Nebraska 2016 State Oral Health Assessment - Focus Areas

Story Behind the Curve

How We Impact

The Office of Oral Health and Dentistry resides within the Department of Health and Human Services, Division of Public Health. This Office includes a Dental Coordinator in addition to the Dental Director. Positive public health outcomes depend on adequate public financial resources, and having this office will enable Nebraska to align with national initiatives and funding opportunities.

The DHHS Oral Health team provides education, outreach and coordination for state dental health leaders and policy makers to engage in oral health community improvement opportunities through the use of evidence based prevention strategies. This Office also conducts quarterly Oral Health Advisory Panel meetings (made up of about 15 community dental health advocates) that help guide and ensure that our activities align with our program priorities.

What We Do

The Office of Oral Health and Dentistry will promote and develop activities which will result in the practice and improvement of the dental health of the people in the state.

Story Behind the Curve

Nebraska is fortunate to have dental two schools within our state. The University of Nebraska Medical Center (UNMC) is a public school based in Lincoln and Creighton School of Dentistry is a private school located in Omaha. Having two dental colleges Nebraska is ahead of most states in training a professional health care workforce to meet needs, but there is always concern if enough providers will remain in state to provide services to Nebraskans. Training programs and incentive opportunities (see below) are in place within the state to encourage Nebraska dental graduates to remain and practice in the state, particularly in rural communities.

Extramural Rotations: Both UNMC and Creighton offer extramural and elective programs that match upper class dental students to public and private locations across the state for 4-6 week periods. These experiences allow the students to gain valuable insight into professional life after school and exposes them to urban and rural parts of the state where they can provide comprehensive under the guidance of approved preceptors. Through this program students are often encouraged to return to these communities to practice.

Student Loan and Loan Repayment: The Office of Rural Health Advisory Commision currently offers two tax free incentive programs- the Nebraska Rural Health Student Loan Program and the Nebraska Loan Repayment Program are available to UNMC and Creighton students. The first is offered to Nebraska medical, dental, physician assistant, and graduate-level mental health students. Students can receive up to $20,000 per year for up to four years. The second can be obtained by licensed graduates and also pays up to $20,000 a year (with a 20K local community matching fund) over a 3 year period to repay student loans. This program encourages graduates in these fields to practice in underserved areas while receiving payment for their student loans.

3RNet Recruitment: National Rural Recruitment and Retention Network (3RNet) is a national non-profit organization that connects rural and underserved communities with health care professionals. It networks with numerous resources around Nebraska to provide background information about current practice opportunites. It also creates a data base of available dental practices in rural and urban settings and currently lists about 35 sites. It is coordinated through the UNMC College of Dentistry Rural Opportunities Program.

UNMC College of Public Health: In 2010 Nebraska opened this center in Omaha that focuses on issues such as urban/rural health, global health, environmental health and biostatistics. The Office of Oral Health will seek opportunities to partner with this professional resource for assistance in dental epidemiology and evaluation.

Why Is This Important?

To improve our oral health, state legislators and federal agencies must have current and reliable information on a regular basis to determine Nebraska’s oral health status. This surveillance is needed to see where we stand now, to determine our deficiencies and to take positive action moving forward. Surveillance is generally carried out by public health officials and may involve collecting data from multiple sources. Nebraska does not have an active system in place which would allow us to track this necessary data. HP 2020 OH-16 target is to have an oral health surveillance system in each state. Currently, Nebraska is only listing data on 6 of the 17 HP2020 objectives.

Goal

The Association of State and Territorial Dental Directors (ASTDD) and the Council of State and Territorial Epidemiologists (CSTE) recommend state dental surveillance plans include oral health outcomes, risk factors, community interventions and access to the oral health care system.¹ There is an array of state level indicators that could be sources of possible oral health information such as information on the dental workforce, community fluoridation levels and cancer rates. A plan will be created to use current data to protect and promote Nebraska population wide oral health. The framework of this surveillance system is expected to include the eight core indicators, the ten essential indicators of the operational definition for OH-16, and other potential indicators. It will monitor the prevalence of oral diseases, to identify the risk factors, to detect the access to dental care, and to determine the effectiveness of preventive services. This surveillance guideline will provide concise and reliable data to the state dental director and the significant others such as general public, public policy makers, and the stakeholders in a timely manner. Information also will be periodically disseminated to the appropriate audiences through an accessible approach. The creation of this system framework begins with the system design, data collection, analysis and public communication of the findings to help shape program policies. A team of experts, mostly from within DHHS Division of Public Health will be needed to collaborate, design and implement Nebraska's oral health surveillance system. below is a basic guide for a oral health surveillance system.

