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Current Issues in Oral HealthWest Virginia Oral Health SummitMarch 4, 2022

Overview1.About the U.S. Public Health Service2.The Pandemic & Oral Health3.Oral Health in America, Advances and Challenges 4.Oral Health, the Community, and the EconomyChildren & AdolescentsWorking-Age Adults and Older AdultsWorkforce, Education, and IntegrationMental Illness and Substance UseEmerging Science & TechnologyHealthy People 2030Overview2

Overview of the USPHSAbout the USPHS3

“Protect, Promote, and Advance the Health & Safety of the Nation”About the USPHS4

USPHS Dentist LocationsAbout the USPHS5

COVID-19 Public-Private Partner Dental Coordination GroupFederal Entities:BOPCDCCMSDoD (A, AF, N)FDAHRSAICE HSCIHSNIDCROSHAUSPHSVHA14Major PHDACPASDA99MedicalOrganizations:Other National Dental & PublicHealth DAAWDCareQuestACDComm. CatalystACFFDTAADEAForsyth Inst.ADSOMSDAAFSNADLNADPNMCHOHRCNNOHAOPENOSAPProj. AOHSanta FeAAPAPHANIIOHNRHA284Partnerships6

Oral Health Interconnectivity“5-eyes” Colleagues: Canada New Zealand Australia U.K. (England, Ireland,Scotland, Wales)USPHS Categories: DieticiansEngineersEnvironmental HealthHealth Services pistsVeterinariansPartnerships7

The PandemicPandemic8

Pandemic Update: Children’s Medicaid Dental ServicesMedicaid children’s dental services are still below pre-PHE levels. loads/covid19-data-snapshot-11122021.pdfPandemic9

Impact on JfM3BaeGhzWm12TnNMdjB4Pandemic10

Dental Scopes of Practice Expansion – COVID-197th PREP Act amendment, effective 3/11/2021, supersedes state authorization.DentistsHygienists# of states allowing dentalstaff to administer COVID-19vaccine2418# of states allowing dentalstaff to administer influenzavaccine81# of states allowing dentalstaff to administer /covid-19-resourcesGEORGIA: 1/15/21 – Gov. Kemp gave temporary authorization todentists.Pandemic11

Vaccinator JfM3BaeGhzWm12TnNMdjB4Pandemic12

Reasons for Not tVVJfM3BaeGhzWm12TnNMdjB4Pandemic13

Staffing Shortages35.8% of dentists recruiting dental assistants28.8% seeking dental hygienists26.5% seeking administrative staff13.1% seeking -emerge-from-covid-19-pandemicPandemic14

Oral Health in America: Advances & Challenges15

To Access the caOral Health in America: Advances & Challenges16

Foundation: 2018 Listening SessionLeft: Steering Committee for the Report, December 2018, with former SG Jerome AdamsRight: With the NIDCR editorial team for Oral Health in America: Advances & ChallengesOHA: Background17

Report Sections Section 1:Effect of Oral Health on the Community, Overall Well-Being, andthe Economy Section 2A:Oral Health Across the Lifespan: Children Section 2B:Oral Health Across the Lifespan: Adolescents Section 3A:Oral Health Across the Lifespan: Working-Age AdultsOHA: Background18

Report Sections Section 3B:Oral Health Across the Lifespan: Older Adults Section 4:Oral Health Workforce, Education, Practice and Integration Section 5:Pain, Mental Illness, Substance Use, and Oral Health Section 6:Emerging Science and Promising Technologies toTransform Oral HealthOHA: Background19

Section 1 Overview: Effect of Oral Health on the Community,Overall Well-Being, and the Economy Good oral health supports overall health and well-being of individuals, families,communities, and the nation. Poor oral health reduces the economic productivity of society by limitingparticipation in the workforce, as well as by increasing health care costs. Natural disasters, the emergence of novel pathogens, such as COVID-19, andother large-scale emergencies underscore the need for public-private partnershipsthat plan and ensure the continued delivery of essential oral health care in times ofcrisis.Oral Health, the Community, and the Economy20

Section 1 Key Graph:Effect of Oral Health on theCommunity, Overall Well-Being, and the Economy Page 1-3 (61)Oral Health, the Community, and the Economy21

Factors Affecting Access to Dental Care – Another ModelOral DiseasesOral Health, the Community, and the Economy22

Access to Dental Care, last 20 yearsYearAccess 43.3%HP2020Goal49.0%HP2030Goal45.0%Oral Health, the Community, and the Economy23

Access by Race/Ethnicityhttps://www.ada.org/ raphic 0421 4.pdf?la enOral Health, the Community, and the Economy24

Oral Health ?utm source adaorg&utm medium hpifeaturedbox&utm content infographicsOral Health, the Community, and the Economy25

Section 1 Call to Action: Effect of Oral Health on theCommunity, Overall Well-Being, and the Economy Policy changes are needed to reduce inequities in oralhealth status and care, ensuring that all Americans canenjoy the benefits of good oral health.Oral Health, the Community, and the Economy26

Section 2 Overview: Oral Health Across the Lifespan –Children & Adolescents About half of all American children do not receive regular dental care because of social,economic, and geographic obstacles. Nearly 1 in 5 children have special physical or health care needs; providers trained inactive prevention and management of these children’s oral health problems help to supporttheir overall health and quality of life. About half of all adolescents will experience dental caries; there has been littleimprovement in the past 20 years. Risk-taking behaviors that commonly occur in adolescence, such as tobacco andsubstance use, as well as the first occurrence of some mental health problems, can affectadolescents’ long-term oral health.Children & Adolescents27

Section 2 Key Graph: Oral Health Across the Lifespan –Children & Adolescents Page 2A-7 (165)Children & Adolescents28

