1. A MODEL FOR DENTAL CARE IN A SCHOOL BASED PROGRAM CHEMAWA INDIAN HEALTH CENTER DENTAL PROGRAM Beth Finnson, RDH, MPH

4. Oral Health in America A Report of the Surgeon General –David Satcher, MD, 2003 Silent epidemic affecting… –Poor children –Elderly –Racial and ethnic minority groups

5. World Health Organization “Dental…disease is not eradicated, but only controlled…”

6. Dental Caries –Chronic childhood disease –51 million school hours lost yearly –164 million work hours lost yearly –16,000 school hours lost yearly in Oregon

7. Oral Health and General Health Optimal oral health provides… –Speaking –Smiling –Chewing –Tasting –Swallowing

8. Oral Health and Learning Early tooth loss results in… –Failure to thrive –Impaired speech development –Malocclusion –Reduced self esteem

9. Oral Health and Learning Chronic Dental Pain causes… –Anxiety –Fatigue –Irritability –Depression –Inability to concentrate –Poor nutrition

11. OUR MISSION… To raise the physical, mental, social, and spiritual health of American Indians and Alaska Natives to the highest level.

12. OUR GOAL… To assure that comprehensive, culturally acceptable personal and public health services are available and accessible to American Indian and Alaska Native People.

13. OUR FOUNDATION… To uphold the Federal Government’s obligation to promote health American Indian and Alaska Native people, communities, and cultures and to honor and protect the inherent sovereign rights of Tribes.

14. IHS/Tribal Healthcare Systems 48 hospitals 280 health centers 147 health stations 34 urban health projects 9 residential treatment centers 176 Alaska village clinics

15. Chemawa Indian Health Center

16. Indian Health Disparities 55% AI/AN rely only on IHS healthcare Reduced life expectancy Higher infant mortality rate Safe/adequate water supplies Waste disposal facilities

17. Indian Population 1997-1999 Current Population Survey –Larger families –Less health insurance –Lower household median income –Lower educational levels –Higher unemployment rates –Young population

18. Service Population Trends 65% population increase (1990-2006) Increase in life expectancy (64-73) Federal recognition for more tribes 56% urban 44% reservation or rural areas Inadequate IHS budget

19. Indian Health Service Mobile Dental Van

20. Challenges in IHS Dental Programs 2,800 patients per IHS dentist 1,500 patients per U.S. dentist $50 average IHS expenditure per patient $300 average U.S. per patient 25% dental access for Indian people

21. Oral Disease Trends 76% pre-school children with caries 68% adolescent children with caries Increased access for sealants 63% 8 year-olds with at least 1 sealant

22. Chemawa Indian School Forest Grove

23. Chemawa Indian School Indian Boys

24. Chemawa Indian School Salem, OR

25. Chemawa Indian School Totem Pole

26. Chemawa Health Center Comprehensive health care facility MedicalPharmacy DentalPublic Health OptometryBehavioral Health LabSchool Nursing RadiologyPodiatry Registration/Billing/Coding

27. Chemawa’s Model for A Dental SBHC Program –Collaboration School staff Health facility staff Dental students Dental hygiene students Volunteers

28. Model for Dental SBHC Screen process Document, document, document… Prioritize Preventive care Clinical care Specialty care Evaluation

29. Documentation NameHygiene care ChartSealants Home stateRetention Rates Screen dateExtractions Exam dateRoot canals Number of cariesPTC Urgent needsDrop

30. Screen Results 2007-2008 462 students, aged 14-19 349 screened 99% have had dental caries 82% with untreated decay 15% reported oral pain

31. Treatment Results 2007-2008 51% complete exams 9% extractions 99% oral hygiene education & cleaning 85% received 498 dental sealants 47% completed treatment

32. Screen Results 2008-2009 387 students, aged 14-19 387 screened 97% have had dental caries 73% with untreated decay (1395 carious teeth) 14% reported oral pain

33. 2010 Target = 57% 19962000 Receipt of Preventive Services by Low Income Children Obj. 21-12 Note: Data are for children under 19 years. Low income is less than 200% of poverty level. Preventive services include examinations, cleaning, x-rays, fluoride treatments and sealant applications. Source: Medical Expenditure Panel Survey, AHRQ.

34. Total 2010 Targets 6-11 Years12-18 Years BlackMexican American White TotalBlackMexican American White Dental Sealants: 1988-94 and 1999-2000 Obj. 21-8 1999-2000 1988-94 Unreliable estimate, relative standard error >30%. Note: Targets are for children 8 years and 14 years. Black and white exclude persons of Hispanic origin. Persons of Mexican-American origin may be any race. Source: National Health and Nutrition Examination Survey, NCHS, CDC. Percent

35. Dental Sealants

36. Obj. 21-1c Adolescents 12-18 Years Who Ever Had Caries in Permanent Teeth, 1988-94 and 1999-2000 Note: Target is for adolescents 15 years old. Black and white exclude persons of Hispanic origin. Persons of Mexican- American origin may be any race. Source: National Health and Nutrition Examination Survey, NCHS, CDC. TotalBlackMexican American White MaleFemale Percent 2010 Target 1988-94 1999-2000

37. Oregon Smile Survey 2007 3,865 1st,2nd & 3rd graders Oregon ranks 25/32 states Disease disparities –Geographic –Poverty –Dental insurance –Race/ethnicity

38. Oregon Smile Survey 2007 64% of children have had dental caries 20% of children with rampant decay (7+) 35% of children with untreated decay 25% with no dental insurance 9% with no dental home 20% need urgent care due to pain/infection 43% with dental sealants

39. Oregon Smile Survey Recommendations –Community water fluoridation –Early-childhood cavities prevention –School based fluoride supplement program –School based dental sealant programs

40. Resources Oregon Dental Association Oregon Dental Hygienists’ Association Dental Foundation of Oregon Tooth Taxi Medical Teams International Mobile Dental Van Boys and Girls Club

41. Resources Oregon Smile Survey Burden of Disease in Oregon Oral Health Data Book King Fluoride Dental Sealants Protect Oregon Teeth: A Guide… http://www.oregon.gov/DHS/ph/oralhealth

42. Tooth Taxi

43. Questions ? Beth Finnson, RDH, MPH Chemawa Indian Health Center 3750 Chemawa RD NE Salem, OR 97305 503-304-7631 beth.finnson@ihs.gov