AlAskA OrAl HeAltH PlAn
Alaska Oral Health Plan2012–2016State of AlaskaDepartment of Health and Social Services
AcknowledgementsSean ParnellGovernor, State of AlaskaWilliam J. StreurCommissioner, Department of Health and Social ServicesWard B. Hurlburt, M.D., MPHChief Medical OfficerDirector, Division of Public HealthStephanie Birch, RNC, MPH, MS, FNPSection Chief of Women’s, Children’s and Family HealthOral Health ProgramBrad Whistler, DMD, Dental OfficialMolly McGrath, CHES, Health Program ManagerSharon Schlicht, RDH, MPH, Health Program ManagerClint J. Farr, MS, Public Health SpecialistAlaska Dental Action CoalitionDelisa Culpepper, MPH, ChairChief Operating Officer, Alaska Mental Health Trust AuthorityJuly 2012Suggested Citation:Whistler, BJ. Alaska Oral Health Plan: 2012-2016. Juneau, AK: Section of Women’s, Children’s and Family Health,Division of Public Health, Alaska Department of Health and Social Services, 2012.Funding for the State Oral Health Plan was provided by the Centers for Disease Control and Prevention through theChronic Disease Prevention and Health Promotion Programs Cooperative Agreement (5U58DP001578). The contentsof this plan are solely the responsibility of the authors and do not necessarily represent the official views of the CDC.
Table of ContentsContributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3National and Alaska Health Objectives for the Year 2010 & Year 2020 . . . . . . . . . . . . . . . . . . 5Child and Adolescent Oral Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Dental Decay . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Children with Special Health Care Needs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Dental Sealants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Orofacial Clefts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Oral Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14Children’s Access to Dental Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14Adult and Senior Oral Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Dental Decay . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Pregnant Women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17Adult and Senior Dental Access . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17Periodontal Disease and Systemic Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17Oral and Other Systemic Connections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18Tobacco Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18Oral and Pharyngeal Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19Oral Health Disparities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21Alaska Natives — Dental Decay . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21Social Determinants of Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22Community Water Fluoridation and Fluorides . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23Community Water Fluoridation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23Topical Fluoride and Fluoride Supplements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24Dental Workforce . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25Dentists . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25Dental Hygienists . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26Dental Health Aide Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27Infection Control in the Dental Office . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28Alaska Dental Action Coalition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28Alaska Oral Health Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29Goals, Strategies and Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30Priority Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30Monitor Progress on Policy Changes Implemented in 2008-2012: . . . . . . . . . . . . . . . . 32Action Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34Appendix I – Sources for National and Alaska Health Objectives for the Year 2010 and Year 2020 . . 45Appendix II – Summary of Alaska Dental Assessments (Basic Screening Survey) . . . . . . . . . . . . 48Appendix III – Medicaid Child Dental Utilization Data . . . . . . . . . . . . . . . . . . . . . . . . . . . 51Appendix IV – Behavioral Risk Factor Surveillance System Dental/Oral Health Data . . . . . . . . . . 58Appendix V – Logic Model – State Oral Health Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61Alaska Oral Health Plan — 2012-20161