Section 2 Key Graph: Oral Health Across the Lifespan –Children & Adolescents Page 2B-3 (261)Children & Adolescents29

Section 2 Call to Action: Oral Health Across the Lifespan –Children & Adolescents Public policies and improved training are needed toreduce oral health inequities by encouraging healthproviders to focus more on individual and publichealth approaches to preventing the occurrence ofnew disease and managing disease earlier. Adolescence is a life stage that has been largelyneglected by researchers and practitioners in es should be developed to address theunique oral health challenges of this group.Children & Adolescents30

Section 3 Overview: Oral Health Across the Lifespan –Working-Age Adults and Older Adults Although adults now retain most of their natural teeth, many working-age adults continue toexperience the same levels of tooth decay, gum disease, and oral cancers that were observed 20years ago. Many working-age adults—especially low income and minority adults—don’t have dental insurance. Older adults are living longer than ever before, many with chronic diseases and complex healthconditions that would be best managed by medical and oral health professionals working together. As working-age adults transition into retirement, most lose their employer-provided dental insurance,and Medicare does not provide an oral health benefit. This puts their oral health at risk.Working Age Adults & Older Adults31

Section 3 Key Graph: Oral Health Across the Lifespan –Working-Age Adults and Older Adults Page 3B-7 (417)Working Age Adults & Older Adults32

Adult Medicaid Benefits 74 million Americans lack dentalcoverage. As of 2021, 21 states haveextensive dental benefits as partof Medicaid. “Extensive” or “Comprehensive”means more than 100 -resources/adult-dental-benefit/Working Age Adults & Older Adults33

Older Adult DisparitiesChanges in functional dentition ( 21 teeth) among adults aged 65and older in the United 01988-19942009-2014Dye et al. https://pubmed.ncbi.nlm.nih.gov/17633507/Working Age Adults & Older Adults34

Section 3 Call to Action: Oral Health Across the Lifespan –Working-Age Adults and Older Adults Policies are needed to improve regular access toprofessional dental care for working-age adults, assuringaccess to both preventive and early treatment services,leading to better oral health. A policy that mandates dental coverage in Medicarewould reduce health inequities for older adults byassuring access to preventive and other oral healthservices for all, including those who are place-bound orin need of caregiver assistance.Working Age Adults & Older Adults35

Section 4 Overview:Practice & IntegrationOral Health Workforce, Education, Today’s oral health workforce includes not only dentists, but other oral healthprofessionals, such as dental therapists, public health dental hygienists, andcommunity dental health coordinators and medical colleagues who provide oralhealth assessment and prevention. Although there are more oral health providers in the U.S. than in 2000, today about60 million Americans live in areas (mostly rural) where there are too few oral healthprofessionals to meet local needs. Strategies for the integration of oral and general health care delivery are emerging.Improving adults’ access to dental care will require a multipronged approach andcoordinated efforts among policymakers, insurers, and dental professionals.Workforce, Education, & Integration36

Workforce Issues – where are dentists going?Supply of Dentists, 2001-2018200,000199,486Dentists per 100,000 population, 201320142015201620172018160,000American Dental Association, Health Policy Institute. Supply of Dentists in the U.S.: 2001-2018, February 2019.Workforce, Education, & Integration37

Section 4 Key Graph:Practice & IntegrationOral Health Workforce, Education, Page 4-12 (506)Workforce, Education, & Integration38

Dental Health Professional Shortage Areas (HPSAs) Over 60 million people living indental HPSAs 6,559 dental health professionalshortage areas (HPSAs) 10,853 practitioners needed toremove HPSA kforce/shortage-areasWorkforce, Education, & Integration39

Number of Dentists Per CapitaActive Dentists in the U.S., s per Workforce, Education, & Integration40

Changing Workforce Models – Group PracticeDentist Practice Type, .30%American Dental Association, Health Policy Institute. Supply of Dentists in the U.S.: 2001-2018, February 2019.Workforce, Education, & Integration41

Changing Workforce Models - Therapy Begun in 2000 No universal model 13 states haveauthorized therapy 2004 – AlaskaAccess 2009 – Minnesota 2018 – Michigan (8th state) 9 states “actively exploringauthorizing dental se-of-dental-therapyWorkforce, Education, & Integration42

Changing Workforce Models – Dental licy-brief-workforce-utilization/Workforce, Education, & Integration43

Changing Workforce Models – Expanded Function Dental licy-brief-workforce-utilization/Workforce, Education, & Integration44

Changing Workforce Models – Community Dental Health CoordinatorsSTATUSFULL FUNCTION CDHC ON-SITECDHC HELP NAVIGATE TO PROVIDERSAccessPILOTING A CDHC PROGRAMVISITING CDHCCDHC PROGRAMS IN mapWorkforce, Education, & Integration45

Workforce i/hpigraphic 0421 1.pdf?rev aa1f41177af94613a74a307adc11f2f0&hash 8F66BABF02828DB2E9A6D5D53908F2DDWorkforce, Education, & Integration46

7.0 million 6-171.1 million 6Workforce, Education, & Integration47

Opportunities for the Present & FutureOther point of care lab testingChildhood immunizations administrationChildhood immunizations screeningHIV screeningDepression screeningSubstance use disorder screeningTobacco use screenings & counselingHPV vaccine administrationCognitive disorder screeningBMI/obesity screeningDiabetes screeningObstructive sleep apnea screeningHPV vaccine educationHypertension screeningWorkforce, Education, & Integration48

Section 4 Call to Action: Oral Health Workforce, Education,Practice & Integration Improving access to oral health care can beachieved by recognizing dental care as anessential health benefit for all Americans,expanding dental coverage for the uninsured,encouraging new professional models, and byproviding educational opportunities thatencourage interprofessional learning and thedelivery of care in new settings.Workforce, Education, & Integration49