Conceptual Design of an Effective Oral Health Surveillance Cycle

1. Council of State and Territorial Epidemiologists, Phipps, K., Kuthy, R., Marianos, D., and Isman, B. State-Based Oral Health Surveillance Systems; October 2013. Available at: http://www.astdd.org/docs/state-based-oral-health-...

Story Behind the Curve

Nebraska does not currently have an active oral health surveillance system. An oral health objective within HP2020 is for all states to have oral health surveillance systems in action. According to the proposed new operational definition of HP2020 OH-16, ten essential indicators are suggested to be tracked in state-based oral health surveillance systems. At least eight of these indicators are needed for the system to be reliable. In 2014, Nebraska could monitor seven of the ten essential indicators, leaving three indicators that are not currently available. A list of these seven indicators can be found in the 2016 Nebraska State Oral Health Assessment.

A state survey, as recommended to be completed every five years by the National Oral Health Surveillance System (NOHSS) was conducted in Nebraska in 2005 to establish a baseline to track dental disease trends. This visual survey was a Basic Screening Survey (BSS) of third grade students across the state. In that baseline survey conducted by the OOHD, 2,057 third graders in 55 elementary schools across the state were visually screened. The data from the 2005 survey is now outdated and needs to be updated. In 20156 there were approximately 25,000 3^rd grade students in 502 schools in Nebraska. The OOHD is in the process of duplicating this BSS survey by sampling approximately 6,000 children in about 75 public and private schools across the state (with oversamples in Omaha and western Nebraska). 800 children in Head Start programs will also be included in this survey. Results will allow us to analyze current trends and compare new data to our 2005 baseline.

The Office of Oral Health also desires to conduct an older adult (65+) basic screening survey in the near future in order to align with Association of State & Territorial Dental Directors state requirements.

Story Behind the Curve

Private health is obtained through dental offices, clinics and centers. The vast majority of Americans access the private system where 91% of our U.S. dentists practice.¹ These patients are primarily comprised of individuals who are employed, with either employer-sponsored health insurance or the ability to pay out of pocket. A full range of comprehensive care is available from general and specialty care practices. Private group practices and dental management organizations are growing and the number of office sites controlled by multi-unit dental companies is increasing. Collaboration between State Oral Health Programs and State Dental Associations serve as an excellent platform to address community oral health issues, especially among the underserved populations. Identifying areas of common ground will improve oral health for all of our residents.

Sources:

1. American Dental Association. A Proposed Classification of Dental Group Practices; February 2014. Available at: http://www.ada.org/~/media/ADA/Science and Res....

Definition

2013 the U.S. Census Bureau reported that 11.3% (approximately 125,000 people in the working class) of Nebraskans under age 65 were without health insurance. It has been estimated that more than twice as many lack dental insurance (approximately 250,000). By 2014, the Affordable Care Act had reduced these numbers for health insurance, but dental benefits were only mandated for children, still leaving a large gap in coverage for adults. Low family income can lead to a lack of opportunity, social difficulty and poverty status. Substandard housing conditions and living in medically underserved communities are additional obstacles to good oral health. In 2014, Kids Count Nebraska reported nearly 41% of our children are growing up in low-income families.

Story Behind the Curve

Public health care delivery system is the second main way to access U.S. dental services. It provides urgent and basic oral health care for millions of Americans who face barriers in accessing the private system. Choosing between the two systems often depends on the person’s employment status, insurance coverage or ability to pay. People deciding to access the public health system often have more unmet oral needs and may come from various underserved groups. The main component of this safety net is a network of community health centers that offer services at reduced or no cost.

What We Do

Federally Qualified Health Centers: FQHCs enhance the provision of primary care services in underserved urban and rural communities. These clinics are located in high need areas and are open to all residents regardless of insurance status. They focus on providing comprehensive primary care services to low income populations in a culturally appropriate manner. In Nebraska, there are now seven FQHCs that serve over 60,000 patients and all centers offer dental services which represents about 28% of their patients. These clinics produced four times as much preventive care as restorative, emergency and other dental services. The value of this care was nearly 8.5 million in 2015. The annual activities of these Health Centers are reported through the Health Center Association of Nebraska.

