Building Health Literacy with Read Across America

If you’ve ever read a book with a child, you know the feeling of joy that comes from the experience, as well as how fundamental literacy is for people of any age.


So it is a source of pride that DentaQuest staff from coast to coast are joining teachers, celebrities, community members and parents in getting kids excited about reading through the National Education Association's (NEA's) Read Across America Campaign, a celebration of reading timed with the birthday of Dr. Seuss.


As health industry professionals, we have a responsibility to educate consumers so they can be active advocates for their own health. In its health literacy fact sheet, the CDC says 9 out of 10 adults struggle to understand and use health information, especially when it is unfamiliar, complex or jargon-filled. In fact, low literacy contributes to poor health outcomes, higher rates of hospital utilization, and less frequent use of preventive services, in addition to overall higher health care costs.


According to the National Center for Education Statistics, since 1993 just 53 to 58 percent of children ages 3 to 5 years read or were read to on a daily basis.


Simply reading daily with a child is important.

• Children who are read to at home have a higher success rate in school. 
• Children who read frequently develop stronger reading skills. 

As part of this year’s NEA campaign, our staff is visiting schools in:

• Columbia, S.C.; 
• Locust Hill and Richmond, Va.; 
• Lincoln, Neb.; 
• Milwaukee and Mequon, Wisc.; 
• Austin and Red Rock, Texas; 
• Doral, Fla.; 
• Snoqualmie, Wa.; 
• Anniston, Ala.; and 
• the Greater Boston area. 

We are reading one of three fun books --Throw Your Tooth on the Roof by Selby B. Beeler, The Tooth Book by Edward Miller, and Open Wide by Laurie Keller. The school’s library will also get the book to keep for future reading.

In Locust Hill #VA, Jackie wowed #HeadStart kids Middlesex Elementary with tales from The Tooth Book. #healthysmiles #READACROSSAMERICA pic.twitter.com/NU6kXJMrm4

— DentaQuest (@DentaQuest) March 1, 2017

Staff who have already visited classrooms said they felt like rock stars and oral health ambassadors. The children loved the facts we shared about their teeth, including how they should take care of their own teeth and gums.


Dental disease is the most common chronic childhood disease – and it is preventable. Introducing children to fun facts about their mouths, teeth and gums through the books we brought for Read Across America is a strong step in building the health literacy skills and disease prevention awareness that will empower this next generation of consumers to be health-knowledgeable adults.


Efforts like these will go a long way to helping us achieve our vision of being a nation where children can grow up free of dental disease.

Why are dentistry and oral health care practices seemingly easy to question?

The topic of evidence in dentistry and oral health care has been in the news a lot recently, with articles like this column in the New York Times by a professor of pediatrics.

In his column, Aaron Carroll discusses the differences he sees between his own and his wife’s dental journeys, as well as what little rigorous research has been done to support certain generally recommended dental practices.

What is interesting is that articles like this one and the popular flossing article from the Associated Press, among others, imply that recommendations made by dentists are based solely on limited or weak evidence – or worse, based simply on what the dentist will get paid for by an insurance company.

They also leave readers feeling that plaque removal and cavity prevention/treatment are the only elements necessary to address for good oral health.

Ultimately, Carroll suggests in his column that while lack of evidence doesn’t mean oral health prevention efforts don’t work, we should invest in research to ensure that those things we do are evidence-based.

For those of us in the business of improving oral health, we couldn’t agree more with that conclusion. But let’s take a closer look at some of the points that may have gone overlooked by recent press coverage.

We know that evidence something works for populations doesn’t directly translate into solutions for a specific individual – that is in fact why Carroll and his wife have such dramatically different dental journeys.

Carroll notes he has had just one filling in his life and doesn’t religiously care for his mouth, while his wife has “more fillings than [he] can count” but is fastidious in her oral care routines.

This underscores two important points:

1. Every person is different. Individualizing care is critical to improved oral health.

While evidence-based research informs standards of care, it is the dental team that must develop the best care plan for any given person’s situation. That is why DentaQuest invests in the development and adoption of evidence-based care protocols that focus on prevention, early intervention and disease management.

Our investments in disease management and risk assessment help provide dental teams with the knowledge and tools they need to best serve their patients.

