areas and goals:
As noted in the Report of the Surgeon General,
“Associations between periodontal disease and diabetes Education and Community Awareness
have long been noted. New research, however, • Increase the public’s awareness and
is pointing to associations between chronic oral understanding of the impact of oral health on
infections and heart and lung diseases, stroke, and overall health
low-birth weight, premature births.”8 Consequently, • Promote educational materials and activities
oral health is increasingly recognized as a critical which focus on oral health prevention and
component of general health and must not be ignored treatment options for vulnerable populations
or neglected. Rather, programs which bring together
oral and physical health must be created and funded, Access to Care and Prevention Initiatives
and the oral health workforce must be enhanced to • Ensure all Missourians have affordable and
ensure access for every Missourian who desires care. accessible dental care
• Increase the number of Missourians who have
It is the Oral Health Task Force’s belief that by a “dental home”
effectively integrating oral health and general health: • Bring healthcare providers (dental and non-
• Access to oral health services will be improved. dental) together to increase oral health
• Oral health prevention efforts will be prevention services and referrals
enhanced. • Increase capacity for oral health education and
• The oral health workforce will be expanded. prevention services through community-based
• Funding for oral health programs will be providers, such as local public health
increased. departments, safety net clinics, and critical
access hospitals
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