The Impact of Oral Disease on the Lives of Washingtonians The Washington State Oral Disease Burden Document July 2007 Offce of Maternal and Child Health Oral Health Program The Impact of Oral Disease on the Lives of Washingtonians The Washington State Oral Disease Burden Document July 2007 DOH 160-001 July 2007 For more information contact: MCH Oral Health Program Washington State Department of Health PO Box 47835, Olympia, WA 98504-7835 Phone: (360) 236-3507 Fax: (360) 236-2323 Email: Suggested Citation Byrappagari D, Alves-Dunkerson J, Chamie C, Peters R. The Impact of Oral Disease on the Lives of Washingtonians – The Washington State Oral Disease Burden Document. Washington State Department of Health. Olympia, WA. July 2007. DOH Pub No. 160-001. Contents Page Content 7 Acknowledgments 10 Executive Summary 12 Background 12 How to use this burden document 12 What are the most common oral (dental) diseases? 13 What does our state look like? 14 National Oral Health Objectives 16 The Burden Of Oral Diseases 16 Dental caries 16 Low-income preschool children (Head Start and ECEAP) 18 Elementary school-age children (second and third graders) 20 A dolescents, pregnant women, adults, seniors, children with special health care needs, and individuals with disabilities. 21 Tooth loss 22 Adults who have had no tooth loss 22 Adults who have lost all natural teeth 23 Periodontal (gum) diseases 24 Oral and pharyngeal cancers 28 Cleft lip and palate 29 Oral Disease Prevention 29 Community water fuoridation 30 Dental sealants 31 Prevalence of dental sealants 32 School based dental sealant programs 33 Topical fuorides and fuoride supplements 34 Preventive visits 34 General population (children and adults) 36 Pregnant women 37 Children with special health care needs and individuals with disabilities. 38 Tobacco control 40 Oral health education 41 Washington State Bright Futures Oral Health Project 41 Tooth Tutor 41 Oral health education of other health professionals 42 Dental Workforce 42 Dental workforce capacity 44 New dental workforce legislation 44 Dental Health Professional Shortage Areas (dental HPSAs) 45 Dental educational institutions 48 Dental workforce diversity Contents Page Content 49 Dental Services 49 Use of dental services 49 Children (0-17 years) 50 Adults (≥ 18 years) 51 Pregnant women 53 Children with special health care needs and individuals with disabilities 53 Long-term care residents 53 HIV/AIDS 54 Financing of dental services 54 Dental insurance 55 Dental Medicaid for children and adults 58 Community Health Services grant program (Health Care Authority) 59 Oral health programs and services 59 Local Health Jurisdictions (LHJs) 59 Primary care safety net dental clinics 61 Indian Health Services dental clinics 61 Correction facilities 62 Dental mobile services 62 Access to Baby and Child Dentistry (ABCD) program 62 Kids Get Care 63 Oral Health Disparities 65 Community Initiatives: Oral Health Coalitions 67 Oral Diseases And Other Systemic Conditions 67 Impact of oral diseases on general health and quality of life 67 Impact of oral diseases on systemic diseases 70 Impact of systemic diseases on oral health 72 Economic costs of oral diseases to individuals and society 75 Conclusion 77 References 83 Appendices 83 Technical notes and data sources 87 Glossary 92 Data tables 104 County Oral Health Profles Acknowledgments Primary Authors Divesh Byrappagari, DDS, MSD, Oral Health Consultant Joseli Alves-Dunkerson, DDS, MS, MPH, MBA, Senior Oral Health Consultant Oral Health Program, Offce of Maternal and Child Health, Community and Family Health Chara Chamie, MPH, Epidemiologist Riley Peters, PhD, MPA, Senior Epidemiologist and Manager Assessment Section, Offce of Maternal and Child Health, Community and Family Health Any questions should be directed to the authors listed above. Report Production Alice Porter, Editor Alessandro Leveque, Graphic Designer Content Contributors and Reviewers From the Department of Health: Maxine Hayes, MD, MPH, Washington State Health Offcer Offces of the Assistant Secretaries Patty Hayes, RN, MN, Assistant Secretary, Community and Family Health Victor Colman, JD, Senior Policy Advisor, Community and Family Health Kelly Cooper, Legislation and Policy Affairs Manager, Environmental Health Karen Jensen, Senior Health Policy Analyst, Health Services Quality Assurance Offce of Maternal and Child Health, Community and Family Health Jan Fleming, MN, Director Diane Bailey, RN, MPH, Maternal and Infant Health Tom Bell, PhD, Epidemiologist, Assessment Section Teresa Cooper, RN, MN, MPH, Child and Adolescent Health Stacey De Fries, MSW, Children with Special Health Care Needs Program Patricia deHart, Sc.D, Epidemiologist, Assessment Section Tabitha Harrison, MPH, Genetics Nancy Reid, MSW, Child and Adolescent Health Teresa Vollan, MPH, Epidemiologist, Assessment Section Candy Wines, MPH, Legislative and Communications Coordinator Offce of Infectious Disease and Reproductive Health, Community and Family Health Richard Aleshire, MSW, Manager of HIV Client Services Maria Courogen, MPH, Section Manager/Senior Epidemiologist Darren Layman, MA, Consortia and Case Manager Programs Supervisor Mark Stenger, MA, Epidemiologist Offce of Community Wellness and Prevention, Community and Family Health Sue Grinnel, Director Mike Boysun, MPH, MPA, Epidemiologist, Tobacco Prevention and Control Gail Brandt, Rd, MPH, EdD, Manager of Basic Nutrition Education Janet Charles, BA, MSW, Manager of WIC Program Kathleen Clark, MS, Rd, CDE, Manager of Diabetes Prevention and Control Pam Hayes, MPA, Manager of Asthma Lauren Jenks, MPH, CHES, Manager of Cancer Prevention and Control Amy Manchester-Harris, MPA, Manager of Steps to a Healthier Washington Jan Norman, RD, CDE, Manager of Chronic Disease Prevention Program Miriam Patanian, MPH, Manager of Heart Disease and Stroke Prevention Terry Reid, MPH, Manager of Tobacco Prevention and Control Susan Richardson, BS, Evaluation Support, Tobacco Prevention and Control Kyle Unland, MS, RD, Manager of Nutrition