Reaffirming our commitment to oral health in rural America

As rural stakeholders from around the country take time today to celebrate Nov. 16th as National Rural Health Day, DentaQuest reaffirms its commitment to improving the oral health of residents living in rural communities. DentaQuest Institute and DentaQuest Foundation have been involved in multiple activities and initiatives in recent years that help to improve oral health access and quality of oral health care for our nation’s rural residents. 

A few of the highlights include:

• The Institute’s Medical Oral Expanded Care (MORE Care) Initiative, which focuses on the integration of oral health care into the rural primary care practice as well as the development of coordinated care networks with community dental providers, has assisted more than 20 rural primary care practices and dental providers in South Carolina, Pennsylvania, and Colorado. Based on learnings from the MORE Care initiatives in the three states, several publications were created to spread resources and knowledge to other rural communities interested in creating rural interprofessional oral health networks.
• White Paper -  “MORE Care: Narrowing the Rural Interprofessional Oral Health Gap” https://www.dentaquestinstitute.org/rural-ipp

• Rural Practice Guide – Released today – that provides practice-level guidance and practical how-to tips for rural health clinics interested in creating interprofessional oral health networks in their community: http://bit.ly/2AQ0LmR 
• 
  
• The Foundation’s support of the National Rural Health Association has enabled community health workers and other providers in Texas to be trained to integrate oral health into their outreach to residents living in colonias, Hispanic-populated communities along the U.S.-Mexico border.

• DentaQuest Foundation grantee National Conference of State Legislatures is educating policymakers on issues that challenge rural communities in their access to oral health care, developing and publishing resources that can be found on their website, here.

• Lastly, we’ve been proud to see some of our rural oral health leaders featured in The Journal of Rural Health and also NRHA’s Compendium of Rural Oral Health Best Practices.

For more information on these and other great projects being led by our Institute and Foundation teams, please visit the websites at www.dentaquestinstitute.org and www.dentaquestfoundation.org. You can also sign up for Socious, our Foundation’s online collaborative platform, to access resources and tools generated by our grantees and partners. Register here: www.oralhealth.network

Oral Health 2020 is helping unify and empower community voices

Hear from so many passionate individuals who are part of the DentaQuest Foundation's Oral Health 2020 National Network, which is working to address oral health equity, policy, and ultimately improved oral health for all.

Learn more about the movement: http://dentaquestfoundation.org/oh2020

Friday Federal Roundup: CBO, CHIP, and More

As a partner to states and the largest Medicaid / CHIP dental benefits administrator in the country, we at DentaQuest must stay updated on the latest health care policy trends - in large part because anything in the health space affects the oral health space.

Recent federal health reform proposals could have significant implications for Medicaid programs, exchange populations, and oral health coverage for low-income families. We keep our employees apprised of the latest happenings in Washington D.C. with weekly federal newsletters, and thought this week was particularly relevant for more than our staff.

Here’s this week’s newsletter.

CBO Releases Report on Subsidies 

According to a report released earlier this week by the non-partisan Congressional Budget Office (CBO), insurance premiums for ACA plans would rise 20 percent next year and in some areas of the country, people would not have any insurance options if the Trump administration scraps key ACA subsidies. Trump has repeatedly threatened to pull the ACA subsidies, particularly since Congress failed to pass repeal and replacement legislation before the summer recess. CBO’s analysis also found that eliminating the payments would increase the federal deficit by $194 billion over a decade because of higher spending on premiums subsidies. Trump must decide by early next week whether or not to make next month’s payment.

Congress Turns Attention to CHIP

Funding for the Children’s Health Insurance Program (CHIP) expires September 30th. With Congress out on recess, this leaves few legislative working days to ensure that nearly 9 million children maintain their medical and dental coverage. While CHIP reauthorization has historically been a bipartisan issue through the years, the hotly-contested debates over ACA repeal and replacement have left state officials anxiously awaiting assurances from Capitol Hill that 2017 will be no different. We will continue to monitor federal discussions on the future of CHIP and advocate where possible for the vital inclusion of dental coverage in reauthorization efforts.

