saa webinar: confronting challenges, advancing prevention

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Confronting Challenges,Advancing Prevention,Dental Sealants & Fluoridation

Oral Health AmericaTuesday, March 24, 2015

Matt JacobDirector of Communications & Outreach

Children’s Dental Health Project©2015, Children’s Dental Health Project

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The Triple Aim

(Source: “Initiatives: The IHI Triple Aim,” The Institute for Healthcare Improvement, http://www.ihi.org/Engage/Initiatives/TripleAim/pages/default.aspx)

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Dental Sealants

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Dental sealants:A pillar of prevention

• They help prevent tooth decay in the most cavity-prone teeth—those with pits and fissures.

• Applying sealants is a fairly simple process and takes only a few minutes.

(Sources: “Dental Sealants: Proven to Prevent Tooth Decay,” Children’s Dental Health Project, May 2014; Falling Short: Most States Lag on Dental Sealants,” Pew Charitable Trusts, January 2013)

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School-based sealant programs (SSPs)

• SSPs are a major vehicle for placing sealants on the teeth of children at highest risk of decay.

• U.S. Task Force on Community Preventive Services recommends SSPs “based on strong evidence” of decay prevention.

• Pew report: 35 states and D.C. don’t have sealant programs in most of their high-need schools.

(Source: “Falling Short: Most States Lag on Dental Sealants,” Pew Charitable Trusts, January 2013; “Preventing Dental Caries: School-Based Dental Sealant Delivery Programs,” April 2013, www.thecommunityguide.org)

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Reaching high-need schools with sealants

(Source: “Falling Short: Most States Lag on Dental Sealants,” Pew Charitable Trusts, Jan.2013)

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(Source: “Dental Caries and Sealant Prevalence in Children and Adolescents in the United States, 2011–2012,” NCHS Data Brief, No. 191, March 2015.)

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CDHP’s 2014 report:

• Received surveys from 40 states and 23 local SSPs about sealant programs

• Examined 5 states with substantial SSPs to explore factors that shape their reach and sustainability:

o IL, NY, OH, SC & WI

(Sources: “Dental Sealants: Proven to Prevent Tooth Decay,” Children’s Dental Health Project, May 2014, https://s3.amazonaws.com/cdhp/CDHP+Sealant+Report+2014.pdf )

https://s3.amazonaws.com/cdhp/CDHP+Sealant+Report+2014.pdf

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• 21 states receive CDC grants that partly support their SSPs

• 10 states receive HRSA grants that can support SSPs

• Medicaid & CHIP reimbursements are a crucial source of funding:

o 21 of 23 local SSPs billed Medicaid/CHIP



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• Called for a work group to update the clinical guidelines by which sealant programs operate

• Called for a work group to offer recommendations for addressing barriers:

o Consent forms

o Cooperation from school officials



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• CDHP – Planning to convene two work groups to update clinical/scientific and programmatic guidelines that shape how SSPs operate.

• Oral Health America – Will meet its goal to seal 2 million children’s teeth later this year, and OHA is supporting CDHP’s work groups.

(Sources: “Topics and Resources: Dental Sealants, Children’s Dental Health Project, 2014; “Seal Two Million,” Oral Health America, http://oralhealthamerica.org/participate/seal-two-million/)

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Community Water Fluoridation

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Community water fluoridation (CWF)

EFFECTIVE

SAFE

COST-EFFECTIVE

After reviewing 161 studies, the U.S. Task Force on Community Preventive Services recommended fluoridation based on “strong evidence” that it prevents decay.

The National Research Council has issued 5 reports on fluoride or fluoridation. No report has identified health harms from the levels used in water fluoridation.

In most cities, the typical cost of filling one cavity exceeds the lifetime, per-person cost of fluoridating the local water system.

(Source: Slade et al., Effects of Fluoridated Drinking Water on Dental Caries in Australian Adults ,” Journal of Dental Research, April 2013, Vol. 92, No. 4, pp. 376-382)

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Fluoridation reduces tooth decay for children and teens

Nevada – Living in a non-fluoridated community was one of the 3 major risk factors for tooth decay.

(Sources: Ditmyer et al., BMC Oral Health, 2010, 10:24; Kumar et al., Public Health Reports, Sept.-Oct. 2010; Morbidity & Mortality Weekly Report, CDC, “Dental Caries in Rural Alaska Native Children – Alaska, 2008,” Sept. 2011)

New York – Medicaid-enrolled kids living in non-fluoridated areas needed 33% more fillings or treatments.

Alaska – Kids living in non-fluoridated areas had a 32% higher rate of decayed, missing or filled teeth

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Adults also benefit

A 2015 study found that “the prevalence of households with fluoridated water in the local electoral district had a statistically significant and positive association with the probability of an older person having all their own teeth”

(Source: V. O′Sullivan & B.C. O′Connell, “Water fluoridation, dentition status and bone health of older people in Ireland,” Community Dentistry and Oral Epidemiology, Vol. 43, Issue 1, February 2015)

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Adults also benefit from fluoridation

Adults who spent more than 3/4 of their lifetime in fluoridated areas had up to 30% less decaythan adults who had lived less than 1/4 of their lifetimes in fluoridated communities.


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Adults also benefit from fluoridation

A co-author of this study told Science Daily:

“In public health terms, it means that more people benefit from water fluoridation than previously thought.”


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It builds on the benefits of F-toothpaste

A study of Illinois and Nebraska towns found that the cavity rate for kids in the fluoridated town was 45% lower than the rate for kids in the non-fluoridated communities.