Medicaid-CHIP: Medicaid-CHIP public subsidized health care plan through the government. The goal of these plans is to increase access to care for low income people, especially children. There are different types of programs under this type of insurance: Medicare, Medicaid and the Children’s Health Insurance Program. Nebraska is one of the few states to cover limited dental services for adults up to a $1,000 dollar limit per year to include exams, prevention, restorations and extractions.¹ Assisting eligible patients to enroll into these existing programs and to utilize these important dental benefits, will allow more of our underserved population in Nebraska to access the private or public dental care systems in the future. All children enrolled in Medicaid up to age 21 are entitled to the comprehensive set of health care services known as Early and Periodic Screening, Diagnostic and Treatment (EPSDT) aimed at low income infants, children and adolescents. These children receive age-appropriate screening, diagnostic and treatment services, including dental services, that are medically necessary to correct any identified conditions.

Safety Net System: Despite financial assistance programs efforts to increase access to care to dental homes through the private and public dental health systems, there are still thousands of Nebraskans who lack the resources to receive dental care on a regular basis. Many safety net components exist to help people who fall into these care gaps and may include: public or charity clinics, university clinics, individual dental professionals and organizations/companies that sponsor charitable events located throughout the state. Some of the largest safety net providers are the UNMC College of Dentistry and Creighton University School of Dentistry. Together they have a large professional workforce of hundreds of faculty and students that annually provide millions of dollars’ worth of free and reduced dental services to underserved populations.

Examples:

Mission of Mercy (MOM)-The Mission of Mercy (MOM) is a non-profit organization started in 2000 that works in partnership with the American Dental Association to address the needs of low income and uninsured dental patients.² Using volunteer dental personnel and donated equipment and materials, they have treated more than 170,000 patients and provided approximately $100 million worth of care.³ In 2005, MOM and the Nebraska Dental Association started in Norfolk and it has moved to a different location each year since. Field Clinics are set up in large community outreach settings with dozens of portable dental units and hundreds of volunteers that provide free exams, X-rays, cleanings, fillings, extractions and even dentures to the needy.

Source: Nebraska Department of Health and Human Service, Office of Oral Health and Dentistry; 2014.

Peoples City Mission Lincoln- The Peoples City Mission Medical Clinic opened in 2008 and provides health care to thousands of Lancaster County residents who are homeless or low income. Its primary purpose is to fill gaps in the existing medical network. Care is provided through group of volunteer doctors, dentists, students and other health professionals who work days, evenings and weekends to treat patients and provide referrals. In 2013, they had over 17,000 patient visits which made them one of the largest free clinics in the U.S. They also performed over 3,000 dental visits and provided more than $1 million worth of dental services.³ The clinic operates entirely on donations and does not accept cash, private or public insurance payments.

Sources:

1. Nebraska Department of Health and Human Service. Nebraska Medicaid Program Client Information. Retrieved Date: 03/12/2015. Available at: http://dhhs.ne.gov/medicaid/Pages/med_clientbook.a....

2. Missouri Mission of Mercy. Webpage. Retrieved Date: 03/18/2015. Available at: http://www.momom.org/.

3. Nebraska Department of Health and Human Service. Office of Oral Health and Dentistry; 2014.

Why Is This Important?

While the existing dental care delivery system in Nebraska may not need to be drastically changed, it is to our advantage to consider new approaches that focus on prevention and bring partners together to address our existing disparities. The Surgeon General and Healthy People 2020 are now asking our health leaders to take a proactive stance and emphasis reduction of this disease with documented wellness outcomes across the lifespan. This means taking action at the communal level and reaching at-risk populations exactly where they live. The key to success is using local organization involvement and expanding the existing infrastructure and capacity of the many local health departments, federally-qualified health centers, Dental Colleges and private dentists / hygienists that are here in Nebraska.

CDC has established strategies for developing and enhancing the infrastructure and capacity of state oral health programs and for extending community-based preventive programs. The strategies are organized in two components: Component One for basic capacity for collective impact, and Component Two for implementation of evidence-based preventive interventions and strategic approaches to impact health systems and access to clinical preventive services. A list of strategies that fall within these two components can be seen blow.

Component One strategies:

• Develop program leadership and staff capacity.
• Develop and coordinate partnerships with a focus on prevention interventions; establish and sustain a diverse, statewide, oral health coalition; and collaborate and integrate with disease prevention programs.
• Develop or enhance oral health surveillance.
• Build evaluation capacity.
• Assess facilitators/barriers to advancing oral health.
• Develop plans for state oral health programs and activities.
• Implement communications activities to promote oral disease prevention.

