department of health and family services

Department of Health and Family Services

Wisconsin Department of Wisconsin Department of Health and Family ServicesHealth and Family Services

Oral Health ProgramsOral Health Programs

Nancy McKenney, RDH, MSNancy McKenney, RDH, MSState Dental Hygiene OfficerState Dental Hygiene Officer

November 18, 2004November 18, 2004


Program CharacteristicsProgram Characteristics

AccessibleAccessible AffordableAffordable AcceptableAcceptable Effective Effective Evidence-BasedEvidence-Based Consistent with Healthiest Wisconsin 2010 Consistent with Healthiest Wisconsin 2010

(State Health Plan)(State Health Plan)


Levels of PreventionLevels of Prevention

Primary (removing or reducing risks, pre-disease Primary (removing or reducing risks, pre-disease initiation)initiation)

Secondary (screening, early detection, intervene Secondary (screening, early detection, intervene to arrest the progress of disease after it occurs)to arrest the progress of disease after it occurs)

Tertiary (rehabilitation and restoration of structure Tertiary (rehabilitation and restoration of structure and function)and function)


State-Based Data Collection PlanState-Based Data Collection Plan


Wisconsin Youth Oral Health Wisconsin Youth Oral Health Data Collection Plan ReportData Collection Plan Report

Factors Affecting Youth Oral Health InFactors Affecting Youth Oral Health In

WisconsinWisconsin

Most recent publication 2001-02Most recent publication 2001-02


PurposePurpose Share information on oral health of Share information on oral health of

Wisconsin childrenWisconsin children Identify key data elements, existing data and Identify key data elements, existing data and

studiesstudies Describe factors affecting youth oral healthDescribe factors affecting youth oral health Provide regional summaries Provide regional summaries Describe available resourcesDescribe available resources Serve as baseline for monitoring factors Serve as baseline for monitoring factors

affecting youth oral health affecting youth oral health


Make Your Smile Count SurveyMake Your Smile Count Survey

Third-Grade ChildrenThird-Grade Children


PurposePurpose

To establish a baseline for monitoring children’s To establish a baseline for monitoring children’s oral health statusoral health status

To assess the extent of children’s oral health To assess the extent of children’s oral health needsneeds

To describe risk factorsTo describe risk factors


SamplingSampling

Self-weighting stratified sample of elementary Self-weighting stratified sample of elementary schools for each of five DHFS regionsschools for each of five DHFS regions

Third-grade childrenThird-grade children Combination of positive and passive consentCombination of positive and passive consent Statewide response rate was 67 percentStatewide response rate was 67 percent


MethodsMethods

Basic Screening Surveys: An Approach to Basic Screening Surveys: An Approach to Monitoring Community Oral Health Monitoring Community Oral Health (ASTDD)(ASTDD)

5 dental hygienists - trained and calibrated5 dental hygienists - trained and calibrated


2003 Healthy Smiles for a Head Start 2003 Healthy Smiles for a Head Start


SamplingSampling

Random sample of Head Start grantees Random sample of Head Start grantees within each DHFS geographic regionwithin each DHFS geographic region

Number screened proportional to the Number screened proportional to the number of children in that region enrolled number of children in that region enrolled in Head Startin Head Start

Representative of Head Start children, Representative of Head Start children, not all preschool children in Wisconsinnot all preschool children in Wisconsin

Needed positive consent formNeeded positive consent form


MethodsMethods

Methods outlined in Methods outlined in Basic Screening Surveys: An Approach Basic Screening Surveys: An Approach to Monitoring Community Oral Health to Monitoring Community Oral Health (ASTDD)(ASTDD)

Trained and calibrated screenerTrained and calibrated screener Information collected:Information collected:

Child’s date of birth, age, gender, race, and ethnicityChild’s date of birth, age, gender, race, and ethnicity Caries experience in the primary dentition (no, yes) Caries experience in the primary dentition (no, yes) Untreated cavities (no, yes)Untreated cavities (no, yes) Early Childhood Caries – decay and/or fillings in the Early Childhood Caries – decay and/or fillings in the

upper anterior teeth (no, yes)upper anterior teeth (no, yes) Treatment urgency (urgent need for dental care, early Treatment urgency (urgent need for dental care, early

dental care is needed, no obvious problems)dental care is needed, no obvious problems)


Maternal and Early Childhood Maternal and Early Childhood Oral Health ProgramsOral Health Programs


Maternal Oral HealthMaternal Oral Health

Preconceptional, prenatal and postnatal Preconceptional, prenatal and postnatal oral healthoral health

Educate primary healthcare providersEducate primary healthcare providers

Promote healthy birth outcomesPromote healthy birth outcomes


Early Childhood Oral HealthEarly Childhood Oral Health Transmissible, bacterial infectionTransmissible, bacterial infection Unique characteristics and risk factorsUnique characteristics and risk factors DHFS oral health consultants train medical/ dental DHFS oral health consultants train medical/ dental

personnel, health dept., rural clinicspersonnel, health dept., rural clinics Training:Training:

– Basic screening surveyBasic screening survey– Anticipatory guidanceAnticipatory guidance– Fluoride varnish applicationFluoride varnish application– ReferralReferral


"Healthy Teeth for Mom and Me"

Project goals include: Increase primary health care provider awareness as to

the importance of oral health Improve oral health awareness among pregnant teens Increase utilization of preventive and restorative dental

services by pregnant teens and infants

Grant collaborators include the Division of Health CareFinancing (DHCF), United Healthcare, Managed HealthServices, Network Health Plan, Southeast DentalAssociates (SEDA) and Doral Dental USA.

