DSHS Grand Rounds Its Hard to Make As with a Toothache: Oral Health - PowerPoint PPT Presentation

DSHS Grand Rounds

It’s Hard to Make A’s with a Toothache: Oral Health Status of Texas Elementary Students Rhonda Stokley, DDS State Public Health Dental Director DSHS DSHS Grand Rounds

It’s Hard to Make A’s with a Toothache: Oral Health Status of Texas Elementary Students Learning Objectives 1. Describe the impact of tooth decay on a child’s ability to learn. 2. Compare the oral health status of younger and older Texas elementary school students. 3. Describe how the oral health status of Texas children compares to Healthy People 2020 objectives and targets. 10/28/2019 3

It’s Hard to Make A’s with a Toothache: Oral Health Status of Texas Elementary Students • Tooth Decay and its Impact on Learning • Overview of Oral Health Improvement Program • Kindergarten and Third Grade Oral Health Surveillance • Healthy People 2020: Oral Health Targets • Discussion • Q&A 10/28/2019 4

What is tooth decay? • Aka Dental Caries • It is the destruction of tooth enamel by acids produced by bacteria in your mouth • Most common chronic childhood disease¹ • Associated with diabetes, heart disease, stroke and low birth weight babies² 1.Centers for Disease Control and Prevention (CDC). (2016, September 22). Hygiene-related Diseases: Dental Caries (Tooth Decay). Retrieved from https://www.cdc.gov/healthywater/hygiene/disease/dental_caries.html 2.Jackson, S. L., Vann, W. F., Kotch, J. B., Pahel , B. T., & Lee, J. Y. (2011). Impact of Poor Oral Health on Children’s School Attendance and Performance. American Journal of Public Health,101(10), 1900-1906. doi:10.2105/ajph.2010.200915

What causes tooth decay? Carbohydrates Bacteria Time CAVITY Tooth

What does tooth decay look like? • Begins as white spots on the enamel (reversible) • Turns brown or black • Can develop on the tongue and cheek sides, chewing surfaces, and between teeth • Dentists can detect early decay before the patient feels them

Tooth Decay and Learning • Children with poor oral health are 1.4 times more likely to have poor school performance and 3 times more likely to miss school. 1,2 • 12.6% of 8 th and 11 th graders reported missing school, at least twice in the past year, because of a sore mouth or teeth 3 • 3.9% of 2 nd graders missed school at least twice for the same reason 3 1. Jackson, S. L., Vann, W. F., Kotch, J. B., Pahel , B. T., & Lee, J. Y. (2011). Impact of Poor Oral Health on Children’s School Attendance and Performance. American Journal of Public Health,101(10), 1900-1906. doi:10.2105/ajph.2010.200915 2. Blumenshine, S. L., Vann, W. F., Gizlice , Z., & Lee, J. Y. (2008). Children’s School Performance: Impact of General and Oral Health. Journal of Public Health Dentist ry,68(2), 82-87. doi:10.1111/j.1752-7325.2007.00062.x 3. Oral Health in Texas Children and Adolescents: School Physical Activity and Nutrition Survey, 2015-2016. Data prepared by: DSHS, Maternal and Child Epidemiology Unit, Sept 2019.

Tooth Decay and Learning • Poor nutrition from difficulty eating and a lack of sleep contribute to an inability to focus and perform well in school. 1,2 • At least twice in the past year, 23.3% of 4 th graders had a sore mouth or teeth that made it hard to eat or chew 3 • Children with dental pain are also more likely to feel worthless, unhappy, shy or embarrassed. 4 1. Jackson, S. L., Vann, W. F., Kotch, J. B., Pahel , B. T., & Lee, J. Y. (2011). Impact of Poor Oral Health on Children’s School Attendance and Performance. American Journal of Public Health,101(10), 1900-1906. doi:10.2105/ajph.2010.200915 2. Thikkurissy, S., DDS, MS, Glazer, K., DMD, MS, Amini, H., DDS, MS, MPH, Casamassimo, P. S., DDS, MS, & Rashid, R., DDS, MS. (2012). The Comparative Morbidities of Acute Dental Pain and Acute Asthma on Quality of Life in Children. Pediatric Dentistry,34(4), E77-E80 3. Oral Health in Texas Children and Adolescents: School Physical Activity and Nutrition Survey, 2015-2016. Data prepared by DSHS, Maternal and Child Health Epidemiology Unit, Sept 2019. 4. Guarnizo-Herreño, C. C., & Wehby , G. L. (2012). Children’s Dental Health, School Performance, and Psychosocial Well -Being. The Journal of Pediatrics,161(6), 1153-1159. doi:10.1016/j.jpeds.2012.05.025

This is 100% preventable!

