Community Oriented Primary Care Dental Services October 18, 2011 - PowerPoint PPT Presentation

Community Oriented Primary Care Dental Services October 18, 2011 Avantika Nath, BDS, DDS - Director of Dental Services, COPC

Community Programs: COPC Administration

Outline I. Scope of Services II. School Based Prevention Programs III. Patient Visits & Demographic Data IV. Special Programs a) HIV Health Services b) Give Kids a Smile Day c) Project Homeless Connect V. Staff VI. Challenges

SFDPH Community Oriented Primary Care (1) Chinatown (1) Dental Services Provided at: Public Health Center Medical Respite and Sobering Center (Polk St) (CPHC) 1) CPHC CHPY Larkin Street Clinic Maxine Hall Health 2) SAFHC Center (MHHC) Housing & Urban 3) SEHC Health Clinic (HUHC) Medical Respite and 4) PHHC Sobering Center (Fell St) Curry Senior Center 5) TWHC + offsite Tenderloin Health (5) Tom Waddell (5) CHPY Cole Street Health Center Clinic (TWHC) 6) SPY Community Oriented Primary Care Administration Ocean Park Health Center (OPHC) San Francisco General Hospital Campus Clinics (SFGH PC) Castro Mission Health Center (CMHC) (4) Potrero Hill Health Center (PHHC) (6) Special (6) Programs for (2) (2) Silver Avenue Youth (SPY) Family Health Center (SAFHC) (3) (3) Southeast Health Center (SEHC) CHPY Hip Hop to Health Clinic CHPY Balboa Teen CHPY Hawkins Clinic Health Center

Scope of Services Clinic Services Provided Priority � Kids � Pregnant women � People Living with HIV/AIDS (PLWH/A) � Homeless Population � SPY � Adults Triage Services

I. Scope of Services Dental Services are offered to the low income, under/uninsured people of SF by COPC, DPH. Priority populations receiving care: • Kids (0 ‐ 19 years) ‐ DentiCal, HK/HF initiative • Pregnant women ‐ DentiCal, HF/HK • Diagnostic, preventive and basic restorative dental services for infants, children, adolescents and pregnant women. In the past Denti ‐ Cal ( part of MediCal) was the primary source of revenue generation for services rendered by COPC. Since July 2009, Denti ‐ Cal cuts from the state whereby they only cover triage services for indigent Adults (extractions and emergency exams), has made it necessary for us to provide only emergency services for Adults. The Homeless dental services are supported by general fund and in a small part by the McKinney grant. The HIV clinic is supported in part by the Tenderloin Health Oral Health Collaboration (ended Aug 2011) and the HIV Health Services Grant (from the SF AIDS Office). The SPY services are supported by general fund. The dental clinics in the health centers are supported by general fund. The School based Kindergarten screening and sealant programs are supported by general fund. Healthy SF ‐ the medical insurance plan for the low imcome populations in the city does not cover dental services.

Clinical Services Provided : • Oral examinations, X ‐ rays and diagnosis • Oral hygiene instructions • Prophylaxis (cleaning), fluoride • Periodontal scaling and root planing • Permanent and temporary fillings • Endodontics; root canals anterior (front) teeth only • Pulpotomy • Uncomplicated extractions, minor tissue surgery and excisions • Emergency care: Services necessary to relieve or control acute oral conditions, ie: pain, inflammation, infection, bleeding, trauma, etc. Clinical Services not provided: • Orthodontics (braces) • Cosmetic dentistry (bleaching, veneers) • Treatment of advanced periodontal conditions • Complicated extractions or impactions • Nitrous oxide analgesia and sedation • Surgical endodontics, root canals posterior (back) teeth • Prosthetics (dentures, partials, crowns, bridges) Other SFDPH Dental Services include : providing and updating oral health education materials; providing educational trainings to health care students and professionals on oral health; developing innovative programs to increase access to dental care, and seeking policy changes to help increase access to dental care.