Health Resources Services Administration


Integrating Preventive Oral Health Measures intoHealthcare: A Training for Primary Healthcare Settings

Regional Oral Health Consultants provide technical assistanceand training for local health departments, tribal health centers,federally qualified health centers, HealthCheck agencies in oralhealth program development in the five DPH Regions.

Primary health providers are trained to provide oral healthscreening, anticipatory guidance, fluoride varnishes andreferral for children and periodontal symptom screening,anticipatory guidance and referral for pregnant women.

Health Resources and Services Administration


Other Fluoride ProgramsOther Fluoride Programs


Community Water Fluoridation ProgramsCommunity Water Fluoridation Programs

Evidence-based prevention program Evidence-based prevention program Reduces health disparities, benefits all ages Reduces health disparities, benefits all ages

and socioeconomic statusand socioeconomic status Reaches 63% of total Wisconsin populationReaches 63% of total Wisconsin population 90% of Wisconsin population on community 90% of Wisconsin population on community

water supplieswater supplies Wisconsin is 12th highest in nationWisconsin is 12th highest in nation


Percent of Wisconsin Population with Fluoridated Water, Total Population and Population on Municipal

Water Systems

63%

90%

63%

90%

56%62%

75%

0%

25%

50%

75%

100%

Total Population Population on Systems

2000 2001 U.S. U.S. Goal


Dietary Fluoride Supplement Dietary Fluoride Supplement ProgramsPrograms

Used since 1940’s Used since 1940’s Children living in households with inadequate levels of Children living in households with inadequate levels of

fluoridated water fluoridated water Prescribed for children six months - six years Prescribed for children six months - six years

– Water supplies must be testedWater supplies must be tested– Other water sources taken into consideration Other water sources taken into consideration

(example: day care)(example: day care) DHFS-supported programs serve approximately 2,245 DHFS-supported programs serve approximately 2,245

children children


School-based Fluoride Mouthrinse School-based Fluoride Mouthrinse ProgramsPrograms

Supervised, weekly, school-based programSupervised, weekly, school-based program Children over age six in non-fluoridated Children over age six in non-fluoridated

communitiescommunities DHFS provides funding and technical assistanceDHFS provides funding and technical assistance DHFS-supported programsDHFS-supported programs

– 66 schools66 schools– Serve over 10,000 childrenServe over 10,000 children


Dental Sealant ProgramsDental Sealant Programs


Healthy Smiles for WisconsinHealthy Smiles for WisconsinSeal-a-Smile ProgramSeal-a-Smile Program

Dental sealants are a thin resin coatingDental sealants are a thin resin coating– Covers chewing surfaces (permanent molars)Covers chewing surfaces (permanent molars)– Provides a physical barrier to cavity causing Provides a physical barrier to cavity causing

bacteria and carbohydratesbacteria and carbohydrates– Pits and fissures are most susceptible (morphology)Pits and fissures are most susceptible (morphology)

Evidence-based prevention strategyEvidence-based prevention strategy MA cost expenditure savingsMA cost expenditure savings Target high-risk children with low access (high Target high-risk children with low access (high

free and reduced lunch school)free and reduced lunch school)


Healthy Smiles for WisconsinHealthy Smiles for WisconsinSeal-a-Smile ProgramsSeal-a-Smile Programs

47% of Wisconsin third-grade children dental 47% of Wisconsin third-grade children dental sealants sealants

Significantly fewer sealants in children enrolled Significantly fewer sealants in children enrolled in higher free and reduced lunch schoolsin higher free and reduced lunch schools

2003-04 hosted 102 events in 14 communities2003-04 hosted 102 events in 14 communities– 4,255 children screened4,255 children screened– 2,898 received sealants2,898 received sealants– 12,461 dental sealants placed12,461 dental sealants placed


Seal-A-Smile ProgramSeal-A-Smile Program

YearYear Screened Received Sealants Sealants Placed Screened Received Sealants Sealants Placed

2000-012000-01 2,0572,057 1,548 1,548 5,571 5,571 2001-022001-02 3,320 3,320 2,366 2,366 8,823 8,823 2002-032002-03 4,3674,367 2,670 2,670 10,681 10,681 2003-042003-04 4,255 2,898 12,4614,255 2,898 12,461


Guardcare Sealant ProgramGuardcare Sealant Program National Initiative, part of clinical trainingNational Initiative, part of clinical training Collaborative effort with Wisconsin Army Collaborative effort with Wisconsin Army

