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Oral Health
Section Newsletter
Spring 2004

Section Chair Message

Jane Steffensen, Oral Health Chair 
Jane Steffensen, OH Chair
Free Membership Offer for New Student Members

The APHA Membership Office has garnered support for three free memberships to be offered to new student members. Each Oral Health Section Member is invited to nominate a NEW STUDENT member for a free membership in APHA and the Oral Health Section. Any Oral Health Section member can nominate one current college or university student or resident. Three new students will be selected randomly to receive annual membership. All nominations must be submitted by July 1, 2004 Midnight CDT to me as Oral Health Section Chair at <>. Please submit each student nomination with the specific information outlined in the article in this newsletter. This is a wonderful opportunity to promote career interests in oral health and public health among students!

Annual Meeting Update

It is that time of year again! Conference and Housing Registration is now open for the 132nd APHA Annual Meeting Nov. 6–10, 2004 in Washington, D.C. The Oral Health Section Program covers a broad array of important oral health topics. (See article in this newsletter for more details). The Oral Health Section Headquarters Hotel is the Renaissance Hotel, 999 9th Street, NW, Washington, D.C. Thank you to the program planning chair and committee members, presenters, and abstract reviewers for your contributions to the 2004 Oral Health Program.

More than 900 scientific sessions with 4,000 scientific papers will be presented at the APHA Annual Meeting. Abstracts for roundtables, poster sessions, panel discussions, and pre-convention Continuing Education Institutes are now available in a searchable database at <>.

The 2004 APHA Annual Meeting Theme is Public Health and the Environment. Erin Brockovich will be the keynote speaker at the Opening General Session, discussing her research and groundbreaking work in the area of industrial environmental negligence, its devastating effects on the public's health, and her continued pursuit for justice for those who have been harmed. The Closing General Session will focus on Environmental Justice an important public health issue concerned with health, quality, and equity. This session will feature a leading academic and a preeminent government regulator to define the issues, note progress made, and identify what remains to be done.

Make Sure Your Voice is Heard on Capitol Hill! Plan to join APHA members on Tuesday, Nov. 9, 2004, 8:30 a.m. for a “Capitol Hill Rally” followed by visits to members of Congress. The rally will take place in room 2168 (the Gold Room) of the Rayburn House Office Building (located at the corner of Independence Ave. and S. Capitol Street, SW). To set up a meeting with legislators or for additional information, please visit the APHA wWb site at <> or e-mail at <>

Section Elections

Thank you to Andrea Azevedo, Nominations Chair for recruiting Oral Health Section members to run for the positions of Chair-Elect, Section Councilor, and Governing Councilor. Thank you to Howard Pollick, Karen Yoder, Emily Firman, Magda de la Torre, and Kathy Geurink for agreeing to be placed on slate of candidates for the election. New Section leaders will begin serving on Tuesday, Nov. 9, 2004 at the Oral Health Section Business Meeting.

Opportunities for Collaboration

During the National Oral Health Conference in May 2004, representatives from the Oral Health Section (Jane Steffensen, Dyan Campbell, and Howard Pollick) had the opportunity to meet with the Executive Committee of the American Association of Public Health Dentistry. We discussed our mutual interests as well as potential avenues for future partnerships and collaborations.

Also, the Oral Health Section was invited and represented at a National Workshop on Enhancing the Dental Public Health Workforce (DPH) and Infrastructure Feb. 26-27, 2004 in Washington, D.C. The Goals of the Workshop were to establish a forum for discussions that promote (a) creative approaches to address dental public health workforce and infrastructure issues, and (b) collaborative, coordinated planning. The Workshop assembled a variety of key stakeholders and representatives from national organizations and federal agencies. The participants developed a draft national action plan that identified ways to increase awareness and knowledge of dental public health workforce issues and potential collaborative approaches to address the DPH workforce shortage. A core group has been established to facilitate follow-up on the action plan. The APHA Oral Health Section has been requested to have representatives serve on the work groups formed and focused on the following areas: (a) Education, (b) Research, (c) Practice, and (d) Advocacy and Communication. See article in this Newsletter for more detailed information about the Workshop and the Work Groups. Please contact Jane Steffensen at <> if you are interested in representing the Oral Health Section on a Work Group.

