STEP UP for Kids: ORAL HEALTHBlueprint for Kentucky’s Children Event

December 1, 2014

Nikki Stone, DMD, Chair, KOHC

The Blueprint for Kentucky’s Children believes all children should have the opportunity to succeed.

In the USA, dental care remains the greatest unmet health need among children.

KY ranks 45th in the percentage of children with untreated dental decay (34.6%).

KY was given a grade of “C” in children’s oral health by the Pew Center on States report.

In 2012, only 40% of KY children enrolled in Medicaid or KCHIP received even a single dental service.

KY ranks 5th in the nation for “toothlessness” (25% of adults age 65 and older have had all their natural teeth removed).

Importance of Oral Health

Good oral health is an integral component of optimal childhood LEARNING.

Children free from dental pain and infection can focus on their schooling.

Access to preventative dental services significantly improves school attendance and developmental growth.

Oral Health and LEARNING

Poor Oral Health Affects Children’s Learning Abilities

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The two schools with the LOWEST untreated tooth decay rates are the two schools with the HIGHEST standardized test scores 07/08.

2015 Policy Agenda FACT SHEET includes:

General Oral Health Information

History of the Legislation

Barriers to Achieving Desired Impact

Pertinent Facts

SOLUTION: Strengthen the Kindergarten Entry Oral Health Screening Requirements

2015 ORAL HEALTH Policy Agenda

Good oral health is CRITICAL to good overall health.

Tooth decay and other oral diseases can have long-lasting impacts on a child’s ability to LEARN, SPEAK, and EAT.

It is critical for families to begin receiving routine dental care for their children during EARLY CHILDHOOD.

Oral Health

The Blueprint helped craft a bill requiring children enrolling in schools to get a dental screening or exam.

The bill passed and was signed into law on April 15, 2008.

The bill requires dental screenings for all children entering kindergarten.

The purpose was so that oral health problems could be addressed early and not interfere with learning.

History of the Legislation

The Legislation

Kentucky law, KRS 156.160(i), requires proof of a dental screening or examination by a dentist, dental hygienist, physician, registered nurse, advanced registered nurse practitioner, or physician assistant. This evidence shall be presented to the school no later than January 1 of the first year that a five (5) or six (6) year old is enrolled in public school.

Barriers to Achieving Desired Impact

Several key elements in implementation are necessary to ensure the requirement achieves the intended impact.

In school year 2013/14, at least 48% of incoming kindergarteners did NOT receive a dental screening or their school district did not report the data.

YES

NO

48%

1. Kindergarten oral health screenings help keep children healthy.

2. Poor oral health hinders children’s ability to learn.

3. Kentucky has not collected comprehensive information on children’s oral health for over a decade.

Pertinent Facts

Tooth decay is a transmissible bacterial infection, usually passed from mother to child before age one.

Tooth decay is the #1 most common CHRONIC childhood disease in the USA (chronic means it is a lifelong struggle).

Tooth decay is often established by the time a child enters preschool.

Untreated tooth decay can lead to serious infections in the mouth and in the body and cause pain, infection, and even death.

Untreated tooth decay and gum disease are linked with chronic conditions in adults such as heart disease, diabetes, and stroke.

1. KINDERGARTEN ORAL HEALTH SCREENINGS HELP KEEP CHILDREN HEALTHY

The bacteria that causes caries is transmissible. Streptococcus Mutans transmission from mother to child

BABIES GET CAVITIES!

10 Volunteers

In our four county service area, in Head Start children ages 2-5,

58% had untreated tooth decay in 2007/08

6 out of 10 PRESCHOOLERSin East KY Age 3-5 Have Cavities

In our four county service area, in elementary children ages 6-12,

68% have untreated tooth decay in 2007/08

This is a permanentsix year molar, noteven fully erupted,already decayed &infected because of untreated decay inbaby teeth.

This is a decayedbaby tooth that

never got treatment.

URGENT dental needs in this group are also 20%.

7 out of 10 ELEMENTARY KIDSin East KY Age 6-12 Have Cavities

ORAL HEALTH SCREENINGS CAN CATCH TOOTH DECAY

EARLY SO IT CAN BE TREATED

Children in pain cannot effectively concentrate in school.

Children who do not receive appropriate dental care are more likely to miss school days and fall behind academically.

2. POOR ORAL HEALTH HINDERS CHILDREN’S ABILITY TO LEARN

Poor Oral Health Affects Children’s Learning Abilities

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The two schools with the LOWEST untreated tooth decay rates are the two schools with the HIGHEST standardized test scores 07/08.

CHILDREN IN PAIN CANNOT LEARN

Infection

20 out of20 teeth decayed(rampant)

Pain

2 out of 10East KY Kids Are in PAIN

OUCH! OUCH!

Thank You to the Volunteers

ENSURING EVERY KINDERGARTENER RECEIVES AN ORAL HEALTH SCREENING WILL RESULT IN STUDENTS WHO ARE

BETTER PREPARED TO LEARN

The last state-wide study on children’s oral health was done in 2001.

