Tuesday, June 14, 2016

Oral Health Disparities between Men and Women

Did you know men are more likely to get oral cancer than women? Men are also more likely to skip dentist and doctor visits. For Men’s Health Month happening now, let’s raise awareness about these and other disparities.

Overall, more than 10 adults out of every 100,000 will develop oral cancer.
Oral cancer incidence among men is more than twice as high as among women in the United States. The same holds true when broken out by race for those who identified as white, American Indian/Alaska Native, and Asian or Pacific Islander.
However, prevalence among black men is more than three times as high as among black women. The disparity is similar among Hispanic men and women, too.
What’s more, oral cancer rates increase with age among both women and men. The increase becomes more rapid after age 50 and peaks between ages 60 and 70.
But diagnosing oral cancer at an early stage significantly increases five-year survival rates. Today, we are more aware of the importance of oral health and how to prevent disease thanks in large part to better education, greater access and advances in technology.

So what more can be done to reduce oral health disparities?

To start, efforts like those funded by the DentaQuest Foundation are designed to target prevention and collaboration in hyper-local ways.
One investment supports the Chicago Community Oral Health Forum to develop and expand school-based oral health education to students in the Chicago Public School system and the development of dental homes for students with urgent needs.
Another investment is supporting the University of Alabama as it implements a framework for interprofessional training that will produce health care practitioners in Alabama with a greater understanding of oral health and the ability to work in health teams to provide optimal care to their patients – from geriatrics to pediatrics.
These types of programs happening across the country target long-term improvements and sustainable changes for a variety of communities – from predominantly black public schools in Chicago to the elderly in Alabama.
The DentaQuest Institute, meanwhile, is expanding oral health care to rural parts of the country. Experts are working closely with local teams, helping providers develop evidence-based and financially-sound practices that ensure a continuum of care for regions that largely have been without regular access to dental care.
With dedication and support, these projects can ultimately change the trajectory of oral health disparities in America.

Tuesday, May 31, 2016

Engaging Grassroots with Grassmiddles to Facilitate Changes in Oral Health Equity

Why should grassroots and grassmiddles engage for oral health care? “If you want to go fast, go alone. If you want to go far, go together.” – African proverb

It’s been a busy spring for our team as we just wrapped up six meetings in six states (in just three weeks!). During the months of April and May, DentaQuest Foundation convened partners in the six states of our Grassroots Engagement Initiative, which launched last year in Arizona, California, Florida, Michigan, Pennsylvania, and Virginia.

The grassroots strategy aims to amplify the voice of those most impacted by oral health disparities –people who are living with tooth and mouth pain, limited access to dental services or affordable coverage, and other barriers to obtaining good oral health.

These meetings brought together those working at the state level (like oral health coalitions) – also known as the “grassmiddles” – with local-level community advocacy organizations – the “grassroots” groups.

DentaQuest Foundation’s grassmiddle partners have been working in oral health for many years and have a deep understanding of the policy environment in their states, often in addition to clinical knowledge or experience. Grassroots organizations, meanwhile, understand the needs of their communities and are experts at organizing and mobilizing community members to create change around issues like the environment, racial justice, jobs and more.

Why the Grassroots Engagement Initiative? Within it, these stakeholders learn from each other’s respective expertise. Together, they can take aligned action to improve oral health while also respecting and including the voices of those most impacted by oral health disparities.

These kinds of partnerships only serve to strengthen the effort of a larger national movement by getting everyone to agree on the priorities and join together where action is needed to improve oral health.

Illustrating the power of partnership

One of the Grassroots Engagement Initiative grantees in California is SCOPE (Strategic Concepts in Organizing and Policy Education) helped bring grassroots and grassmiddle partners to agreement on oral health change efforts.

SCOPE is a group that first emerged in the early ‘90s in the midst of the Los Angeles uprising following the Rodney King verdict. Staff from SCOPE facilitated what’s called “power mapping” at each of the six state meetings.

 “Power mapping” asks:
  •  what are the major issues in a state (for example, in Arizona: lack of adult dental coverage in Medicaid, lack of access to quality oral health care in Native American and other poor communities, and a weak social safety net);
  • who are the decision makers that could potentially influence those issues (for example, Governor Ducey and the Arizona legislature); and finally,
  • who else might be potential allies or challengers.

Participants then map out where all of these factors and people stand on the issue. Finally, they strategize on what’s needed to shift these dynamics in a way that positively impacts oral health in the state. Ultimately, the resulting power map should be used to track progress by revisiting it periodically to see how opinions have shifted.