May 2004 - American Journal of Public Health Focuses on Oral Health

A series of articles were published in the American Journal of Public Health in May 2004 and reviewed the importance of oral health and public health. Share the Journal and these articles with your colleagues and students!

The articles included:

  • Kavita Ahluwalia, Oral Health Care for the Elderly: More Than Just Dentures, Am J Public Health 2004 94: 698.

  • Ira B. Lamster, Oral Health Care Services for Older Adults: A Looming Crisis, Am J Public Health 2004 94: 699-702.

  • Allan J. Formicola, Marguerite Ro, Stephen Marshall, Daniel Derksen, Wayne Powell, Lisa Hartsock, and Henrie M. Treadwell, Strengthening the Oral Health Safety Net: Delivery Models That Improve Access to Oral Health Care for Uninsured and underserved populations, Am J Public Health 2004 94: 702-704.

  • Elizabeth Fee and Theodore M. Brown, Popularizing the Toothbrush, Am J Public Health 2004 94: 721. (In Images of Health).

  • James Crichton-Browne, An Address on Tooth Culture, Am J Public Health 2004 94: 722-725. (In Voices from the Past).

  • Luisa N. Borrell, Brian A. Burt, Harold W. Neighbors, and George W. Taylor, Social Factors and Periodontitis in an Older Population, Am J Public Health 2004 94: 748-754.

  • Evanthia Lalla, David B. Park, Panos N. Papapanou, and Ira B. Lamster, Oral Disease Burden in Northern Manhattan Patients With Diabetes Mellitus, Am J Public Health 2004 94: 755-758.

  • Richard J. Manski, Harold S. Goodman, Britt C. Reid, and Mark D. Macek, Dental Insurance Visits and Expenditures Among Older Adults, Am J Public Health 2004 94: 759-764.

  • Mona T. Lydon-Rochelle, Paula Krakowiak, Philippe P. Hujoel, and Riley M. Peters, Dental Care Use and Self-Reported Dental Problems in Relation to Pregnancy, Am J Public Health 2004 94: 765-771.

  • Jessica Y. Lee, R. Gary Rozier, Edward C. Norton, Jonathan B. Kotch, and William F. Vann, Jr, Effects of WIC Participation on Children's Use of Oral Health Services, Am J Public Health 2004 94: 772-777.

Best wishes for a healthy and safe summer holiday! See you in D.C. in November!

APHA Annual Meeting 2004

APHA Annual Meeting 2004
November 7 – 10, 2004

In our Nation’s Capital – Washington, D.C.

Visit APHA Annual Meeting Web site
for Updates on Registration and Program


Sunday, Nov. 7, 2004
Oral Health Section Council Meeting I; Opening General Session; Oral Health Section Council Meeting II

Monday, Nov. 8, 2004
Current Issues in Vision Care and Oral Health (joint session with Vision Care); Oral Health Session – Round Table Discussion, “What’s going ‘round in Oral Health?”; Updates: Call to Action and HP 2010; Seniors in Our Changing Environment (joint sessions with Gerontological Health); John W. Knutson Award Ceremony; and Oral Health Section Dinner

Tuesday, Nov. 9, 2004
Oral Health Poster Sessions I & II; Integrating Oral Health and General Health; Strengthening the Oral Safety Net: Community-Based Delivery Models for the Underserved; Don’t Start School Without it – (Healthy Teeth) – Head Start’s Role; Oral Health Section Reception; Oral Health Section Business Meeting; Myron Alluekian Flying Feet Dance Contest

Wednesday, Nov. 10, 2004
Tobacco and Diabetes: The Need for Comprehensive Care; Dental Workforce Issues; Closing General Session

Oral Health Section Headquarters Hotel
Renaissance Hotel, 999 9th Street, NW, Washington, D.C.