Therefore, Kentucky relies on the kindergarten oral health screening data to see where we stand on children’s oral health.

Currently, there is inconsistent data entry from the screening forms, so we lack reliable, quality data.

3. KENTUCKY HAS NOT COLLECTED COMPREHENSIVE INFORMATION ON CHILDREN’S

ORAL HEALTH FOR OVER A DECADE

Prevalence of Early Childhood Caries (under age 5): USA reported 12%

KCOHS reported 31%

The new regional dental program in Hazard collected county-level data and found rates were 58% !!!

HealthyPeople 2010 set the target GOAL as 9%...

WE NEED GOOD DATA TO TRACK THE PROBLEM!!

2001 KCOHS Kentucky Children’s Oral Health Survey

Service AreaSoutheastern KY – the Heart of Rural Appalachia

Letcher

KnottPerry

LeslieOver 2,400 children areseen every year at 40 different sites in areaHead Start centers and elementary schools.

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White Black MexicanAmerican

EASTERNKENTUCKY

AlaskanNative

American

Pre-School (ages 2-5) Elementary (ages 6-12)

2nd Highest Tooth Decay Rates in USA(58% of preschool & 69% of elementary kids had

untreated tooth decay in eastern Kentucky in 2007/08)

Compared with National Data (NHANES)

ORAL HEALTH DATA IS NECESSARY FOR INFORMING POLICY MAKERS ON THIS CRITICAL HEALTH ISSUE FACING KENTUCKY’S CHILDREN

ECONOMIC IMPACTWould you hire this person for a job?

ECONOMIC IMPACT

http://www.nydailynews.com/celebrities-teeth-gallery-

1.1305882#pmSlide=0

http://www.sadanduseless.com/2013/03/

celebrities-without-teeth/

PSYCHOLOGICAL IMPACTWill this child have high self esteem?

“The other kids call me “Snaggle Tooth.” “The other kids said I have ugly teeth.”

Bad Teeth & Gums Cause:

Pain, infection Abscess can spread to brain causing death Bad breath Digestive problems Self-confidence / self-esteem / self-image Distraction / trouble concentrating Can’t learn in school / bad grades Can’t get a job Expensive to fix and replace lost teeth

Improve child health:

Strengthen the kindergarten entry oral health screening requirements.

2015 Policy AgendaSOLUTION:

Lack of clarity on who can conduct the screenings.

Lack of clarity on training required for conducting screenings.

Confusion on how to fill out the screening form.

Lack of accountability in following the regulations at the school and district levels.

Lack of guidance or process to ensure that children get treatment if there are urgent needs found.

Kentucky Oral Health Coalition Received Input on the Issues

Establish a systematic referral process for children identified with tooth decay.

Expand training to nurses and other health professionals such as pediatricians.

Require, enforce, and incentivize data entry from the screening form (at least in the aggregate).

Create linkage agreements with community health professionals and schools.

Update the form for clarity and standardization. Ensure that the form is distributed to those who need it, such as

dentists, nurses and pediatricians. Provide education on how to use the form.

Kentucky Oral Health Coalition’s Recommendations

2015 Policy Agenda:

Strengthen kindergarten entry oral health screening requirements.

STEP UP for Kids !Attend the Annual Children’s Advocacy Day at the Capitol on February 5, 2015.

Every pregnant woman had all of her oral health needs taken care of either before or during pregnancy…

Every new mother received the education she needed to know how to properly feed her child and clean her child’s gums and newly erupting teeth…

Every medical provider and health department was trained on and discussed with parents the importance of oral health at every well-child visit…

Every preschool or Head Start child received dental visits and fluoride varnishes at their own school…

Every preschool or Head Start parent received training in caring for the oral health of their family…

What if…?

Every child had a dental screening before entering Kindergarten…

…and every child with dental needs was linked with a local dental office and received the care he/she needed…

Every elementary student received a dental visit at his/her own school every school year which included an exam, cleaning, fluoride, and sealants placed on permanent molars…

Every elementary student received science-based classroom education in oral health every school year…

Every family established a “dental home” in their own community and made oral health a priority…

What if…?

Focus on PREVENTION

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When a forest fire is burning out of control, fire fighters focus their efforts on the mountain that is not on fire yet, SOAKING it down, so that it doesn’t catch fire… a different approach… PREVENTION !!We can SOAK the kids with fluoride & sealants.

Trying to fight toothdecay in Eastern KY is like trying to put out a forest fire with a squirt gun…This approach has failed for decades!

Preventive Dental Outreach Program LOWERS Tooth Decay Rates

01020304050607080

01020304050607080 DOWN 19%

% Elementary Children with Untreated Tooth Decay

% Head Start Children with Untreated Tooth Decay

69%

51%58%

39%

DOWN 18%

“You can’t stay in your corner of the woods waiting for others to come to you. .. You have to go to them sometimes.”

~Winnie the Pooh

QUESTIONS ???