At each state meeting, SCOPE helped participants reach consensus on a draft power map to begin using and measuring against. The agreement resulted from peer-to-peer learning, as well as collaboration across grassmiddles and grassroots experience.

Why does this matter? How will oral health equity improve?

Power mapping can be an excellent complement to the state’s oral health plan, which is goal-oriented and shows where the state wants to go. In fact, the power map and community level actors can help inform how to get there – an element that is improved with grassroots and grassmiddles on the same page.

Ultimately, it’s crucial that efforts to create change are in line with one another when facing a problem as significant as poor oral health. These state meetings seek to encourage all of us to see ways in which we can work together, and bring our respective strengths to the table, as we work for a healthier America. 

Monday, May 9, 2016

Oral Health, Meet Eye Health

During Healthy Vision Month each May, the National Eye Institute encourages Americans to make their eye health a priority and informs them about steps they can take to protect their vision. But why are we talking about eye health on an oral health blog? 

Oral health is a critical piece to the oral health puzzle, but so is vision. Just as the mouth can be the first place to spot signs of chronic disease, so can the eyes. 

An eye exam, for example, can uncover broken or leaking blood vessels in the retina, which are an indicator of diabetes. Specifically, the capillaries that deliver blood to the retina can be broken down by a buildup of sugar in the bloodstream, and elevated blood sugar is a warning sign for diabetes that a vision provider would spot perhaps before anything else triggers a diabetes test from a primary care provider. 

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Some even suggest that identifying chronic diseases such as diabetes and hypertension at the eye doctor or dentist is more cost effective and can mean better outcomes for people who otherwise might not be diagnosed until a chronic disease has progressed or other complications develop.
Moreover, a healthy set of eyeballs means productivity and independence are within reach for much longer.

So what does the National Eye Institute encourage for healthy vision?

  • Get a comprehensive dilated eye exam.
  • Live a healthy lifestyle, including eating healthy foods, maintaining a healthy weight, managing chronic conditions, and not smoking.
  • Know your family history.
  • Use protective eye wear.
  • Wear sunglasses.

Taking these steps can help prevent vision loss or blindness, which can result from many diseases and conditions. In addition, comprehensive dilated eye exams can detect problems early, when they’re easier to treat.

DentaQuest believes in eye care as much as oral health because you cannot have improved overall health without healthy eyes and mouths. This is in part why we created eyeQuest back in 2009.

At the start of 2009, we began administering a Medicaid vision program for 40,000 people in Nevada with Amerigroup coverage. As of April 1, 2016, we now administer vision programs across 9 states for 1.6 million people!

Still need convincing that vision is important to care for the same way you care for the rest of your body? Commemorate Healthy Vision Month by pondering and sharing these fun facts:

  • 80 percent of what we learn is through our eyes.
  • Eyes are the second most complex organ after the brain.
  • An eye is composed of more than 2 million working parts.

Thursday, April 28, 2016

Beyond Your Mouth: The Social Determinants of Oral Health

April is minority health month, and there’s no better time to focus on dental health—which so profoundly affects the overall health of minorities. As the commemorative month comes to a close, consider the importance of improving the oral health of all (our mission lived each day).

“Oral health implies much more than healthy teeth. The mouth is both a cause and a reflection of individual and population health and well-being,” states a study published in BMC Oral Health. This notion reflects the fact that many of the determinants of dental health go way beyond medical factors—they are behavioral, cultural, social, and economic as well.

For example, tooth decay is a major dental health issue for the United States. And the food we eat plays an important role in this. Foods rich in sugar and carbohydrates help to form plaque acid that attacks tooth enamel. But those who live in food deserts with no access to healthy, nutrient rich food, may be forced to rely heavily on these foods in their diet.

Education also plays an important role in tooth decay. 

  • Adults aged 35–44 years with less than a high school education experience untreated tooth decay nearly three times that of adults with at least some college education.
  • In addition, adults aged 35–44 years with less than a high school education experience destructive periodontal (gum) disease nearly three times that of adults with at least some college education.
Access to fluoride is also key. 
Prior to World War II, Americans were plagued by toothache and tooth loss.  But in 1948 the National Institute of Dental and Craniofacial Research was formed and researchers began demonstrating the effectiveness of fluoride in preventing tooth decay. 