Component Two strategies:

• Maintenance of Component One strategies.
• Coordinate /Implement school-based/-linked sealant programs, targeting low-income and/or rural settings.
• Collect and report sealant program data to track program efficiency and reach.
• Collect and report program data and track policy changes on community water fluoridation.
• Educate on the benefits of community water fluoridation.
• Promote and provide support for quality control and management of fluoridated water systems.
• Implement strategies to affect the delivery of targeted clinical preventive services and health systems changes.

Source: Centers for Disease Control and Prevention. Division of Oral health; Last updated 1/15/2013. Available at: http://www.cdc.gov/OralHealth/state_programs/cooperative_agreements/.

Why Is This Important?

The Nebraska DHHS 2010 comprehensive five year needs assessment found that less than half of Medicaid eligible children were receiving their annual preventive dental services.¹ They also discovered oral health disparities that affected very young, low income and children with special health care needs. Lack of pediatric dentists, shortages in funding and lack of coordination of existing efforts were contributing factors to poor oral health. MCH created a priority listing of their top focus areas for 2010-2015 and increased access to oral health care for children was among the top ten in significance. MCH can support the OOHD through internal allocations and LPHDs can receive sub awards to support community dental programs.

1. Nebraska Department of Health and Human Service. Nebraska’s Title V 5-Year Needs Assessment 2010; 2010. Available at: http://dhhs.ne.gov/publichealth/Documents/NeedsAssessmen2010FINAL.pdf.

How We Impact

Many state level dental programs partner with the Maternal and Child Health Bureau (MCH) to jointly provide preventive and primary care services through the Title V MCH Block Grant.¹ Title V and Title XIX (Medicaid) of the Social Security Act jointly require that the state level Title V program and Medicaid have an interagency agreement to coordinate and maximize services. This agreement further ensures that Medicaid enrolled MCH populations have access to dental care.

Source:

1. Nebraska Department of Health and Human Service. Nebraska Maternal and Child Health Block Grant 2015. Retrieved Date: 03/11/2015. Available at: http://www.amchp.org/Policy-Advocacy/MCHAdvocacy/2015%20State%20Profiles/Nebraska%202015.pdf.

Who We Serve

MCH serves all infants, children, youth, women of child bearing age and children with special health care needs.

Story Behind the Curve

The Tobacco Settlement Act of 2001 established twenty Local Health Departments (LHDs) that cover all 93 counties (see the map below). Many of our local health departments offer preventive dental service programs and a few have actual dental clinics, with Lincoln Lancaster County Health Department being the largest. There are also 135 smaller rural health clinics located within our borders. Most state dental programs partner directly with their local health departments to provide educational, promotional and preventive services at the community level.

Partners

The OOHD will collaborate with both the Nebraska Association of Local Health Directors (NALHD) and the Public Health Association of Nebraska to work with local health departments to help assure the provision of oral health services. In addition, the OOHD will partner with the Health Care Association of Nebraska(HCAN), the University of Nebraska College of Dentistry, Creighton University School of Dentistry, the UNMC College of Public Health, and the Nebraska Dental Association as much as possible on all future dental disease prevention projects and program activities.

What We Do

Women, Infant and Children (WIC) is available in over 110 clinics that cover all of Nebraska (see map below).¹ The Nebraska WIC Program provides health screenings, free healthy food, nutrition information and breastfeeding support to more than 38,000 low income women, infants and children across the state each month.² Community oral health education and prevention programs can partner with WIC clinics to provide services and offer patient referrals. Dental health promotional events and outreach activities can also be coordinated through these sites.

1. Nebraska Department of Health and Human Service. Nebraska WIC Program. Retrieved Date: 03/11/2015. Available at: http://coventrywcs.com/web/groups/public/@cvty_medicaid_nebraska/documents/newsletter/c076924.pdf.

2. Nebraska Department of Health and Human Service. Nebraska WIC Program; 09/19/2014. Available at: http://dhhs.ne.gov/publichealth/Pages/wic_local-ag....

