SAA Webinar: Confronting Challenges, Advancing Prevention

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Confronting Challenges, Advancing Prevention, Dental Sealants & Fluoridation Oral Health America Tuesday, March 24, 2015 Matt Jacob Director of Communications & Outreach Children’s Dental Health Project ©2015, Children’s Dental Health Project

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The Triple Aim

(Source: “Initiatives: The IHI Triple Aim,” The Institute for Healthcare Improvement, http://www.ihi.org/Engage/Initiatives/TripleAim/pages/default.aspx)

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Dental Sealants

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• They help prevent tooth decay in the Dental most cavity-prone teeth—those with sealants: pits and fissures.

A pillar of prevention • Applying sealants is a fairly simple

process and takes only a few minutes.

(Sources: “Dental Sealants: Proven to Prevent Tooth Decay,” Children’s Dental Health Project, May 2014; Falling Short: Most States Lag on Dental Sealants,” Pew Charitable Trusts, January 2013)

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School-based sealant programs (SSPs) • SSPs are a major vehicle for placing sealants on the teeth of children at highest risk of decay.

• U.S. Task Force on Community Preventive Services recommends SSPs “based on strong evidence” of decay prevention.

• Pew report: 35 states and D.C. don’t have sealant programs in most of their high-need schools.

(Source: “Falling Short: Most States Lag on Dental Sealants,” Pew Charitable Trusts, January 2013; “Preventing Dental Caries: School-Based Dental Sealant Delivery Programs,” April 2013, www.thecommunityguide.org)

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Reaching high-need schools with sealants

(Source: “Falling Short: Most States Lag on Dental Sealants,” Pew Charitable Trusts, Jan.2013)

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School-based sealant programs (SSPs)

(Source: “Dental Caries and Sealant Prevalence in Children and Adolescents in the United States, 2011–2012,” NCHS Data Brief, No. 191, March 2015.)

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School-based sealant programs (SSPs)

(Source: “Dental Caries and Sealant Prevalence in Children and Adolescents in the United States, 2011–2012,” NCHS Data Brief, No. 191, March 2015.)

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CDHP’s 2014 report: • Received surveys from 40 states and 23 local SSPs about sealant programs • Examined 5 states with substantial SSPs to explore factors that shape their reach and sustainability: o IL, NY, OH, SC & WI

(Sources: “Dental Sealants: Proven to Prevent Tooth Decay,” Children’s Dental Health Project, May 2014, https://s3.amazonaws.com/cdhp/CDHP+Sealant+Report+2014.pdf )

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CDHP’s 2014 report: • 21 states receive CDC grants that partly support their SSPs • 10 states receive HRSA grants that can support SSPs • Medicaid & CHIP reimbursements are a crucial source of funding: o 21 of 23 local SSPs billed Medicaid/CHIP (Sources: “Dental Sealants: Proven to Prevent Tooth Decay,” Children’s Dental Health Project, May 2014, https://s3.amazonaws.com/cdhp/CDHP+Sealant+Report+2014.pdf )

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CDHP’s 2014 report: • Called for a work group to update the clinical guidelines by which sealant programs operate • Called for a work group to offer recommendations for addressing barriers: o Consent forms o Cooperation from school officials (Sources: “Dental Sealants: Proven to Prevent Tooth Decay,” Children’s Dental Health Project, May 2014, https://s3.amazonaws.com/cdhp/CDHP+Sealant+Report+2014.pdf )

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School-based sealant programs (SSPs) • CDHP – Planning to convene two work groups to update clinical/scientific and programmatic guidelines that shape how SSPs operate.

• Oral Health America – Will meet its goal to seal 2 million children’s teeth later this year, and OHA is supporting CDHP’s work groups.

(Sources: “Topics and Resources: Dental Sealants, Children’s Dental Health Project, 2014; “Seal Two Million,” Oral Health America, http://oralhealthamerica.org/participate/seal-two-million/)

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Community Water Fluoridation

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Community water fluoridation (CWF)





EFFECTIVE

SAFE

 COST-EFFECTIVE

After reviewing 161 studies, the U.S. Task Force on Community Preventive Services recommended fluoridation based on “strong evidence” that it prevents decay.

The National Research Council has issued 5 reports on fluoride or fluoridation. No report has identified health harms from the levels used in water fluoridation.