and Physical Activity Offce of Data Resource Management, Information Resource Management Craig Erickson, GIS Administrator Offce of Drinking Water, Environmental Health Denise Clifford, BS, Director Stephen Baker, BS. Water Treatment Operations Specialist Richard Pedlar, BA, RS, Public Health Advisor Leslie Thorpe Gates, MPA, Manager of Constituent Relations Offce of Environmental Health Assessments, Environmental Health Robert Duff, Director Koenraad Marien, PhD, Senior Toxicologist Milo Strauss, MS, Manager of Toxicology and Chemical Hazards Offce of Community and Rural Health, Health Systems Quality Assurance Kristina Sparks, RN, MSN, Director Diana Ehri, BS, MA, Manager Mary Looker, BA, Manager of Primary Care Offce Laura Olexa, CHES, Health Care Access Analyst Vince Schueler, MBA, Research Investigator Juno Whittaker, MPA, Community Development Manager Offce of Health Professions Quality Assurance, Health Systems Quality Assurance Joy King, BS, Executive Director Lisa Anderson, Health Professions Manager Vicky Brown, Health Professions Manager Center for Health Statistics, Health Statistics and Public Health Laboratories Katrina Simmons, PhD, BRFSS Coordinator From other Agencies and Organizations: Community Services Program, Health Care Authority Connie Mix-Clark, RDH, Dental Program Manager Department of Corrections Arnold Mike Morton, DDS, Chief of Dental Services Health and Recovery Services Administration, Department of Social and Health Services John Davis Sr., DDS, JD, Chief of Dental Services Cathie Ott, Chief of Medicaid Systems and Data Gary Coats, MA, BS, Information Technology Specialist Faith Lai, PhD, Database Manager Taik Lee, Information Specialist Health Resources and Services Administration, Department of Human and Health Services Forrest Peebles, DDS, Region X Dental Consultant Snohomish Health District LeeAnn Hoaglin Cooper, RDH, Public Health Dental Hygienist University of Washington Schools of Dentistry and Medicine Martha Somerman, DDS, PhD, Dean Wendy Mouradian, MD, MS, Professor and Director of Regional Initiatives in Dental Education (RIDE) Washington Association of Community and Migrant Health Centers Molly Belozer, MPH, Director of Policy Washington State Dental Association David Hemion, MPA, Associate Executive Director Washington State Dental Hygiene Association Gene Patterson, MA, Executive Director Washington Dental Service Foundation Laura Smith, Deputy Director Within Reach (formerly Healthy Mothers Healthy Babies) Bill Laaninen, Direct Services Manager Yakima Valley Farm Workers’ Northwest Dental Residency Mark Koday, DDS, Dental Director Linda Selsted, Clinic Director, Children’s Village Executive Summary The U.S. Surgeon General characterizes good oral health as a prerequisite for people’s general health and quality of life. Yet many barriers prevent some Americans from having optimal oral health. Oral health affects people both physically and psychologically. It infuences how they grow, enjoy life, look, speak, chew, taste food, and socialize. Poor oral health brings negative effects to children and adults in all settings— home, school, work, and social activities. Oral diseases, such as dental caries and periodontal disease, are important public health issues because they are common and have high socioeconomic costs. Fortunately, most oral diseases can be prevented with simple and effective measures. This report, The Impact of Oral Disease on the Lives of Washingtonians, is a new, comprehensive document that provides an overview of the oral disease burden in Washington State. It also describes the state’s dental workforce, the preventive measures available to promote the oral health of all who live here, as well as existing resources for dental care and its fnancing. The main section presents statewide data, while the appendices have more information at the county level, especially for those counties that completed their own oral health needs assessments (Smile Survey) in 2005. The information in this report comes from a variety of sources. Oral disease data come from the newly established Washington State Oral Disease Surveillance System, which contains the results of national and state surveys.1 Information on workforce and resources for care and fnancing are the generous contribution of several public and private oral health partners. The Department of Health plans to update this document as new data become available. This document can be used to:2 • R aise awareness among the public, health professionals, and policy makers about the importance of oral health to general health and quality of life. • Understand the effect and cost of oral diseases on individuals and communities. • Track the trends of oral diseases and related disparities among Washingtonians. • Measure Washington State’s progress toward national public health objectives. • L earn about workforce issues and resources available, such as preventive and treatment programs and services at the state and county levels. • H ighlight existing community initiatives. • I dentify and pursue partnerships within existing oral health resources and other public health areas such as tobacco prevention and nutrition. • P rovide information to decision-makers on the successes, challenges, gaps, and opportunities related to oral health in our state. • A id in the planning of effcient and effective oral health promotion and disease prevention programs. 1 A public health surveillance system “is the ongoing, systematic collection, analysis and interpretation of health-related data essential to the planning, implementation, and evaluation of public health practice, closely integrated with the timely dissemination of these data to those responsible for prevention and control.” 2 S ource: D’Angelo D, Colley Gilbert B, editors. From Data to Action: Using Surveillance to Promote Public Health, Examples from PRAMS. Atlanta, GA: Division of Reproductive Health, National Centers for Chronic disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 2002. 10