Trump Administration Encouraging Medicaid Redesign Efforts, State Innovation

As Congress takes a pause on repeal and replacement efforts while they are on recess, states are looking to the Trump administration in the interim for more regulatory flexibility. CMS is expected to soon approve a Medicaid waiver from Kentucky which among other things would require most Medicaid-eligible adults to work as a condition of receiving coverage. Arizona, Arkansas, Indiana, and Maine are considering similar work requirements. HHS Secretary Tom Price and CMS Director Seema Verma have both expressed that they are in favor of such Medicaid redesign proposals.

Last month Alaska became the first state to get increased flexibility from the administration to prop up its individual marketplace with a reinsurance program. Minnesota, New Hampshire, Oklahoma, and Oregon are some other states that have already filed or are considering similar waiver proposals to submit to CMS.

HHS Proposes to End Obama-era Payment Programs

HHS Secretary Price has announced plans to eliminate two Obama-era Medicare bundled payment programs and scale back on a third. This proposal would cancel initiatives that make hospitals more accountable for the cost of certain joint replacement surgeries and cardiac care, and shrink an existing program covering hip and knee surgeries. This is considered a victory for providers who oppose requirements to participate in new payment models. We will continue to monitor whether or not HHS will take further action to roll back requirements in order to slow down the transition to value-based reimbursement structures.

DentaQuest Foundation grassroots grantees ready to leap for oral health

I recently heard the perfect analogy for our oral health advocacy during the DentaQuest Foundation’s Grassroots Engagement Strategy annual meeting. It’s a saying gardeners have about the growth process of perennials: “The first year they sleep, the second year they creep, then the third year they leap!”  This year is the year for the grassroots organizations and their partners to leap!

DentaQuest Foundation’s Grassroots Engagement Strategy started in March 2015 as an initiative to engage those most directly impacted by oral health inequities. Focused in six key states - Arizona, California, Florida, Michigan, Pennsylvania, and Virginia - the Grassroots Engagement Strategy leverages an existing network of key oral health advocates and stakeholders operating at the state level. The DentaQuest Foundation has funded 20 community-based organizations within these states to provide oral health outreach and take action on social justice and oral health equity, all with the goal of improving public perception of the value of oral health in their communities.

These 20 grantees represent deep and diverse experience working directly with community members and contribute essential perspectives of community advocacy and action. They are providing community-grounded voices within a broad group of stakeholders at the state, regional, and national levels, a perspective that is critical if we are to reach our mission of improving oral health for all.

The Grassroots Engagement Strategy has now entered its third year of development, and the purpose of the annual meeting this spring was for grantees to learn from one another about what has been accomplished in the last year, what is planned for the year ahead, and how to deepen the commitment to health equity.

On day one, each organization presented its community-driven plan that covered stakeholders, how they have incorporated the Oral Health 2020 goals into their communities, 2017 organizational priorities, their proudest moments, and their greatest challenges.

For example, one organization discussed advancing a legislative advocacy strategy around protecting oral health equity policies, while dealing with the major challenge that oral health is not a top priority for the community members facing other economic and social challenges.

On day two, many of the Oral Health 2020 national advocacy partners presented the resources and tools in development that will support the grassroots organizations in their work. Attendees also discussed how they can learn from one another and build their capacity to make change at the community level.

Additionally, there were presentations on different approaches to advocacy and lobbying, including how to provide empowerment opportunities for community members in advocacy and public policy.  Partners also discussed how they work collaboratively with other organizations to activate coalitions and networks that share common goals.

The underlying themes throughout the discussion:

• health equity 
• the link between oral health and other social determinants of health 
• the implications that these have 
• who  needs to be at the table  

Similar to previous years, the grassroots organizations returned home with a sense of rejuvenated momentum for oral health.   Words like “motivated,” “energized,” and “connected” were used by attendees format the close of the meeting.  With the political landscape changing, the role of grassroots organizations engaging in advocacy is even more critical at the local, state and national levels.