According to a Surgeon General’s report, “Community water fluoridation remains one of the great achievements of public health in the twentieth century—an inexpensive means of improving oral health that benefits all residents of a community, young and old, rich and poor alike.”

While community water fluoridation is highly recommended by nearly all public health, medical and dental organizations, some may still lack this important program. (Check your community’s status in this CDC fluoride finder.)

Dental insurance inequalities also contribute to health disparities, as preventive oral care including check-ups and regular dental cleanings are crucial. That is one reason we created the unique PreventistrySM approach, which not only fully covers most preventive services, but also helps highlight for network dentists those members at higher-risk of tooth decay.

This year’s minority health month theme is Accelerating Health Equity for the Nation. Long past just recognizing health inequalities, this theme calls us to improve our work toward health equity, in part by focusing specifically on the social determinants. 

As you continue to think about this theme—hopefully long past April—don’t forget about the intertwined importance of oral health.

Friday, March 18, 2016

World Oral Health Day: Increasing Access in the United States and Across the Globe

By Natalia I. Chalmers, DDS, PhD, DentaQuest Institute

When I talk about oral health, I refer to everything from cavities to mouth cancer to nutrition, from babies to people of all ages, from dentists to hygienists to all health professionals. And I don’t only think about America.

According to the FDI World Dental Federation (FDI), 90 percent of people worldwide will suffer from oral health problems in their lifetime. This alarming statistic underscores the need for World Oral Health Day, held annually on March 20.

This observance pushes those of us passionate about oral health to take action to reduce the incidence of dental disease, while providing a moment in time for us to elevate the issue globally. To commemorate World Oral Health Day 2016, I took a look at the global burden of untreated caries and how we stack up against our neighbors across the pond when it comes to oral health.

Global Burden of Untreated Caries

According to the World Health Organization, caries is the fourth-most expensive chronic disease to treat. While the prevalence and incidence of untreated caries remained static between 1990 and 2010, there is evidence (as noted in the Journal of Dental Research article also linked above) that the burden of untreated caries is shifting from children to adults.

Oral Health in the United States vs. United Kingdom

It is a common misconception that Americans have “better” teeth than the British, a stereotype perpetuated in the entertainment industry. However, a recent study published in the British Medical Journal shed light on the actual oral health differences between the two countries, illustrating that, in fact, the picture is more complex.

In the study, researchers looked at data from the English Adult Dental Health Survey (ADHS) and the U.S. National Health and Nutrition Examination Survey (NHANES) to analyze baseline measures, such as the number of missing teeth and oral health’s impact on daily life. The analysis yielded some of the following results:
  • U.S. adults had more missing teeth than their U.K. counterparts (an average of 7.31 to 6.97 missing teeth, respectively).
  • The impact of poor oral health on U.K. daily life was more prevalent.
  • The highest U.S. socioeconomic group had better oral health, while those in the lowest U.K. socioeconomic group had better oral health.

While these results indicate there is room for improvement in both countries, the last finding stood out to me.

Researchers in the study suggest this finding may be due to differences in how health care is funded in each country. U.K. dentistry is largely supplied by the National Health Service, while it’s largely dependent on access to dental insurance for Americans. 

Differences aside, these results point to the larger problem at hand — barriers to access in the United States.

Most Americans who fall within the lower socioeconomic category lack access to care, education, and transportation, which subsequently impacts the incidence of disease. One potential reason those with low socioeconomic status thrive in the United Kingdom is that they have resources that connect them with proper oral health care. 

This issue of access and resources is an important factor when evaluating disease causation — when we increase access, we improve oral health.

Greater Access Can Lead to Better Outcomes

So we know the burden of untreated caries is shifting from children to adults. There is evidence that the U.S.-U.K. oral health gap is not as large as we may think. Imagine what this means for our misconceptions about oral health in general across the globe.

Knowing disparities are complex, I hope this World Oral Health Day becomes the global call to increase access to oral health care for all. Let’s elevate the conversation and raise awareness: with support, access to preventive services will increase health outcomes globally and bring relief to all 90 percent of the world’s population in need.

Monday, February 22, 2016

A Million Hearts: Improving Oral Care for Healthier Hearts

By Brian B. NovĂ˝, D.D.S. F.A.D.I., Director of Practice Improvement, DentaQuest Institute

In 1964, President Lyndon B. Johnson designated February as “American Heart Month,” drawing national drew attention to heart disease, today’s number one killer in America. Heart disease claims more lives than all forms of cancer combined.