What We Do

In Nebraska there are 16 Head Start and 14 Early Head Start programs¹ that serve over 5,800² children in the 17 grantee areas. Head Start programs can operate in HS centers, schools or via home visiting programs. Good oral health is essential to a child’s behavioral, speech, language and overall growth and development. Head Start personnel track the provision of oral health care and help parents obtain a professional dental examination and follow up care at a dental home. They also promote good oral hygiene in the classrooms with individual materials and brush in programs. Head Start directors, teachers and staff are valuable partners in the field of oral health and can help set up nutrition guidance, and provide counseling to parents and guardians.

1. Nebraska Head Start Association. Service Area. Retrieved Date: 03/11/2015. Available at: http://www.neheadstart.org/index.php/service-area.html.

2. Nebraska Department of Health and Human Service. 2013-2014 Head Start Program Information Report Enrollment Statistic Report-State Level Nebraska; 10/14/2014. Available at: http://www.education.ne.gov/oec/hssco/programdata.pdf.

Who We Serve

Nebraska Head Start Program Service Areas

Note: Those counties in white are areas not served by Nebraska Head Start

Source: Nebraska Head Start Association, 2014

What We Do

Prevention strategies utilized to reduce dental caries and other oral health complications:

• Fluoride Varnish is an Food and Drug Administration (FDA) approved lacquer gel containing 5% sodium fluoride in a resin base. When applied topically, by a qualified health professional, it provides a highly concentrated temporary dose of fluoride to the tooth surface. It can be painted on the tooth surfaces in just minutes which makes easy use outside of the dental office. Fluorides act to strengthen tooth enamel through a process called re-mineralization, and has been found to be effective in reducing decay on both primary and permanent teeth by up to 25%.¹ Repeated fluoride treatment is needed and should be applied at two to three times per year.
• Preventive Sealants are protective coatings that are bonded to the biting surfaces of posterior teeth in a process that takes only minutes to apply. These teeth have many grooves and pits where food and bacteria can stick and where most of childhood decay forms. Sealants are smooth and do not interfere with biting, but they do prevent the bacteria and food from sticking to these vulnerable parts of the tooth. Sealants can be placed on primary or permanent teeth. Sealants may also release fluoride which reinforces the enamel. They are designed to wear off after 4-6 years and are replaced during the teenage years. Studies have shown that properly placed sealants use can reduce decay by up to 60%.²

1. Association of State and Territorial Dental Directors. Fluoride Varnish: an Evidence-Based Approach Research brief; September 2007. Available at: http://www.astdd.org/docs/Sept2007FINALFlvarnishpa....

2. P rogram Strategic Plan 2011-2014; March 2011. Available at:http://www.cdc.gov/oralhealth/pdfs/oral_health_strategic_plan.pdf.

Who We Serve

The Office of Oral Health and Dentistry's target populations for the above prevention strategies:

• 0-5 Age Children are our first target group for prevention activities. The local health departments will often collaborate with teachers and staff at Early Head Start, Head Start, WIC clinics, preschools and daycare centers to offer dental services. Dentists and authorized public health hygienists can also obtain parental consent to provide dental topical fluoride varnish applications in Nebraska.
• 6-18 Age Youth are our second target group for prevention activities and these services can often be based at the elementary, middle and high school levels. Making oral health services available at schools enables students to access care in a safe and familiar environment. The local health departments can establish relationships through the school health nurses and parental consent forms to regularly provide and expand preventive services. Dental screenings are now mandated annually in Nebraska for grades Pre K-4, 7 and 10. Every 3 years an aggregated report is produced by the State which can be used to help track dental disease and to inform community leaders, school board members and policy makers about the impact of this condition on Nebraska schools. Oral health information should become a part of the overall student primary health education curriculum. Topical fluoride applications also continue to be beneficial during this time, as do sealants.
• 65+ Older Adults are our third target group for prevention efforts. Goals are to increase daily oral hygiene and annual preventive dental cleanings for residents of assisted living and long term care facilities in Nebraska.

Why Is This Important?

Maximizing the utilization of the existing dental workforce assets is a key goal in early intervention. Dentists, dental hygienists, school nurses and other allied medical health professionals can play a significant role in delivering services through public health programs. Thirty five states now have policies that allow qualified hygienists to provide preventive oral health care in community based settings.¹ In Nebraska, hygienists can obtain a Public Health Authorization Permit (Child and/or Adult) which allows them to provide preventive services under the scope of their license in public health settings. In 2015, there were 80 hygienists with this permit. Nebraska can directly reimburse these hygienists once they obtain a Medicaid provider number.² Increasing the mobilization of these skilled public health dental hygienists could help provide needed preventive services in Nebraska’s projected dental shortages areas.