When community members are educated on the topic of oral health and have the passion and understanding of its impact, their voices are powerful.  

The Oral Health 2020 Network is excited to see the progress that will continue in these communities and beyond. The grassroots grantees are ready to “leap” into action for year three of the Grassroots Engagement Strategy!

---
Guest post from DentaQuest Foundation's grants team member Liana DiRamio. Learn more about the grants and programs here: http://dentaquestfoundation.org/about/our-mission. 

Dental Coverage has Bipartisan Support among Voters

As the new Trump Administration and Republican Congress begin their work this month, they will have the opportunity to advance conservative priorities through major legislative changes. At the top of their list is repealing the Affordable Care Act (ACA), which will have implications for the dental health and overall health of many Americans.

ACA replacement proposals from President-elect Trump, Speaker Paul Ryan, and the nominee for Secretary of Health and Human Services Rep. Tom Price should signal major changes forthcoming to the health care industry.

The ACA’s Medicaid expansion, essential health benefits, and exchange provisions have increased access to dental care for both children and adults. While the future of these elements is uncertain, we at DentaQuest want to ensure that replacement proposals do not jeopardize this important access to oral health. We’ve made great strides in eliminating barriers to dental coverage for millions of Americans who gained access through the ACA.

As policymakers consider different replacement plans, the role of oral health must remain a priority. 

In a recent survey of 2,000 registered U.S. voters conducted by DentaQuest via Morning Consult, the inclusion of dental coverage in public programs received widespread support from voters of both parties.

The survey showed that:

• 83 percent of respondents think dental coverage should be a part of Medicare
• 83 percent of Republicans agree
• 86 percent of Democrats agree
• 81 percent of Independents agree
• 73 percent of respondents believe dental coverage should be a required benefit in Medicaid
• 64 percent of Republicans agree
• 82 percent of Democrats agree
• 71 percent of Independents agree

Dental coverage is not currently included in Medicare, nor is it a required benefit for adults in Medicaid. A full repeal of the ACA could compound oral health access issues by eliminating Medicaid expansion and the exchanges— two important sources of affordable dental coverage.

Research continues to show a connection between oral and overall health. Dental coverage is a critical first step to improve both oral and overall health outcomes, reduce persistent health disparities, and contain systemic costs.

As policymakers seek to improve our existing health care system, oral health must be a part of the solution. 

It is clear: Dental coverage has demonstrated itself to be a bipartisan priority for the American public. As we enter a 2017 legislative session with significant health care policy changes on the agenda, dental coverage must also remain a priority for Congress.


The full survey conducted by DentaQuest and Morning Consult will be released in 2017.

Best Wishes for Happy Holiday Season and a Healthy New Year

No matter what holiday you celebrate this season, we wish you good oral health.
Happy Holidays from all of us at DentaQuest.

View our video greeting here: DentaQuest Holiday

What you don’t know about oral health may hurt you

By Dr. Doyle Williams, Chief Dental Officer

When people hear the phrase, “I’m in good health,” chances are they aren’t thinking about their mouths.

But you should. A regular check up with your dentist is as important as an annual physical. If you are someone who is afraid of the dentist and only make an appointment when you are in pain – think of this: regular preventive care is not painful and it will help prevent painful visits in the future. Good oral health serves much more than cosmetic purposes – it is integral to your overall good health.

Teeth, gums and oral soft tissue are all susceptible to a range of conditions and diseases, including cavities, gingivitis and oral cancer. The irony is that dental disease – cavities and gum disease – are nearly 100 percent preventable if you know what to do. It’s what you don’t know about oral health that may hurt you. That’s oral health literacy.

Culturally-competent oral health literacy is as important as seeing an oral health professional. For some, a painful tooth may be enough reason to schedule a visit with a dentist. But others may wait to see bleeding, swelling, or a fever before thinking about getting care.