For instance, across a five-year period, the DentaQuest Oral HealthCenter demonstrated that risk assessment and intense preventive efforts (including sealants and fluoride varnish) directly resulted in a reduction in the need for invasive surgical procedures.

Sealants are one of the most cost-effective strategies for protecting teeth, as noted in another recent New York Times column. This is because they provide a physical barrier against cavities. They can even be applied to teeth that are just starting to show signs of new cavities, and stop them from getting bigger.

The best time to seal a tooth is immediately after it erupts in the mouth, and so the DentaQuest Oral Health Center strives to set aside extra time at visits for children ages 6 and 11 since the permanent molars are usually erupting at that time. It is also why the DentaQuest Foundation collaborates so closely with school-based health alliances working to improve access to oral health care – and sealants – among children in grade school.

Additionally, with a patient population of over 10,000, the DentaQuest Oral Health Center works in collaboration with the DentaQuest Institute to refine strategies that make patients healthier. And when these best practices are implemented, they actively improve peoples’ health.

2. Prevention and oral health improvement do not take place solely in the dental chair.

Preventive dental visits provide an important opportunity for people to check in on their oral health habits and get evaluations for early signs of not just dental disease, but also chronic diseases like diabetes and hypertension.

Most of us spend two hours a year in a dental office. And, if we are to reconsider the benefit of two annual preventive visits as Carroll suggests, some of us might end up spending even less time with a clinician. So what about the other 8,758 hours?

The differences in the oral health of Carroll and his wife are not because he brushes with an electric toothbrush every day or because she is doing something “wrong” in her routine. Oral health care is more than just brushing and flossing. In fact, it is about more than your teeth and gums.

To make an impact, we have to take a look at how we pay for oral health care, how our public policies enable it, and how our communities prioritize it, in addition to how we provide it.

Addressing just one of those will not improve oral health care on the larger scale or reduce health care costs, as Carroll aims to do with his recommendations. We know oral health care is indeed critical for overall health. This is why we at DentaQuest look far beyond the dental chair.

For example, as part of Oral Health 2020, the DentaQuest Foundation is investing in efforts to incorporate oral health into the primary education system. Oral health education, screenings, assisted referral, and delivery of preventive care through our schools provide equitable, reliable entry into long-term oral health care.

DentaQuest also champions efforts to include innovative financing models for dental in person-centered approaches to care enabled by the Affordable Care Act (ACA).

Over the last decade, we’ve seen significant movement to transform our health care system into one that improves quality, lowers costs, and makes people healthier. In fact, on the medical side the Triple Aim is starting to be supported by alternative payment and care delivery models that are person-centered and focus on prevention.

Why did that happen? Because experts and advocates knew there had to be a better way forward for a healthier America.

The same is true for oral health. We are beginning to see that it is possible to live in a world where optimal oral health is the expectation, not the exception. We must continue to invest the same transformative energy into improving the oral health of all because you cannot have optimal overall health without optimal oral health.

 

Penny Wise, Pound Foolish?

This week, two news stories caught my eye. One, in the Washington Post, was about a vote taken in the U.S. House of Representatives to repeal mandatory funding for school-based health center construction. The other, in the Worcester, MA Telegram & Gazette, recalled the days when children in Worcester received their dental care within the public school system. That ended in the late 1970s when most school dental clinics were closed. And since then, the rate of dental disease in the city’s children has been on the rise. It also doesn’t help that the city of Worcester does not fluoridate its water supply.

Across the United States, school-based health centers are becoming an important vehicle for health care delivery for all children, but especially for poor, uninsured or underinsured children. Providing health services where children spend the greatest part of their day makes sense. It eliminates the biggest impediments to getting care – such as the parent/caregiver getting time off from work, finding a provider who accepts the family’s insurance plan, and securing appropriate transportation. School-based health centers help families too, especially when the providers introduce children, siblings and the extended family to community health resources that all can use.

School-based clinics are a first line of disease prevention and eradication. When children and their caregivers know what to do to take care of teeth, and when they are able to see a dentist when something is wrong, cavities are nearly completely preventable. And when neither of the above takes place, children can end up with serious decay and infections that require emergency room care and extreme interventions. (Read about Early Childhood Caries in this blog here and here.)