ContributorsThe goals and recommendations of the Alaska Oral Health Plan are designed to improve the oral health status ofAlaskans. The development of this plan would not have been possible without the involvement of the individuals andorganizations participating in the Alaska Dental Action Coalition (ADAC).ADAC Vision Statement:Optimizing Oral Health for All AlaskansValue Statements:1.2.3.4.5.Prevention and education are priorities in improving the oral health of Alaskans.Oral health services should be available, accessible, timely, culturally competent and valued.Oral health should be recognized as part of total health and well-being.Responsibility for creating an environment to maximize oral health is shared by every Alaskan.Every adult takes responsibility for their own oral health and each family takes responsibility for their dependents’ oralhealth.ADAC Membership: Alaska Commission on Aging Alaska Dental Society Alaska Department of Education and EarlyDevelopment - State Head Start Collaboration Office Alaska Department of Environmental Conservation Division of Environmental Health Alaska Department of Health and Social Services- Division of Health Care Services- Division of Public Assistance, WIC Program- Division of Public Health Section of Chronic Disease Prevention andHealth Promotion Section of Health Planning and SystemsDevelopment Section of Public Health Nursing Section of Women’s, Children’s and FamilyHealth- Governor’s Council on Disabilities and SpecialEducation- Office of Children’s Services Alaska Mental Health Board Alaska Mental Health Trust Authority Alaska Native Tribal Health Consortium- Dental Consultant & DENTEX Dental Health AideTraining Program- Division of Environmental Health and Engineering Alaska Primary Care Association2 Alaska Public Health AssociationAlaska State Dental Hygienists’ AssociationAll Alaska Pediatric PartnershipAmerican Association of Retired Persons, AlaskaChapter Anchorage Neighborhood Health Center Centers for Disease Control and Prevention, ArcticInvestigations Program Denali Commission Head Start Grantees- Rural Alaska Community Action Program- Kid’s Corp, Inc. Rasmuson Foundation Southcentral Foundation Dental Clinic Stone Soup Group United Way of Anchorage University of Alaska Anchorage, School of AlliedHealth Sciences - Dental Hygiene and Dental AssistingProgramsAlaska Oral Health Plan — 2012-2016
IntroductionThe mouth is vital to everyday life. It serves to nourish ourbodies as we take in water and nutrients. It is how wecommunicate our thoughts, our mood and our dreams. Oralhealth is an essential and integral component of overall healththroughout life. Oral health includes more than just healthyteeth – it includes the whole mouth, including the teeth, gums,hard and soft palate, lining of the mouth and throat, tongue,lips, salivary glands, chewing muscles, and upper and lowerjaws. It also is more than being free of tooth decay and gumdisease. Oral health also means being free of chronic oral painconditions, oral cancer and other conditions that affect themouth and throat. Optimal oral health includes the surgicalcorrection and treatment of birth defects such as cleft lip andpalate. Oral health includes the ability to carry on the mostbasic human functions such as chewing, swallowing, speaking,smiling, kissing and singing.In the Surgeon General’s report on “Oral Health in America”former Surgeon General David Satcher referred to a “silentepidemic” of oral disease restricting activities in school,work and home and often diminishing the quality of life.The report noted those who suffer the worst oral health arefound among the poor of all ages, with poor children and poorolder Americans particularly vulnerable. The report furtherdetailed how oral health is promoted, how oral diseases andconditions are prevented and managed, and what needs andopportunities exist to enhance oral health. Water fluoridationand dental sealants were noted as two interventions that havereduced dental decay. The report noted the ongoing needto reduce oral health disparities.1 In the United States, 25percent of children and adolescents experience 80 percentof all dental decay occurring in permanent teeth.2 Five to 10percent of preschool-age children have early childhood caries– this rate is higher among families with low incomes andsome racial/ethnic minorities.3Improving access to dental care is an increasing issueof national attention. It is estimated about 130 millionAmericans lack coverage for dental care.4 In 2008, 4.6million children went without needed dental care becausetheir families lacked dental coverage. In 2006, it wasestimated almost two-thirds of retirees did not have dentalcoverage, in part because Medicare does not cover routinedental services. The U.S. Health Resources and ServicesAdministration estimate 33 million Americans reside in areaswhere there aren’t enough dentists.5 For low-income children,Medicaid is a major coverage source for dental