National Guard, 13th Medical and Dental National Guard, 13th Medical and Dental Detachment, DHFS, LHD, health professional Detachment, DHFS, LHD, health professional education, community organizations, agencieseducation, community organizations, agencies

Free sealants to underservedFree sealants to underserved Since 1995: Since 1995:

– 3,074 children served3,074 children served– 15,070 teeth sealed15,070 teeth sealed


JJoohhnnssttoonn CCoommmmuunniittyy HHeeaalltthh CCeenntteerr

Comprehensive dental care provided to children of primarily Hispanicethnicity, including a school-based dental sealant program componentin Milwaukee targeted to low-income children in second, fifth, andeighth grades and a Head Start program component providingpreventive services to Head Start programs for screening and fluoridevarnish application.

Head Start component: children screened = 114 fluoride varnishes applied = 114

Outreach dental sealant program: children screened = 2,118 children receiving sealants = 1,106 total number of sealants = 4,204

Dental services at Johnston: visits = 1,109 and patients = 646


Spit Tobacco ProgramSpit Tobacco Program


Spit Tobacco ProgramSpit Tobacco Program

Smokeless tobacco associated with oral cancerSmokeless tobacco associated with oral cancer Use often begins in adolescenceUse often begins in adolescence 20% reported 20% reported everever using using 9% of all students reported using in the past 30 9% of all students reported using in the past 30

daysdays– 14% of males14% of males– 4% of females 4% of females


Spit Tobacco ProgramSpit Tobacco Program DHFS contracts with WDA DHFS contracts with WDA Partners include: Milwaukee Brewers Baseball Club Partners include: Milwaukee Brewers Baseball Club

and Department of Public Instructionand Department of Public Instruction Five-day curriculum: comic book with health Five-day curriculum: comic book with health

messages, integrates math, science, geographymessages, integrates math, science, geography– Served 150 schools, 80,000 fifth-grade students Served 150 schools, 80,000 fifth-grade students

including Brewer’s Day in the Parkincluding Brewer’s Day in the Park– Evaluation indicates teacher satisfaction with Evaluation indicates teacher satisfaction with

curriculum and improved child learning and attitudecurriculum and improved child learning and attitude


Program ModelsProgram Models

Price CountyPrice County

CESA 11CESA 11

Children’s Dental Health Clinic in Children’s Dental Health Clinic in MadisonMadison


Clinic-Based ServicesClinic-Based Services


Rural Dental ClinicsRural Dental Clinics

State funding supports three rural dental clinicsState funding supports three rural dental clinics– Cooperative Education Service Area (CESA 11) Cooperative Education Service Area (CESA 11)

manages Menominee projectmanages Menominee project– Marshfield Family Health Center (federally qualified Marshfield Family Health Center (federally qualified

health center) manages health center) manages Ladysmith projectLadysmith project, , strengthening coordination of care between strengthening coordination of care between medical/dental clinicsmedical/dental clinics

– Tri-County Community Dental Clinic serves Tri-County Community Dental Clinic serves Winnebago, Calumet and Outagamie counties (03-04)Winnebago, Calumet and Outagamie counties (03-04)


Marquette University School Marquette University School of Dentistryof Dentistry

Provides comprehensive services to patients Provides comprehensive services to patients of all income levelsof all income levels

Serves over 15,000 unduplicated patients Serves over 15,000 unduplicated patients during approximately 47,500 visitsduring approximately 47,500 visits– 65% paid out-of-pocket 65% paid out-of-pocket – 18% Medicaid/BadgerCare18% Medicaid/BadgerCare– 10% Medicare10% Medicare– 7% private insurance 7% private insurance


Marquette University School Marquette University School of Dentistryof Dentistry

ClinicsClinics– Marquette University School of Dentistry Clinic Marquette University School of Dentistry Clinic

(Milwaukee)(Milwaukee)

– Isaac Coggs Community Health Center Isaac Coggs Community Health Center (Milwaukee)(Milwaukee)

– Johnston Community Health Center Johnston Community Health Center (Milwaukee)(Milwaukee)

– Oneida Community Health Center Oneida Community Health Center (Oneida)(Oneida)

– Tri-County Community Dental ClinicTri-County Community Dental Clinic (Fox Valley) (Fox Valley)


Donated Dental ServicesDonated Dental Services The Foundation for the Handicapped The Foundation for the Handicapped

– National charitable organization National charitable organization – Started to assist medically compromised, aged, Started to assist medically compromised, aged,

indigent, and people with disabilitiesindigent, and people with disabilities– Wisconsin Foundation for the Handicapped is an Wisconsin Foundation for the Handicapped is an

affiliateaffiliate Wisconsin provides state funds annually for a Wisconsin provides state funds annually for a

program coordinator at WDAprogram coordinator at WDA– Dentists provide donated servicesDentists provide donated services– DHFS monitors contractDHFS monitors contract

department of health and family services

Documents