Deamonte Driver A 12 year old boy from

Deamonte Driver A 12 -year old boy from Maryland who died of a toothache in 2007 when the bacteria from a dental abscess spread to his brain An $80 tooth extraction could have saved him A $1 fluoride varnish could have prevented the abscess to begin with

Addressing an Epidemic Implementing a Fluoride Varnish Program for Adolescents at School Based Health Centers Shannon C. Wirth Samuel Merritt University

Objectives The objective of this presentation is to: • Examine the evidence that justifies providing a fluoride varnish program to adolescents in school based health centers. After this presentation, the participant will understand: • The epidemiology of the dental caries rate among various populations • The barriers to access of dental care • The benefits of dental fluoride varnishes • The proposed intervention to address the dental carries rate among adolescents

OVERVIEW Dental Caries Dental decay is the leading chronic disease of childhood in the United States – 5 times more common than asthma – 3 times more common than obesity

OVERVIEW Adolescent Population 59% of adolescents have had dental caries in their permanent teeth 23% have untreated decay

OVERVIEW Fluoride Varnish The regular application of fluoride varnish on permanent teeth can reduce dental decay by 46%

FLUORIDE VARNISH • What is it? – Highly concentrated varnish that is painted directly onto the teeth – Does not adhere permanently, but instead holds a high concentration of fluoridated material close to the teeth, repairing and strengthening the enamel over time

DEFINITIONS/THEORY • • Adolescent Dental Caries Fluoride Varnish Nancy Milio “A Framework for Prevention: – Personal choicemaking in the context of societal optionsetting

EPIDEMIOLOGY • Overall rate of dental caries is decreasing • Remains highest during adolescence – 59% of adolescents have had caries in permanent teeth – 23% have untreated decay • Distribution of dental caries in permanent teeth in different age groups: – 50% in 12 - to 15 -year-olds – 78% in 17 -year-olds

WHY ADOLESCENTS? • Distinct need for oral health as compared to other stages of childhood: – – Dental carries is a progressive condition Immature permanent tooth enamel Increase in susceptible tooth surface Change in nutritional habits • Increase in sugary food/liquids – – Use of tobacco, alcohol, other drugs Pregnancy and eating disorders Low priority for oral hygiene Ability to avoid care through gain in independence

COST OF DENTAL DECAY • Diminished quality of life – Diet, nutrition, sleep, social interactions • School absences – Missed opportunities for learning – Loss in school funding • Increased cost of care • Systemic health ramifications • Death

EPIDEMIOLOGY Digging Deeper • Distribution of dental decay follows the 80/20 rule – 80% of decay is found in 20% of the population • The burden of dental decay is disproportionately carried by low income and minority children – Highest rates in Latino children – High rates also seen in African American and Native American children – Low socioeconomic status (SES) is the common denominator

STATISTICS Dental Visits • Latino and multiracial children were found to have the highest risk of never having seen a dentist (18% and 16%) • Native American children (15%), Latino children (12%) and African American children (11%) made no preventive dental visit in the past year, compared to 5 -7% of other racial or ethnic groups

ACCESS • Adolescents are less likely to visit a dentist the older they become • Having private dental coverage doubles the likelihood of a teen having a dental visit

ACCESS • Is insurance the barrier to access? – Low-income parents have problems with access despite insurance status • Healthy Family dental visits – 2008: 56% of the enrollees saw a dentist – 2007: 57% of the enrollees saw a dentist – 2006: 62% of the enrollees saw a dentist • Medi-Cal – 2007: 31% of the enrollees saw a dentist

ACCESS Financial vs. Non-Financial Barriers • FINANCIAL – $1, 500 yearly limit on dental services for children covered by the Healthy Families program – Families pay for half of all dental expenditures, while only one third are paid by dental insurance

ACCESS Financial vs. Non-Financial Barriers • NON-FINANCIAL BARRIERS – Dentists providing Medicaid services • Finding a dentist who accepts Medicaid can be difficult, or such is the perception – Language • Children from ESL households have triple the odds of unmet dental care needs – Culture • Foreign born children receive less preventive care, despite insurance status – Cultural concept of dental care – Importance of preventive care – Navigation of the US medical/dental system

ADDRESSING THE NEED FOR PREVENTION Intervention Apply fluoride varnishes at every sports physical and well-child exam at the School Based Health Clinics of the Native American Health Center in Oakland, CA.

WHY SCHOOL BASED HEALTH CENTERS? • Targets preventive services directly to underserved, low-income youth • Mitigates many of the barriers to care • SBHC of NAHC: – 4 high school and 2 middle schools – Meets the kids where they’re at

WHY FLUORIDE VARNISH? • 46% reduction of dental carries in permanent teeth • Highest recommendation from the CDC and ADA for at-risk youth • Benefits the child, the clinic and therapeutic relationship between patient and provider

FLUORIDE VARNISH • Benefits – Cost effective: • $0. 82 -$2. 36/ unit • Reimbursable by Medicaid • Minimal provider time and materials required – Fits well in SBHC/Primary Care • No special dental equipment • No special preparation of teeth • Natural fit with healthy lifestyle / healthy habits discussion

IMPLEMENTATION PLAN • • • Stakeholder identification and buy-in Staff-training Pilot program implementation Evaluation Expansion

IN CONCLUSION • Good oral health requires good overall health • Untreated dental decay leads to infection, pain, and absence from school - leading to reduced quality of life and lost opportunities for learning • The regular application of fluoride varnish can reduce dental decay in permanent teeth by 46% • The application of fluoride varnish is an ideal intervention to address the oral health epidemic in this nation