care, howevermany dentists do not participate in the program. Commonstated dental concerns are lower reimbursement underMedicaid and failed dental appointments.Because the mouth is an integral part of the human anatomy,oral health is intimately related to the health of the rest of thebody. For example, mounting evidence suggests infections inthe mouth such as periodontal (gum) disease can increasethe risk for heart disease, may put pregnant women at greaterrisk for premature delivery, and complicate controlling bloodsugar for people living with diabetes. Conversely, changesin the mouth are often the first signs of problems elsewherein the body such as infectious diseases, immune disorders,nutritional deficiencies and cancer.Alaska Oral Health Plan — 2012-2016In 2007, the average annual cost of dental care for individualsthat visited the dentist was 600. Dental insurance canalleviate some of that expense, but even those individualswith coverage pay an average of about 30 percent of theirdental costs out-of-pocket.5 National expenditure informationfinds dental expenses are second only to prescription drugsin out-of-pocket expenditures in the U.S, totaling an estimated 30.7 billion in 2008.6Increasing costs, dental access concerns and problemswith the number and distribution of dentists are leading tochanges in dental practice and/or dental workforce. The past3
decade has seen federal funding to expand development ofcommunity health centers to provide services, including dentalservices, to underserved populations. National and stateprograms have been developed and/or expanded to provideincentives for dental practice in underserved areas. There hasbeen increased attention on collaboration with physicians,nurses and physician assistants to address the oral healthconcerns of young children. Use of medical providers is beingpromoted assist provision of preventive services and earlydetection of children at risk for dental decay so they canbe referred to dentists. These dynamics are also leading tochanges in supervision for dental hygienist practice and theearly development of alternative dental providers. Many ofthese concerns and policy issues are also being discussed oraddressed in Alaska.The Alaska Oral Health Plan contains two major sections. Thefirst section of the document includes information on: 4status and burden of oral disease in Alaska;community water fluoridation;disparities in oral health;dental workforce;infection control guidelines; andthe Alaska Oral Health Program and Alaska DentalAction Coalition.The second section of the documents highlights the goals,strategies and recommendations as developed by the AlaskaDental Action Coalition and stakeholders to: address the oral health of Alaskans; address oral health disparities; provide access to evidence-based preventionapproaches; address dental workforce issues; and improve access to dental care.The goals, strategies and recommendations were identifiedby the Alaska Dental Action Coalition (ADAC) and interestedstakeholders. The top five priorities were established at theSeptember 2011 facilitated coalition meeting utilizing apriority-setting process developed by the Children’s DentalHealth Project. A follow-up survey of coalition members anddiscussion at the January 2012 ADAC meeting establishedthe remaining priorities. The action plan that follows thelisted priorities was developed with input from coalitioncommittee members and stakeholders. Development ofrecommendations and suggested actions typically involveda review of surveillance information and oral disease, dentalaccess and/or dental workforce data as outlined in thosesections of this document.Alaska Oral Health Plan — 2012-2016
National and Alaska Health Objectives: 2010 & Year 2020Healthy People 2020In December 2010, the U.S. Department of Health and HumanServices (USDHHS) launched Healthy People 2020. Fouroverarching goals for this plan are to: Attain high-quality, longer lives free of preventabledisease, disability, injury, and premature death; Achieve health equity, eliminate disparities, andimprove the health of all groups; Create social and physical environments that promotegood health for all; and Promote quality of life, healthy development, andhealthy behaviors across all life stages.Healthy People 2010One component of the national plan for oral health is a set ofmeasurable and achievable objectives on key indicators oforal disease burden, oral health promotion and oral diseaseprevention. In November 2000, a set of oral health indicatorswas developed for inclusion in the national health objectivesfor the year 2010 in the document entitled, Healthy People2010. The Alaska Department of Health and Social Servicesdeveloped a state