Annual Meeting Updates

Additional Annual Meeting Updates

Register Today!
Visit APHA Annual Meeting Web Site <>
Early Bird Discount on Registration
Deadline: August 27, 2004

  • Registration at the APHA Annual Meeting entitles you to full access to the Annual Meeting, including New Connections Reception, Nearly 900 Scientific Sessions, Poster Sessions, Public Health Expo (620+ booths of information, state-of-the-art products, and services geared towards public health professionals), Everything APHA - Publications, Merchandise and More (Formerly PubMart), and Public Health Career Mart, etc.

  • Ongoing planning is in progress with other APHA Sections for the continued enhancement of interdisciplinary dialogue and collaboration. One session will be formatted for round table discussion to provide greater opportunity for dialogue between presenters and participants. Sandra Nagel Beebe, RDH, PhD, is serving as the 2004 Oral Health Section Program Planner. She can be reached through Health Care Professions, Dental Hygiene, Southern Illinois University Carbondale, 69 Roosevelt Rd., Carbondale, IL 62901, Phone: (618) 529-7591, Fax: (618) 453-7020, <>

  • Please Note: LCD Projectors and computers are now included as part of the standard audiovisual package in each scientific session room at the Annual Meeting. This technology will enable presenters to upload their PowerPoint presentations in advance of the meeting and have them pre-loaded on the APHA session computers. Individual presentations then begin with a click of the mouse. The cost and inconvenience of bringing a computer to the annual meeting has been eliminated for presenters. Take advantage of new technologies and be a part of the E-ssentialLearning experience.

  • Stuart Lockwood, Chair and the Award Committee members have worked diligently on the selection of a distinguished colleague to receive the John W. Knutson Distinguished Service Award in Dental Public Health. The Knutson award is given annually to an individual who "has made an outstanding contribution to improve oral health in the United States." Watch for an announcement in the next Oral Health Section Newsletter. Alice Horowitz and other DC-area Oral Health Section members are coordinating local arrangements for an enjoyable time to share with colleagues and friends.

  • Karen Zinner, APHA Action Board, Oral Health Section Representative wants to inform all Oral Health Section members that APHA is requesting that members not visit their legislators on behalf of APHA concerns individually while in Washington during the Annual Meeting.

  • APHA urges members to come together on Tuesday, Nov. 9, 2004 for a “Capitol Hill Rally” followed by visits to members of Congress. The rally will take place in Room 2168 (The Gold Room) of the Rayburn House Office Building (located at the corner of Independence Ave. and S. Capitol Street, SW) beginning at 8:30am. During the rally, APHA will provide tips for a successful meeting with legislators. To set up a meeting with legislators or for additional information, please visit <> or send an e-mail to <>.

Members, start entering the conference dates in your Palm Pilots, mark your calendars, look for deals on flights, shine your dancing shoes, prepare for your presentation and poster to share with your colleagues, turn in your travel request, do whatever you need to plan and prepare to attend what promises to be one of the most exciting Annual Meetings. See you in D.C.!

Free Membership Offer for Three Students

Oral Health Section Members are invited to nominate a brand NEW STUDENT member for a free membership in APHA and the Oral Health Section. This is a great opportunity to promote interests in oral health and dental public health as well as infuse the Oral Health Section with new student members!

This offer is open to any Oral Health Section member to nominate one current college or university student or resident. All nominations must be submitted by July 1, 2004 Midnight CDT . Please submit each student nomination to Jane Steffensen, Oral Health Section Chair by e-mail to <>.

Be sure to include the following information:

Oral Health Section Member Nominating Student:
Student's Name:
College or University Name:
Academic Program at College or University:
Student's Postal Address:
City, State, Zip Code:
E-mail Address:
Telephone Number:

Three New Students will be selected randomly to receive annual membership. Yvonne Kazim at the APHA Membership Office will coordinate the membership process of the selected students.