COPC Dental Clinics • Potrero Hill Health Center Dental Clinic (adults, infants, children, adolescents and pregnant women) • Southeast Health Center Dental Clinic (adults, infants, children, adolescents and pregnant women) • Silver Ave. Family Health Center Dental Clinic (infants, children, adolescents and pregnant women) • Chinatown Public Health Center (infants, children, adolescents and pregnant women) • Tenderloin Health Center (HIV services) • Tom Waddell Health Center (Homeless/HIV services)

II. School Based Prevention Programs Kindergarten Dental Screening Surveillance Program One of the three public health core function is Assessment through monitoring health status to identify community health problems. The Kindergarten Dental Screening Program is the Department’s primary oral health surveillance activity. This program is a collaborative between the San Francisco Department of Public Health (SFDPH), San Francisco Dental Society (SFDS) and the San Francisco Unified School District (SFUSD) which provides a yearly oral health assessment to every kindergartener enrolled in the SFUSD. The program was created: • To monitor and identify disease trends over time (level and demographic distribution) • To provide data to develop and target appropriate interventions and resources • To mobilize community partnerships to identify and solve oral health problems • To develop policies and plans that support individual and community health • To research for new insights and innovative solutions • To demonstrate that public ‐ private partnership can improve health outcomes • To assist children into a dental home – a place where he or she receives continuous, comprehensive, coordinated and culturally competent oral health care

Kindergarten Dental Screening Surveillance Program, continued Since its inception during the 2000 school year, over 40,000 children have received an oral health assessment, the results of the assessment and information on insurance and dental care resources. The San Francisco program was one of the models used to support the development of Education Code Section 49452.8, legislation passed in passed in 2005 as AB 1433, which requires public school children to have their oral health assessed by a licensed dental professional (dentist or dental hygienist) by May 31 of their first year of school. During the 2010/2011 school year: • 4,274 children received a dental screening in 72 schools. • 22% had one or more actively decayed teeth (untreated caries) • 41% had experienced decay (treated and/or untreated caries) Over the last ten years we have observed a 17% decrease in the percentage of SFUSD Kindergarteners with untreated caries. Comparing these results to national data is difficult because there is no exact national comparison. The closest may be the National Healthy People 2010 objectives for children ages 6 ‐ 8. We have almost reached the Healthy People 2010 objective of no more than 21% of 6 ‐ 8 year old children with untreated caries (22%). We have surpassed the National Healthy People 2010 target of 42% for caries experience in 6 ‐ 8 year olds (41%).

Kindergarten Dental Screening Surveillance Program, continued There are multiple factors that may contribute to these improvements including: • Community water fluoridation • San Francisco’s commitment to fund universal health care including dental services for children through the Healthy Kids program • Small but significant number of private practice dentists accepting public insurance plans and willing to treat children ages 0 ‐ 5 and two dental schools for advanced specialty care • Priority of safety ‐ net dental providers (including SFDPH Dental Services) to see children ages 0 ‐ 5 • Various programs, collaborations and initiatives between SFDPH Dental Services and other DPH departments and community partners which provide case management, training of Pediatrics and Family Medicine residents on early childhood oral health, perinatal oral health services and pre ‐ school/Head Start screenings

Seal San Francisco, Dental Sealant Program In 2007 the CDC’s Task Force on Community Preventive Services released a report strongly recommending two community ‐ based interventions to prevent tooth decay— community water fluoridation and school dental sealant programs. Dental sealants are a highly effective thin plastic coating painted on the chewing surfaces of the back teeth to seal out and prevent tooth decay. Although highly effective, national and state data show sealants are generally underutilized on children with both public and private dental insurance coverage. School ‐ based programs provide pit and fissure dental sealants to the permanent teeth of children in a school setting and generally target vulnerable populations less likely to receive dental care such as children eligible for free and reduced lunch programs. Our dental sealant program, Seal San Francisco, is a school ‐ based dental disease prevention program targeting second graders which: • Helps to eliminate barriers that contribute to health disparities • Prioritizes disease prevention and health promotion • Provides oral health services in a non ‐ traditional setting • Follows public health population ‐ based principles

Seal San Francisco, Dental Sealant Program, continued Seal San Francisco began in 1997 as a pilot program and grew with the help of a grant from the Dental Health Foundation. Mobile dental equipment is utilized to create a temporary “clinic” in the school. Approximately 12 ‐ 14 schools are served per year. For the 2010 ‐ 2011 school year: • 917 children in grades 1 ‐ 5 were screened • 783 children received dental sealants