Public health programs need to collaborate to pool resources, share experiences, duplicate their efforts to promote oral health within their regions. With state support, community backing, local workforce and proper equipment these partnerships can expand preventive services into non-traditional settings that can deliver positive results. Close coordination of the statewide LPHDs with the OOHD through the Nebraska Association of Local Health Directors will be needed with constant communication.

Sources:

1. Department of Health and Human Service, Centers for Medicare and Medicaid Service. Keep Kids Smiling: Promoting Oral Health Through the Medicaid Benefit for Children & Adolescents; September 2013. Available at: http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Benefits/Downloads/Keep-Kids-Smiling.pdf.

2. American Dental Hygienists Association. States Which Directly Reimburse Dental Hygienists for Services under the Medicaid Program; June 2010. Available at: https://www.adha.org/resources-docs/7519_Direct_Re....

What We Do

Current community based intervention projects occurring in Nebraska:

Oral Health Access for Young Children: The OHAYC program was first implemented in January 2011 in 15 LPHDs and FQHCs across Nebraska. The projects provided preventive dental screenings and supplies, fluoride varnish applications, oral health education and dental referrals to high-risk children and families with limited access to dental health care in WIC, Head Start/Early Head Start, and Day Care settings.

Elder Health Enduring Smiles: Through a sub grant between the DHHS, Division of Public Health Office of Oral Health and Dentistry and The University of Nebraska Medical College oral health training toolkits were created and distributed to senior center across Nebraska. The training module topics include: oral health care for senior residents, oral assessments, the oral effects of medications prescribed for residents and the oral-systemic link of diseases for elders. A new grant was issued in January 2015 to continue this work and a DVD will be left at centers to train new employees. The collaborators will also explore expanding this training to help people with disabilities.

UNMC Sealant Program: The UNMC College of Dentistry has operated the Dental Hygiene Sealant Program since 2003. This program pairs hygiene students with instructors who visit selected public elementary schools in Lincoln, Omaha and rural areas of the state on an annual basis. Traveling in teams, these providers go into the schools and set up portable equipment to hold a sealant clinic on site.

Building Healthy Futures: Building Health Futures is a non-profit organization that works with the Omaha Child Oral Health Collaborative. This group brings many local dental partners together to provide increased access to dental services for underserved children. They work with the Douglas County Health Department, One World Community Health Center, Charles Drew Community Health Center, Creighton University College of Dentistry and the UNMC Pediatric Dental Residency Program. These partners work together along with local private dentists to provide educational, preventive, and patient referrals to dental homes in several Omaha public schools.

Loup Basin Smiles Dental Program: In 2005, The Loup Basin Public Health Department started a dental disease prevention program that went into about 25 pre-school and elementary school settings. They offered oral screenings to over 1,000 children per year along with fluoride varnish applications performed by a dental hygienist. Based upon the screening findings, proper dental referrals were then made. A six year study from 2006 to 2012 found that there was a 35% decrease in the number of students who needed immediate referrals to a dentist.

Miles of Smiles Program: Miles of Smiles Program is a prevention project in O’Neill. The North Central District Health Department serves 48,000 people in nine counties in rural northern Nebraska. Six of these counties are designated as general dental shortage areas by the state. In 2012, they started the Miles of Smiles dental program that went into about 35 elementary and middle school settings. They offered oral screenings to about 35% of the students along with fluoride varnish applications and proper referrals. A dramatic decrease in children that required immediate dental referrals occurred between 2012 and 2014 (30% in 2012 to 19% in 2014), which demonstrates how large of an impact community oral health prevention programs can make.

Why Is This Important?

For almost 70 years, community water fluoridation has been a scientifically proven, safe and cost effective way to strengthen teeth for people of all ages and to reduce tooth decay rates by about 25%.¹ The fluoride mineral is especially important for children age 0-5 to help fortify the enamel in their developing teeth. CDC has recognized water fluoridation as one of 10 great public health achievements of the 20th century.²

In 2008, the Nebraska Legislature passed a law to require all Nebraska cities with over 1,000 people to add fluoride.³ Cities had the option to opt against this and 49 communities did (including Grand Island, Hastings and Beatrice). In 2014 approximately 70% of Nebraskans were drinking from community water systems with optimal fluoride levels which was slightly below the 2014 national average (74.7%), and the HP 2020 target of 79.6%. Below is a map that indicates the percentage of population in each Nebraska county that has access to public water that contains the recommended fluoridation levels.