In most cities, the typical cost of filling one cavity exceeds the lifetime, per-person cost of fluoridating the local water system.

(Source: Slade et al., Effects of Fluoridated Drinking Water on Dental Caries in Australian Adults ,” Journal of Dental Research, April 2013, Vol. 92, No. 4, pp. 376-382)

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Fluoridation reduces tooth decay for children and teens Nevada – Living in a nonfluoridated community was one of the 3 major risk factors for tooth decay.

New York – Medicaid-enrolled kids living in nonfluoridated areas needed 33% more fillings or treatments.

Alaska – Kids living in non-fluoridated areas had a 32% higher rate of decayed, missing or filled teeth (Sources: Ditmyer et al., BMC Oral Health, 2010, 10:24; Kumar et al., Public Health Reports, Sept.-Oct. 2010; Morbidity & Mortality Weekly Report, CDC, “Dental Caries in Rural Alaska Native Children – Alaska, 2008,” Sept. 2011)

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Adults also benefit A 2015 study found that “the prevalence of households with fluoridated water in the local electoral district had a statistically significant and positive association with the probability of an older person having all their own teeth”

(Source: V. O′Sullivan & B.C. O′Connell, “Water fluoridation, dentition status and bone health of older people in Ireland,” Community Dentistry and Oral Epidemiology, Vol. 43, Issue 1, February 2015)

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Adults also benefit from fluoridation Adults who spent more than 3/4 of their lifetime in fluoridated areas had up to 30% less decay than adults who had lived less than 1/4 of their lifetimes in fluoridated communities.

(Source: Slade et al., Effects of Fluoridated Drinking Water on Dental Caries in Australian Adults ,� Journal of Dental Research, April 2013, Vol. 92, No. 4, pp. 376-382)

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Adults also benefit from fluoridation A co-author of this study told Science Daily:

“In public health terms, it means that more people benefit from water fluoridation than previously thought.”

(Source: Slade et al., Effects of Fluoridated Drinking Water on Dental Caries in Australian Adults ,” Journal of Dental Research, April 2013, Vol. 92, No. 4, pp. 376-382)

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It builds on the benefits of F-toothpaste A study of Illinois and Nebraska towns found that the cavity rate for kids in the fluoridated town was 45% lower than the rate for kids in the non-fluoridated communities.

u u u

90%+ of kids in each town regularly used F-toothpaste.

(Source: Journal of Public Health Dentistry, Winter 1998, Vol. 58, No. 1, 30-32.)

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The safety of fluoridated water • National Research Council (1951-2007) has issued five reports on fluoride or fluoridation.

• Public Health England (2014) found no links between fluoridation and cancer, kidney stones and other health conditions.

• Royal Society of New Zealand (2014) report led its chief science advisor to conclude fluoridation “poses no risk of adverse health effects.”

(Sources: “National Academy of Sciences on Fluoride in Drinking Water,” Centers for Disease Control and Prevention, 2013; Report by Public Health England, March 2014; Royal Society of New Zealand, Aug. 22, 2014)

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Misinformation circulates widely

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Many online messages are not accurate

Comments: HealthPosse371 I don't want fluoride in my drinking water, and I'll be damned if a selfish majority decides to put it there. Look, fluoride works much better topically in higher concentrations than it does in water at miniscule concentrations.

(Source: Comment posted by Hon Yo on April 19, 2013 on OregonLive.com, The Oregonian newspaper.)

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Many online messages are not accurate

Comments: HealthPosse371 I don't want fluoride in my drinking water, and I'll be damned if a selfish majority decides to put it there. Look, fluoride works much better topically in higher concentrations than it does in water at miniscule concentrations.

(Source: Comment posted by Hon Yo on April 19, 2013 on OregonLive.com, The Oregonian newspaper.)

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Many online messages are not accurate

Comments: HealthPosse371 I don't want fluoride in my drinking water, and I'll be damned if a selfish majority decides to put it there. Look, fluoride works much better topically in higher concentrations than it does in water at miniscule concentrations.

(Source: Comment posted by Hon Yo on April 19, 2013 on OregonLive.com, The Oregonian newspaper.)