That’s the challenge of oral health literacy – making sure people know how to care for their teeth and gums, making sure they know the signs for concern, and making sure they know when and where to go for help.

Here are two examples:

• The U.S. Surgeon General stressed that parents who are unfamiliar with the importance and care of their child’s primary teeth are unlikely to take appropriate action that may prevent Early Childhood Caries (ECC). That includes food choices, bedtime bottle routines, daily oral hygiene, and failure to see a health professional as the baby teeth are starting to come in.

• Recently, a 24-year old father from Cincinnati, Ohio died from a tooth infection because he could not afford his medication. When his face and mouth began to swell, the man visited the emergency room at his local hospital where he was given prescriptions for pain medication and antibiotics. Because he could not afford both medications, he only filled the prescription for the pain medication. That helped the pain but the infection continued to spread, eventually to his brain.

Knowledge is power. Everyone has a role in making sure that oral health is an integral part of their overall health.

What do you think needs to be addressed to improve America’s oral health literacy?

Prevention is Key

It was great to see the National Prevention Council’s recently released action plan for health prevention – but I couldn’t help but notice that there was no mention of the importance of oral health—at all.

Prevention is what helps us have good oral health vs. poor oral health. And prevention is all about understanding your risk factors and protective factors. This is true if you are a child or an adult.

In this Oral Health Matters blog, I try to get my readers to think about the risk factors—the things in your life which contribute to poor oral health. There are protective factors too and I’ll talk about them in another blog post. Right now, however, I’ll highlight some common risk areas. I hope you will read through them thoughtfully. If you say ‘yes’ to any of them, it is time to make an appointment with your dentist.

Common risk areas:

1. Not brushing and flossing your teeth every day – to remove food and bacteria. Making this part of your daily routine is a small change that pays big benefits.


2. Irregular visits to the dentist. I encourage visiting your dentist at least once a year. Why? Your dentist can detect early signs of trouble and help you get on track.


3. Have you had a cavity within the last 3 years? Have you lost teeth because of tooth decay or gum disease? Do you have puffy or bleeding gums, receding (shrinking) gums, or areas of the gum line where the root surface of the tooth is exposed? This could mean there may be active gum disease in your mouth. Your dental professional will want to watch you closely for this.


4. How is your health? Are you pregnant? Have you been diagnosed with diabetes? Do you use/abuse tobacco (cigarettes, pipes, cigars, chewing) or drugs? Do you regularly take prescription/over-the counter-medicines? Do you have braces or partial dentures? Are you undergoing chemotherapy or radiation therapy? Do you have an eating disorder? Do you have dry mouth? Each of these conditions puts you at higher risk for tooth decay or gum disease. Your oral health professional will help you make adjustments to keep your mouth healthy.


5. Are you a between-meal-snacker? Do you have a fondness for sugary foods? Do you drink a lot of soda or energy drinks? The sugars and acids in these foods/drinks can encourage tooth decay—especially if you let them linger in your mouth for hours. Again, your oral health professional can help you understand how to lower your risk of oral disease with things as simple as rinsing your mouth with water after eating to keep your teeth healthy.

Think about your answers to these questions and use them to start a conversation with your dentist about managing your areas of risk.

I would like to see Americans get smarter about the role of oral health in their overall health. That’s why I write this blog. When consumers have the knowledge to prevent problems and know when to seek care, they will likely be healthier. That’s why it is upsetting to me that oral health was missing from the National Prevention Council’s action plan.

I’d like to hear what you have to say on the importance of prevention. What does prevention mean to you?

Related Posts:

• Making Coverage Matter: Pew’s 50 State Report on Children’s Oral Health
• State of Oral Health In America Is Not So Good
• A New Chapter for Prevention
• Let’s Talk About the Oral Health of America’s Children
• Healthy Smiles in Miami Dade Schools

Sip Safely

Spring and summer are a time of sports and hot, humid weather which leads to very thirsty kids. That often translates into an increase in the consumption of sugary and acidic sports drinks. These seemingly harmless liquids can actually wreak havoc on children’s teeth.