What is DSHS doing to help?

Oral Health Improvement Program • Part of Community Health Improvement Division • Surveillance, education, prevention • Priority populations: children, infants and pregnant women • Three major programs: • Smiles in Schools • Smiles for Moms and Babies • Oral Health by the Numbers Photo courtesy of Dr. Kimberly Melendez, DSHS Regional Dentist

OHIP: Smiles in Schools • Screened 10,094 children during FY19 • Contributed to another 7,152 through community collaborations • Limited oral evaluations, fluoride varnish, dental sealants, education • Data collection (Oral Health Basic Screening Survey) • Collaborations with dental schools, dental hygiene programs, nursing programs, community-based events, home visiting programs, etc. Top: Cynthia King, Regional Dental Hygienist Bottom: Dr. Anita Albert, Regional Dentist

OHIP: Smiles for Moms and Babies • Goals: Improved oral health for pregnant women and first dental visit before age 1 • Training, resources and technical assistance for home visiting programs • Over 400 HVs trained to date • Oral health videos, including newly- released Baby Steps for Tiny Teeth in English and Spanish • Oral Health Care During Pregnancy: Practice Guidance for Texas Prenatal and Dental Providers , coming soon

OHIP: Oral Health by the Numbers • Oral Health Basic Screening Survey data • Analyze oral health data in other statewide surveys • Add oral health questions to surveys • Share data through presentations, data briefs, list serv, Grand Rounds, etc.

Oral Health Basic Screening Survey (BSS) • Developed by Association of State and Territorial Dental Directors for uniform oral health data • Statewide data that meets certain requirements is submitted to the National Oral Health Surveillance System (NOHSS) • 2 parts: parent questionnaire and direct observation of child’s mouth astdd.org/basic-screening-survey-tool/ Accessed 10/1/2019

Oral Health Basic Screening Survey (BSS) Parent questionnaire: • Demographics • Type of dental insurance • Free/Reduced School Lunch Program status • Has your child ever been to the dentist for any reason? • In the past 12 months, has your child seen a dentist for a routine dental checkup? astdd.org/basic-screening-survey-tool/ Accessed 10/1/2019

Oral Health Basic Screening Survey (BSS) Direct observation: • Untreated decay • Treated decay • Dental sealants on permanent first molars • Urgency of need for dental care astdd.org/basic-screening-survey-tool/ Accessed 10/1/2019

Oral Health Basic Screening Survey (BSS) • OHIP enters data into Epi Info, developed by the Centers for Disease Control (CDC) and the World Health Organization (WHO) http://wwwn.cdc.gov/epiinfo/ • Data quality: • DSHS teams are calibrated • Quality assurance measures built into database • IRB-exempt: standard public health activity, not research • Memorandums of Understanding with schools or school districts

Oral Health Basic Screening Survey (BSS) Sampling strategy: • Probability proportional to size • Stratified by geographic location • Sorted by % of children eligible for free and reduced lunch Study populations: • Public elementary schoolchildren in kindergarten and third grade Sampling frame: • List of schools from Texas Education Agency Time frame: • 2017-2018 and 2018-2019 school years Inclusion criteria: • Parental consent • Child’s willingness to participate • Child being present on day of evaluation Final data: • Weighted to represent all public school kindergarten and third grade children in Texas

BSS Results Kindergarten Third Grade Sample size Sample size Participating Schools 139 a 140 Class enrollment on 13,687 14,191 screening day Completed evaluations 4,722 4,630 Partial evaluations b 250 193 Returned consents c 4,972 (36.3%) 4,823 (34.0%) FRL status on day of 2,278 (48.2%) 3,154 (68.1%) screening d a No consenting participants in one school (n=8); b Partials include absentees; c Includes positive consents only; d Free/Reduced Lunch (FRL) status is self-reported Source: DSHS MCH Epi Unit

Oral Health BSS: Results • 10.7% had never seen a • Nearly 25% did not have a dentist for any reason routine dental check-up in the past year • Almost 20% had no dental coverage • Compared to white non- Hispanic children, those identified as Hispanic were 60% more likely to have a history of tooth decay, regardless of grade Source: DSHS MCH Epi Unit

Oral Health BSS: Results • Regardless of grade, almost 20% of young children had untreated tooth decay • More than 50% of young children had a history of tooth decay • Kindergarteners and third graders of race/ethnicities other than white has significantly higher odds of untreated tooth decay than white children. Source: DSHS MCH Epi Unit