90%+ of kids in each town regularly used F-toothpaste.

(Source: Journal of Public Health Dentistry, Winter 1998, Vol. 58, No. 1, 30-32.)

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The safety of fluoridated water

(Sources: “National Academy of Sciences on Fluoride in Drinking Water,” Centers for Disease Control and Prevention, 2013; Report by Public Health England, March 2014; Royal Society of New Zealand, Aug. 22, 2014)

• National Research Council (1951-2007) has issued five reports on fluoride or fluoridation.

• Public Health England (2014)found no links between fluoridation and cancer, kidneystones and other health conditions.

• Royal Society of New Zealand (2014) report led its chief science advisor to conclude fluoridation “poses no risk of adverse health effects.”

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Misinformation circulates widely

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Many online messages are not accurate

(Source: Comment posted by Hon Yo on April 19, 2013 on OregonLive.com, The Oregonian newspaper.)

Comments:

HealthPosse371

I don't want fluoride in my drinking water, and I'll

be damned if a selfish majority decides to put it

there. Look, fluoride works much better topically

in higher concentrations than it does in water at

miniscule concentrations.

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What makes fluoridated water different from other sources of fluoride

British Dental Journal:“Fluoridation of the

drinking water is still the optimal method of fluoride delivery…”

(Sources: J.M. ten Cate, “Contemporary perspective on the use of fluoride products in caries prevention,” British Dental Journal, Feb 2013; “Fluoridation Basics,” CDC, updated on July 25, 2013.)

The CDC:“Water fluoridation

prevents tooth decay mainly by providing teeth with frequent

contact with low levels of fluoride throughout

each day…”

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Truth about fluoride doesn't include Nazi myth

Here's a reason to support a Florida county's decision to cut fluoride out of its drinking water: The idea came from the Nazis.

The Nazis put fluoride in water to pacify Jews during World War II, a local resident told members of the Pinellas County Commission on Oct. 4, 2011, before the commission voted 4-3 vote to stop fluoridating water.

“History shows, actually, that in Nazi Germany, one of the first things that they did was add fluoride to the water in the ghettos where the Jews stayed," Matt Leffler of Clearwater said.

Once the St. Petersburg Times published its story about the decision —similar, anonymous comments on the Web piled up:

Opponents lack credibility

(Source: Becky Bowers, PolitiFact, Tampa Bay Times/Miami Herald, October 6, 2011.)

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Milwaukee alderman says fluoride in toothpaste is a poison

The debate over the use of fluoride in Milwaukee’s water supply was pretty much a one day affair. Led by Ald. Jim Bohl, in that short time frame, the public heard a barrage of unusual claims about their water, rat poison, and even their toothpaste.

Indeed, we thought the debate over fluoridation of water had long been settled.

Since 1953, the Milwaukee Water Works has added a tiny amount of fluoride to the drinking water. Many cities have done this for years to boost dental hygiene and the U.S. Centers for Disease Control and Prevention considers it one of the most important public health efforts of the past 50 years.

Some, including Bohl, have criticized the process. They raise a variety of


(Source: James B. Nelson, PolitiFact, Milwaukee Journal-Sentinel, July 9, 2012.)

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Milwaukee alderman says fluoride in toothpaste is a poison

The debate over the use of fluoride in Milwaukee’s water supply was pretty much a one day affair. Led by Ald. Jim Bohl, in that short time frame, the public heard a barrage of unusual claims about their water, rat poison, and even their toothpaste.

Indeed, we thought the debate over fluoridation of water had long been settled.

Since 1953, the Milwaukee Water Works has added a tiny amount of fluoride to the drinking water. Many cities have done this for years to boost dental hygiene and the U.S. Centers for Disease Control and Prevention considers it one of the most important public health efforts of the past 50 years.

Some, including Bohl, have criticized the process. They raise a variety of

In a letter to the editor published in the March 18 Austin Chronicle, Mike Ford suggests Austin residents have reason to question whether fluoridated water is safe.

"How many would be comfortable if they knew that the fluoride Austin is putting into our drinking water is fluorosilicic acid (toxic waste from the fertilizer industry) that the city buys

from Lucier Chemical Industries?" his letter states.

Eww. Ford, an Austin resident, is part of Fluoride Free Austin, which has urged the city to stop putting fluoride in drinking water. On March 22, a City Council committee took testimony on the practice--and at least one speaker referred to the chemical additive as an industrial toxic waste, according to video of the hearing placed online.

Austin resident: fluoride added to water supply is "toxic waste"

(Source: W. Gardner Selby, PolitiFact, Austin American-Statesman, April 19, 2011.)

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Strategies you can use

• Be proactive — look for opportunities to educate others

• Monitor the dialogue in your city or town. If your community is fluoridated, look for the warning signs:

o An anti-fluoride Facebook page

o Letters to the editor

o Regular speeches at city council meetings

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Messages you can use

• Fluoride is a mineral that exists naturally in public water supplies — even in the ocean.

• Water fluoridation is backed by 70 years of research and experience.

• In most cities, the per-person lifetime cost of fluoridation is less than the cost of filling a single cavity.

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A Fluoridation Tool-Kit for Advocates

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• The tool-kit materials are accessible by clicking on the “Act Now” button at ILikeMyTeeth.org

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Questions orComments?

Matt JacobDirector of Communications & Outreach

Children’s Dental Health ProjectP: 202-417-3600

E: [email protected]: @Teeth_Matter

saa webinar: confronting challenges, advancing prevention

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