The combination of acidic components, sugars, and additives in sports drinks combine to erode the tooth’s surface, weakening the enamel that protects teeth from bacteria. The enamel erosion ultimately makes teeth more susceptible to bacteria and leads to hypersensitivity, staining, and tooth decay.

Frequent consumption of sports drinks lowers the pH in the mouth promoting the demineralization of tooth enamel. (The lower the pH, the more acidic the item.) Demineralization is caused primarily by stable acids found in acidic foods and drinks or which form as by product from bacteria feeding on starches and sugars in the mouth, especially refined sugars.

Demineralization begins at a pH level of 5.5 although under certain conditions, may even start at a higher pH. Popular sports drinks can have a pH of 2.4 and contain 5.5 tsp of sugar in a 12 oz can. So, not only does the drink have a pH that promotes demineralization, it also contains 5.5 tsp of sugar, which can independently contribute to demineralization and tooth decay.

To put the sports drink pH of 2.4 in perspective, compare it to battery acid, which has a pH of 0 and water, which has a pH of 5-7 (neutral). Shocking that a sports drink is closer on the pH scale to battery acid, than water.

Given all this, water is always the best option for everyone but the highest performing athletes who need to replenish minerals from intensive workouts.

If these facts haven’t convinced you to avoid the casual consumption of sports drinks, here are a few tips to keep in mind:

Don’t sip the drink throughout the day. - Drinking them for short periods of time means less time for the sugars and acids to erode enamel. Rinse your mouth with water when you’re done to clear away remaining acids and sugars.

Don’t swish the drink around your mouth. - That only increases the risk of erosion. Instead, use a straw so teeth aren’t immersed in or in direct contact with the sugars and acids in the beverage.

Resist the urge to brush your teeth immediately after finishing a sports drink. - Tooth enamel softens after consumption of acidic drinks, making teeth susceptible to more wear from the abrasives in toothpaste. Wait 45 minutes to an hour before brushing to give your saliva time to re-mineralize the tooth structure and neutralize the damage.

Seek regular dental care. - Tooth decay is the most common chronic childhood disease, five times more common than asthma. It’s also preventable with proper care. Your dentist can identify early signs of erosion, pinpoint the causes, and advise you on how to prevent further damage and more serious problems from occurring.

State of Oral Health in America is Not So Good

In April, the Institute of Medicine (IOM) released a report on the state of oral health in America, concluding a two year evaluation of the current oral health care system. The U.S. Department of Health and Human Services (HHS) requested and funded this report to inform its work in addressing oral health challenges across America. HHS asked the IOM to assess the current oral health system and make strategic recommendations for its future programming. HHS is the federal agency which directs many of the government’s dental delivery, research, training and other programs.

Here are highlights:

• Tooth decay continues to be a common chronic disease in the United States


• The prevalence of oral diseases pose a significant burden on the health and well-being of the American people


• Evidence shows that decay and other oral health complications may be associated with adverse pregnancy outcomes, respiratory disease, cardiovascular disease, and diabetes


• Tooth decay is a highly preventable disease


• The general public and many healthcare professionals remain unaware of oral disease risk factors and preventive approaches and they do not fully appreciate how oral health affects overall health and well-being.

The IOM recommended that HHS design an oral health initiative that addresses areas in greatest need of attention, using approaches that have the most potential for creating improvement s, and to support this effort with strong leadership, sustained interest, and the involvement of multiple stakeholders.

“The Committee on an Oral Health Initiative reaffirms that oral health is an integral part of overall health and points to many opportunities to improve the nation’s oral health,” IOM President Harvey V. Fineberg, M.D., PhD., said in the foreword to the report. “We issue this report in the hope that it will prove useful to responsible government agencies, informative to the health professions, and public, and helpful in attaining higher levels of dental health.”