Oral Health Section Represented at National Workshop: Enhancing the Dental Public Health Workforce and Infrastructure

Feb. 26-27, 2004, Washington, D.C.


Oral Health in America: A Report of the Surgeon General (2000) emphasized that “the public health infrastructure for oral health is insufficient to address the needs of disadvantaged groups, and the integration of oral and general health is lacking.” Healthy People 2010 oral health objective 21.17 calls for an increase in the number of state and local dental programs with public health trained directors; objective 21.14 calls for expansion of community health centers and local health departments with an oral health component; objective 1.8 calls for increasing racial and ethnic representation in health professions; and a number of infrastructure objectives (chapter 23) relate to a well-trained and competent public health workforce. Proceedings of recent workshops for dental public health residents and diplomats stress the need to develop a continuum of educational opportunities, career paths and leadership opportunities.

Many dental public health leaders will be retiring in the next 10 years, and there are insufficient numbers of young professionals, especially ethnic minorities, who show interest in a dental public health career. The 1994 Future of Dental Public Health report stressed the need to ensure recruitment and professional development of qualified individuals for dental public health positions. Vacancies continue to exist in clinical, educational, policy, programmatic, and research positions. A National Call to Action to Promote Oral Health: A Public/Private Partnership Under the Leadership of the Office of the Surgeon General, released on April 29, 2003, includes one area relating to workforce that requires action: increase oral health workforce diversity, capacity, and flexibility. A number of documents, including those already mentioned, will be useful for creating recommendations for workforce development. Numerous organizations have developed workforce initiatives, but efforts have been fragmented and insufficient.

National Workshop

In 2000 the Association of State and Territorial Dental Directors (ASTDD) convened a Leadership Committee through a cooperative agreement from the HRSA Maternal and Child Health Bureau and issued an ASTDD Dental Public Health Leadership Initiative in 2002. The first goal, “Develop a sustainable plan for assuring an adequate cadre of dental public health leaders,” included action steps to convene a meeting of partners to plan collaborative strategies and outline roles, and to identify funding options for the various projects. ASTDD wrote a proposal to the Centers for Disease Control and Prevention in response to a conference grant RFP to convene a national workshop to address dental public health workforce issues in a coordinated, multi-disciplinary, collaborative fashion. ASTDD subsequently received CDC funding for the National Workshop, matched by funding from HRSA MCHB through the existing cooperative agreement.

The ASTDD Leadership Committee created a subcommittee to serve as the Planning Committee to oversee the workshop. Another group of 10 people, who represented potential participating organizations and agencies, agreed to serve on a Steering Committee. Jane Steffensen, APHA Oral Health Section Chair represented APHA and served on the Workshop Steering Committee. These committees created an invitation list of approximately forty-five national organizations and federal agencies and selected workshop speakers.

The long-term aim of the Workshop is to increase capacity to recruit and retain a diverse and competent dental public health workforce that can help to reduce oral health disparities in underserved populations in the United States. The objectives of the National Workshop were to:

* Assemble representatives from a variety of key stakeholders from national organizations and federal agencies;
* Increase awareness and knowledge of dental public health workforce issues;
* Brainstorm potential collaborative approaches to address the DPH workforce shortage;
* Develop a draft national action plan; and
* Establish a core group to facilitate follow-up on the action plan.

The National Workshop: Enhancing the Dental Public Health Workforce and Infrastructure was held Feb. 26-27, 2004 in Washington, D.C. Two HRSA MCHB funded partner organizations provided assistance, and five national organizations provided additional support for the Workshop. Fifty-one persons representing 40 organizations and federal agencies attended the workshop. Jane Steffensen, Chair, Oral Health Section represented APHA Oral Health Section at the National Workshop.