Today Worcester, MA is working to establish a pathway for young at-risk children and their families to a lifetime of good oral health. Through a pilot program, 730 Head Start children and their families are learning about oral health as part of classroom activities and parent meetings. They are introduced to the dentist as a friendly, supportive adult. Parents/caregivers get a colorful “Baby Tooth Timeline” -- a growth chart which tracks age, height and weight and provides useful dental health information for the child’s first five years. The chart explains when to expect first teeth, what to do to prevent decay, and when to schedule dentist visits.

The next step is to be sure the children have connections in the community to get care when they need it. Statistically, low-income children suffer from dental disease at much greater rates than the general population. Many Head Start children are covered by Medicaid; but not all dentists accept Medicaid patients.

And, not all school-based health centers provide dental services. We think they should. As the Worcester example shows, prevention works. It would be nice if the U.S .House of Representatives would reconsider their recent vote, and instead, approve the wise investment in school-based health centers.

Dr. Mark Doherty is Executive Director of the DentaQuest institute, a not-for-profit organization focused on improving efficiency, effectiveness and quality in dental care.

Keeping America’s Oral Health Safety Net Strong

Ask any American what they think about healthcare reform and, for better or worse, you’ll probably find very strong opinions about the role of government and spending.

However, backstage, away from the public debate about the new law, a quiet revolution is underway to help the 59 million Americans who go without medical care and the 100 million who have not had dental care this year, get the care they desperately need.

It’s not the individual mandate or the state health exchanges. It’s the most significant investment in primary care you’ve probably never heard of—an $11 billion commitment to community health centers and $15 billion to prevention programs. It may sound like small potatoes compared to the estimated total cost of healthcare reform--$940 billion over 10 years--but the impact will be significant, especially for those who need it the most.

These funds, reopened for debate by Congress, would double the capacity of community health centers (CHCs) from serving 20 million people a year to 40 million. As the only access point for care besides the emergency room, CHCs provide critical prenatal care, behavioral health services, primary and specialty care for 1 out of 7 uninsured individuals. By 2015, with new capacity, CHCs will serve 1 out 3 uninsured.

Healthcare reform requires that CHCs offer oral health services. This means as many as 17 million children will get to see a dentist, some for the first time ever. Currently, these children are significantly underserved because they can’t access to care to prevent tooth decay and, once they have decay, to get timely treatment.

There’s a reason why former U.S. Surgeon General David Satcher declared childhood tooth decay a “silent epidemic”. 6.5 million children have untreated dental disease, the majority of whom are from low-income households. Half of these children are estimated to go to school with mouth pain—as children who cannot eat properly or pay attention in class and do well in school.

For infants 3 years old and younger, this can mean a mouth full of diseased baby teeth that can only be treated through surgical intervention. This is followed by a life time of being at greater risk for tooth decay, because the corrosive bacteria that cause tooth decay have colonized their mouths in greater proportion.

Tooth decay not only disrupts development and educational attainment, it can also turn deadly. The 2007 death of a 14-year-old Maryland boy is a tragic reminder of how one ‘simple’ toothache can develop into an unchecked infection that can quickly spread to the brain. His death could have been prevented with a timely dental care, but, at the time, oral health services were difficult to find for families on Medicaid.

From our work as president of a foundation focused solely on oral health and as a lifelong practicing dentist in both a private practice and a community health center, we see evidence every day of how oral health disparities in underserved communities are every bit as cruel as violence, inadequate housing, or poorly performing schools.

Fortunately, dental disease is nearly 100% preventable with education, regular check-ups for prevention, and treatment. That is why we’re committing DentaQuest Foundation resources to supporting and strengthening the community care safety net for oral health. We want to make sure that greater numbers of health centers will be prepared to provide effective, high-quality oral health services to children and families. The DentaQuest Institute and its Safety Net Solutions program are joining us to make sure that happens.

It may take decades before the impact of this investment in community health centers is fully appreciated. That’s okay. Today we are thinking about the millions of children who will have greater opportunity in life because of accessible health care.

Blog post by Ralph Fuccillo and Dr. Mark Doherty.

Ralph Fuccillo is President of the DentaQuest Foundation.
Dr. Mark Doherty is Executive Director of the DentaQuest Institute. Its Safety Net Solutions Program is helping community health center dental programs become more efficient, effective and financially stable.