To further President Johnson’s effort and heart disease prevention overall, President Barack Obama officially launched “Million Hearts” in 2011. Aiming to prevent 1 million heart attacks and strokes by 2017, the Centers for Disease Control and Prevention and the Centers for Medicare & Medicaid Services co-sponsored this national initiative on behalf of the U.S. Department of Health and Human Services.

This initiative seeks to:

  • Improve access to effective care;
  • Focus clinical attention on the prevention of heart attack and stroke; and
  •  Motivate the public to lead a heart-healthy lifestyle.

What exactly is the connection between gum disease and heart disease? According to the Mayo Clinic, research suggests that the inflammation and infections associated with oral bacteria might be linked to heart disease, clogged arteries and stroke.

Prevention is necessary when combating bacteria that leads to the inflammation associated with gum and heart disease. Regularly brushing and flossing combined with bi-annual dental appointments are important steps to remove the bacteria, plaque and tartar that are detrimental to your oral – and heart – health.

As an additional step, dentists can learn to identify warning signs for heart disease and encourage patients to get screened if their mouths show signs of bacteria or inflammation during a routine cleaning or check-up.

At DentaQuest, we share many of the same goals that the Million Hearts initiative aims to achieve. Expanding access to care, stressing the importance of prevention, and improving the oral health of all are points that we live out day to day as a part of our core values.

Since the mouth is the gateway to the body, living a life with positive oral health habits can also lead to a heart and overall-healthy lifestyle. So this American Heart Month, don’t forget about the connection between oral and heart health. 

Thursday, February 18, 2016

National Children’s Dental Health Month: Our Commitment to Improving the Oral Health of the Next Generation

By Steve Pollock, President and Chief Executive Officer, DentaQuest

This February marks the 75th annual National Children’s Dental Health Month, bringing together dental and health leaders across the country to raise awareness of and provide tools to improve kids’ oral – and overall – health. We are working hard to address the impact of sugar consumption on children’s long-term oral health with this year’s kid-friendly Sugar Wars campaign, hosted by the American Dental Association.

To help illustrate the importance of this campaign, added sugar consumption among children across the United States accounts for 15 percent of calories every day. This is a full 5 percent higher than the recommendations from the recently-released 2015-2020 U.S. Dietary Guidelines, which indicate that added sugars should account for less than 10 percent of calories daily.

Now, think of the impact this has on their health, ranging from weight gain to nutritional deficiencies to tooth decay. Sugar helps nurture cavity-causing bacteria in the mouth. If left unchecked, sugar intake can lead to significant tooth decay.

Would you believe that tooth decay is the most common chronic childhood illness in the United States?

Tooth decay in kids is five times more common than asthma. Today, about 20 percent of children ages 5 to 11 have at least one untreated decayed tooth, and the percentage of children ages 5 to 19 with untreated tooth decay is actually twice as high for those from low-income families – when compared with children from higher-income households.

The implications of childhood tooth decay can carry into adolescence and even adulthood. Not only can childhood tooth decay have long-term effects linked to poor oral health, heart disease and even diabetes, but it also has a significant financial impact on our health care system. This impact can be measured in the millions of dollars we spend as a country on emergency room care for dental issues today or with the long-term financial implications of poor oral health on the treatment of those with certain chronic illnesses.

So, how do we win the Sugar Wars?

Education, access and prevention. We must be advocates for our communities and educate people about the importance of oral health and sugar intake for kids, work with leaders to increase access to care and prioritize preventive dental services that will address these issues head on.

At DentaQuest, we are committed to improving the oral health of our next generation by transforming the systems of care, finance, community and policy to achieve optimal oral health for all. We have already taken steps to achieve this vision by:
  • Working with our nation’s leaders to extend funding for the Children’s Health Insurance Program (CHIP), which provides vital health coverage to kids across the country who wouldn’t otherwise have much-needed care.
  •  Creating and growing the Early Childhood Caries (ECC) Collaborative, a program piloted by the DentaQuest Institute that teaches medical providers about best practices for managing and preventing tooth decay in young children.
  • Encouraging our leaders to act on the Oral Health 2020 Goals, which are aggressive, industry-changing charges developed by the DentaQuest Foundation and the Oral Health 2020 national network to improve the oral health of all. Among others, we aim to:
    • Eradicate dental disease in children
    •  Incorporate oral health into the primary education system
Throughout the month of February and 2016, we are committed to elevating the importance of oral health in children, implementing preventive care models and improving oral health for the next generation.