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What makes fluoridated water different from other sources of fluoride

British Dental Journal: “Fluoridation of the drinking water is still the optimal method of fluoride delivery…”

The CDC: “Water fluoridation prevents tooth decay mainly by providing teeth with frequent contact with low levels of fluoride throughout each day…”

(Sources: J.M. ten Cate, “Contemporary perspective on the use of fluoride products in caries prevention,” British Dental Journal, Feb 2013; “Fluoridation Basics,” CDC, updated on July 25, 2013.)

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Opponents lack credibility

Truth about fluoride doesn't include Nazi myth Here's a reason to support a Florida county's decision to cut fluoride out of its drinking water: The idea came from the Nazis.

The Nazis put fluoride in water to pacify Jews during World War II, a local resident told members of the Pinellas County Commission on Oct. 4, 2011, before the commission voted 4-3 vote to stop fluoridating water. “History shows, actually, that in Nazi Germany, one of the first things that they did was add fluoride to the water in the ghettos where the Jews stayed," Matt Leffler of Clearwater said.

Once the St. Petersburg Times published its story about the decision — similar, anonymous comments on the Web piled up:

(Source: Becky Bowers, PolitiFact, Tampa Bay Times/Miami Herald, October 6, 2011.)

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Opponents lack credibility

Milwaukee alderman says fluoride Truth about fluoride doesn't include in toothpaste is a poison Nazi myth The debate over the use of fluoride in Milwaukee’s water supply was pretty much a one day affair. Led by Ald. Jim Bohl, in that short time frame, the public heard a barrage of unusual claims about their water, rat poison, and even their toothpaste.

Indeed, we thought the debate over fluoridation of water had long been settled.

Since 1953, the Milwaukee Water Works has added a tiny amount of fluoride to the drinking water. Many cities have done this for years to boost dental hygiene and the U.S. Centers for Disease Control and Prevention considers it one of the most important public health efforts of the past 50 years.

Some, including Bohl, have criticized the process. They raise a variety of

(Source: James B. Nelson, PolitiFact, Milwaukee JournalSentinel, July 9, 2012.)

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Opponents lack credibility

Austin resident: fluoride added Milwaukee alderman says fluoride Truth about fluoride doesn't include to water supply is "toxic waste" in toothpaste is a poison NaziInmyth a letter to the editor published in the March The 18 debate over the use ofMike fluoride Austin Chronicle, Fordinsuggests Austin Milwaukee’s supply was pretty much a residentswater have reason to question whether one fluoridated day affair. Led by is Ald. Jim Bohl, in that water safe. short time frame, the public heard a barrage of "How manyabout wouldtheir be comfortable if they knew unusual claims water, rat poison, fluoride Austin is putting into our and that eventhe their toothpaste. drinking water is fluorosilicic acid (toxic waste Indeed, thought theindustry) debate over fromwe the fertilizer that the city buys fluoridation of water had long been settled. from Lucier Chemical Industries?" his letter states.

Since 1953, the Milwaukee Water Works has added a tiny amount of Eww. Ford, an Austin resident, is part of Fluoride Free Austin, which has fluoride to the drinking water. Many cities have done this for years to urged the city to stop putting fluoride in drinking water. On March 22, a boost dental hygiene and the U.S. Centers for Disease Control and City Council committee took testimony on the practice--and at least one Prevention considers it one of the most important public health efforts of speaker referred to the chemical additive as an industrial toxic waste, the past 50 years. according to video of the hearing placed online.

Some, including Bohl, have criticized the process. They raise a variety of

(Source: W. Gardner Selby, PolitiFact, Austin AmericanStatesman, April 19, 2011.)

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Strategies you can use • Be proactive — look for opportunities to educate others • Monitor the dialogue in your city or town. If your community is fluoridated, look for the warning signs: o An anti-fluoride Facebook page o Letters to the editor o Regular speeches at city council meetings

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Messages you can use • Fluoride is a mineral that exists naturally in public water supplies — even in the ocean.

• Water fluoridation is backed by 70 years of research and experience.

• In most cities, the per-person lifetime cost of fluoridation is less than the cost of filling a single cavity.

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A Fluoridation Tool-Kit for Advocates

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• The tool-kit materials are accessible by clicking on the “Act Now” button at ILikeMyTeeth.org

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• The tool-kit materials are accessible by clicking on the “Act Now” button at ILikeMyTeeth.org

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Questions or Comments?

Matt Jacob Director of Communications & Outreach Children’s Dental Health Project P: 202-417-3600 E: mjacob@cdhp.org T: @Teeth_Matter