Sources:

1. American Dental Association. Fluoridation Facts; 2005. Available at: http://www.ada.org/~/media/ADA/Member%20Center/FIles/fluoridation_facts.ashx.

2. Centers for Disease Control and Prevention. Community Water Fluoridation; 07/10/2013. Available at: http://www.cdc.gov/fluoridation/.

3. Fluoride Action Network. State Fluoride Database, Nebraska. Retrieved Date: 2/4/2015. Available at:http://fluoridealert.org/researchers/states/nebraska/.

Why Is This Important?

Success of oral health initiatives is often dependent on modifying individual behavior oral health care. Taking health literacy in to consideration when educating the community and promoting health behaviors is vital. Additionally, the incorporation of age appropriate dental education and nutrition counseling into clinical and school settings is essential to creating community level change. Educating the public in basic preventive behaviors will improve the health of those people who are suffering with untreated dental disease and will, more importantly, empower individuals to stop new disease before it starts. This is especially important for parents and care givers. Comprehensive oral health education should include the role of nutrition because eating patterns and heavy sugar consumption is associated with dental decay. While awareness about the importance of oral health is on the rise, there is a ways to go yet in terms of promoting oral health policies, program and health behaviors which will ultimately reduce oral disease.

What We Do

Lifespan Dental Education: The Office of Oral Health and Dentistry education efforts moving will be aimed across a lifetime of target audience age groups: 0-5, 6-18, 19-64 and 65+ as each category has a specific population with unique dental needs and challenges as described in the needs assessment section of this dashboard. This age relevant information will come from reliable professional sources such as the American Dental Association, the Centers for Disease Control and Prevention, The Association of State and Territorial Dental Directors and the Council for State and Territorial Epidemiologists. Efforts will be aimed at expectant mothers, parents, children, students, teenagers, adults, senior citizens and other vulnerable groups. It will be shared with local health departments, federally-qualified health centers, private dental offices and Nebraska dental colleges. Information on lifespan dental education efforts will be posted and updated on a regular basis on our Nebraska DHHS OOHD website www.dhhs.ne.gov/dental.

Children’s Dental Health Month: February is National Children's Dental Health Month. In 2015 The Office of Oral Health and Dentistry collaborated with Together for Kids and Families and the Pregnancy Risk Assessment Monitoring Program (in the Lifespan Health Unit) and the Head Start State Collaboration Office (in the Nebraska Department of Education) to provide oral health kits to approximately 6,000 Head Start and Early Head Start students across the state. Each oral health kit contained 1 toddler tooth brush, 1 tube of children’s tooth paste, 1 adult tooth brush, a 2 minute timer and educational materials. We hope that this can become an annual event with more partnerships and activities that can increase the impact of this health promotion campaign across Nebraska.

Early Dental Health Starter Kits: The OOHD has developed an dental hygiene kit aimed at infants and children age 0-5. These specialized cleaning tools are designed by age to help mothers and their babies remove dental plaque and improve oral hygiene through the early years of development when early childhood caries often occur. The kit comes with five cleaning aides, a two-minute time and an instruction card in English and Spanish. In 2016, about 8,500 kits were sent out to the Nebraska Early Childhood Development Network, Early Head Start and the Nebraska Maternal, Infant, Child Home Visiting program, Sixpence and several Foster Care programs. The OOHD will look to partner with more program to further distribute these kits in the future.

Definition

There are new approaches to public health dentistry that will make its delivery more effective in the future. Improving dental health with cultural and linguistically appropriate oral health services will allow patients to more clearly understand professional information and make personal decisions to protect and promote their health.

Oral health is starting to have an increased importance in health histories, primary assessments and physical exams. In medicine, we are starting to see a team-based approach to primary care with inter-professional cooperation across all disciplines that will improve our systemic health outcomes. Pediatricians, nurse practitioners and physician assistants are beginning to perform dental screenings and provide direct preventive services. Students from different backgrounds, such as physicians, dentists, pharmacists, nurses, and physician assistants, are beginning to train together during rotations to learn oral health core competencies which will improve communications and patient results. Mobilizing our existing trained public heath hygienists, school health nurses, teachers, community health workers and senior caregivers all will play a valuable role in connecting children a and elders to local dental homes that provide education, prevention and corrective dental services.