companion plan that included oral healthobjectives in April 2002 - Healthy Alaskans 2010: Targets andStrategies for Improved Health. Both the national and statestrategies are aimed atOral health has been selected by USDHHS as one of theleading health indicators for the Healthy People 2020 process– noting the growing body of evidence that has linked oraldisease, particularly periodontal disease, to several otherchronic diseases. The indicator for oral health for the leadingindicator is: Persons aged 2 years and older who used the oralhealth care system in the past 12 months (OH-7 listedon Table 2). Increasing the quality and years of healthy life; and Eliminating health disparities.Included in Healthy People 2010 are objectives for improvingoral health (See Table 1). They represent the ideas andexpertise of a diverse range of individuals and organizationsconcerned about the nation’s health. Table 1 also reflectsAlaska data, when available, for comparison with nationalbaselines. Alaska indicators for caries experience, untreatedcaries and dental sealant utilization of Alaskan third-gradersrepresent statewide data developed by the Oral HealthProgram’s dental assessments – this data was not availableat the time of publication of Healthy Alaskans 2010.Alaska Oral Health Plan — 2012-20165
Table 1. Healthy People 2010 Oral Health Indicators,Target Levels and Current Status in the United States and AlaskaHealthy People 2010 ObjectiveTargetU.S. Status Alaska BaselineAlaska Status21-1:Dental caries experienceYoung children, aged 2-4Children, aged 6-8Adolescents, age 1511%42%51%18%52%61%DNA65% (2004)DNADNA62% (2010/2011)DNA21-2:Untreated cariesYoung children, aged 2-4Children, aged 6-8Adolescents, age 15Adults, aged 35-449%21%15%15%16%29%20%27%DNA28% (2004)DNADNADNA24% (2010/2011)DNADNA21-3:Adults with no tooth loss, ages 35-4442%31%60% (2002 – MT)70% (2010 – MT)21-4:Edentulous (toothless) older adults, ages 65-7420%26%24% (2002)16% (2010 – MT)21-5:Periodontal diseases, adults aged 35-44GingivitisDestructive periodontal disease41%14%48%22%DNADNADNADNA3-6:Oral and pharyngeal cancer death rate (per 100,000 persons)2.73.03.7 (1996-2003)2.0 (2008-2010 ) MT21-6:Oral and pharyngeal cancer detected at earliest stage50%35%29% (1996-2000)24% (2005-2009)21-7:Oral cancer exam in past 23 months, age 40 20%13%DNA35% (2008&2010) MT21-8:Dental sealantsChildren, age 8 (1st molars)Adolescents, age 15 (1st and 2nd molars)50%50%23%15%52% (2004, - MT)DNA47% (2010/2011)DNA21-9:Population served by fluoridated water systems75%62%64% (2006)45% (2011)21-10: Dental visit within past 12 monthsChildren, age 2 Adults, age 18 56%56%44%44%DNA66% (2002 – MT)DNA68% (2010 – MT)5-15:75%58%DNADNA21-11: Dental visit in the past 12 monthsAdults in long-term care25%19%DNADNA21-12: Preventive dental care in the past 12 monthslow-income children and adolescents, age 0-1857%20%29% (FFY2000)41% (FFY2010)21-13: School-based health centers with oral health component, K-12DNADNADNADNA21-14: Community based health centers and lo
Alaska Oral Health Plan — 2012-2016 Alaska Oral Health Plan — 2012-2016 5 Healthy People 2010 One component of the national plan for oral health is a set of measurable and achievable objectives on key indicators of oral disease burden, oral health promotion and oral disease prev
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improvements in oral health over the course of the next ten years in California. Addressing these challenges, he California Oral Health Plan 2018-2028 identifies five key goals for improving oral health and achieving oral health equity for all Californians: Goal 1: Improve the oral health of Californians by addressing determinants of health and
Judge Larry Zervos Alaska Superior Court, Sitka Rural Access Subcommittee Judge Dale Curda, co-chair Alaska Superior Court, Bethel Judge Roy Madsen (retired), co-chair Alaska Superior Court, Kodiak Louise Brady Sitka Tribe of Alaska, Sitka James Jackson Alaska Court Magistrate, Galena Judge Michael Jeffery Alaska Superior Court, Barrow
Alaska Airlines Inflight Magazine. Economics 300: Economy of Alaska, Notes-Introduction to Alaska Geography, page 9 Alaska Census Areas For purposes of collecting and reporting economic and social Alaska data, Alaska is divided into 27 “census areas.” These census areas are shown in the map below.
adult oral health infographic and will distribute to the participating nursing homes throughout the state this summer as we conduct our 2018 oral health survey of older adults. “ Meet Our New Staff Members Michelle Mieses joined KDHE Bureau of Oral Health in October 2017. Michelle serves as the Oral Health Program Manager at the Bureau of .
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