The IOM report and brief are posted online at www.iom.edu/Reports/2011/Advancing-Oral-Health-in-America.aspx

Rating the Performance of Your State’s Health System

There’s an interesting new report by the Commonwealth Fund, Securing a Healthy Future: The Commonwealth Fund State Scorecard on Child Health System Performance, 2011 that is worth looking at.

The Commonwealth Fund’s researchers took a number of objective measures for good health -- such as access to prevention and treatment, the potential to lead a healthy life (defined as factors such as low prevalence of specific health problems, low obesity, and lack of habits and behaviors that impact health, such as smoking) and socio-demographic dimensions (such as income and where you live) -- and looked at how each of these measures impact the others. The result is a very interesting and comprehensive picture of elements that contribute to children's health in each state.

We’re pleased that this report includes preventive dental care and the absence of dental problems as measures of access to prevention and treatment and a factor in healthy lives. The Report concludes that the high rate of poor yet preventable dental health outcomes among children in many states points to the need to improve preventive dental health care.

Better access to oral health services can reduce tooth decay and lead to a better quality of life for children, as well as reduce financial and societal costs. The Commonwealth Fund found that almost one third of children did not see a dentist for a preventive visit in the bottom-ranked state and more than 10 percent did not have a dental check-up in the top-ranked state. Want to know who they are? Click the link on the report title and check out the report!

Dental disease is nearly 100% preventable when people have access to information about keeping their mouths healthy and access to dental services. Public education, expansion of access to dental care, and integration of oral health into routine well-child care are smart ways to do this.

It works best when FAMILIES are able get the services they need to maintain their oral health since parents need dental care themselves for their own good health AND so they can be a good example for their children. The U.S. Department of Health and Human Services Healthy People 2010 goals recommend that children have at least 1 dental visit annually. And the American Dental Association says that you can start this at the age of 1 or when the first tooth erupts.

So, check out the data for your state. And then let me ask you -- is an annual visit to the dentist something that you do for yourself and for your children?

Smokeless Tobacco – YOU’RE OUT!

Images of opening day should be of cheering fans, baseball diamonds, baseball caps and crisp new uniforms, and NOT containers of smokeless tobacco anywhere near the dugout. Smokeless tobacco in all its forms -- chewing, plug, twist, snus, snuff, dissolvable -- is a dangerous (and dirty) habit that I hope will no longer be glorified on baseball fields – professional or neighborhood. This year Congress is putting pressure on Commissioner Bud Selig and MLB players association chief Michael Weiner to ban smokeless tobacco all together this baseball season. I can’t agree more. We do not want impressionable children and teens to see their sports heroes using smokeless tobacco and get the wrong message about the dangers. Make no mistake about it, smokeless tobacco is dangerous.

• Smokeless tobacco contains higher quantities of nicotine than most cigarettes. And it increases the likelihood that the person using it will become a smoker.1


• It shocked me to learn that according to the Academy of General Dentistry (AGD) 4% of boys in middle school and 20% of high school boys use smokeless tobacco. Half of them will likely develop pre-cancerous white patches in their mouths. ·


• Smokeless tobacco products, just like cigarettes, contain at least 28 cancer-causing chemicals. And the sugar that is often added to enhance the flavor increases the risk for tooth decay.2 ·


• Smokeless tobacco is known to cause cancers of the mouth, lip, tongue and pancreas. Users may also be at risk for cancer of the voice box, esophagus, colon and bladder, if they swallow toxins in the juice.2

April isn’t just the time that baseball comes back in full swing; it’s also Oral Cancer Awareness Month. That makes this a great time to remind you that oral cancer affects males and females, adults and kids. And even if you are not a smoker, make sure your dentist does an oral cancer exam [pulls and twists your tongue] at every visit.

Please share these facts with the teens and youth in your life. And I’d be curious to know what they think about smokeless tobacco and keeping it out of baseball? Check out the facts:

• University of Iowa
• CDC