The welcome and opening presentation was offered by Ms. Kneka Smith, ASTDD Leadership Chairperson, followed by Dr. Marianos giving the charge to the group. Dr. William Maas, Director, Division of Oral Health, National Center for Chronic Disease Prevention and Health Promotion set the stage by reviewing current dental public health infrastructure and workforce trends. Dr. Jack Dillenberg, Dean of the Arizona School of Dentistry and Oral Health, then challenged the group to think creatively and futuristically in terms of recruiting and educating new members of the workforce. Dr. Marianos then quickly summarized the breadth of activities already occurring to address workforce issues. Tim Henderson from the National Council of State Legislatures served as the primary facilitator, assisted by Don Marianos, ASTDD Leadership Coordinator, Beverly Isman, RDH, MPH, ELS Project Director, and Mary Beth Kinney, formerly of the Indian Health Service, who served as recorder. Dr. Dushanka Kleinman, USPHS Chief Dental Officer, presented some thoughts on what next steps the group should consider that would be in line with the Surgeon General’s National Call to Action. At the conclusion of the workshop, Candace Jones, President, American Association of Public Health Dentistry, asked the group to evaluate the workshop process and outcomes, emphasizing that this was only a first step in a much broader process to develop a national collaborative action plan to enhance the dental public health workforce and infrastructure.

National Action Plan to Enhance the Dental Public Health Workforce and Infrastructure

Prior to the workshop, an organizational self-assessment was distributed to all participating organizations and agencies to determine what organizations were doing related to workforce issues and what roles and resources they may be able to contribute to future collaborative endeavors. A summary of the responses was distributed at the workshop. Workshop packets contained overviews of all participating organizations as well as meeting materials. Additional resource materials, (e.g., policy papers, competency statements, etc.) were displayed at the Workshop.

The Participants at the Workshop focused on three areas: (a) Education, (b) Research, and (c) Practice. They developed objectives, action steps, and identified organizational players. Critical objectives were developed for improving the dental public health (DPH) workforce and for each critical objective. The participants identified organization(s) to be invited to help implement the key objectives. Criteria for organizational involvement included but were not limited to providing expertise and capability, leveraging financial and political support, and demonstrating leadership. The following section outlines the Objectives to Enhance the Dental Public Health Workforce and Infrastructure.

Education Objectives

1. Define and implement new, essential public health standards for accreditation of dental and dental hygiene programs.

2. Facilitate the integration of an oral health component/education into the curricula of:
MPH programs, public health schools, medical schools, medical residency programs,nursing schools, physician assistant programs, social work schools, and other professional programs.

3. Develop, implement, and evaluate models to increase diversity (in all its dimensions) in schools of dentistry, dental hygiene, and public health.

4. Create mechanisms to reduce the costs of postgraduate education for those who are interested in dental public health by resolving their debt and paying them during MPH & residency programs.

Research Objectives

1. Research the characteristics of those currently in the dental public health workforce to develop a profile (e.g., what keeps them in public health, what contributes to their leaving, and what are their training needs).
2. Conduct studies of dental public health workforce impact, especially in relation to implementation of community interventions, health outcomes, economics, and other variables — e.g., do we make a difference?
3. Integrate research and evaluation as essential components of public health practice to show quality and health outcome measures.

Practice Objectives

1. Know, use, and apply essential public health functions, core competencies, and evidence-based approaches in public health practice.
2. Explore ways to provide training in oral health to other health professionals.
3. Upgrade the value of the dental public health profession (e.g., encourage officials who hire professionals to set higher standards for training and experience).

Additional Objectives

1. Review the American Board of Dental Public Health certification process.
2. Create additional funding for dental pubic health residencies.
3. Raise the profile of the dental public health workforce and create a demand for dental public health workers.
4. Promote roles of dental hygienists and develop career paths in public health.
5. Include more public health information in graduate dental education.
6. Ensure oral health inclusion in public health workforce legislative efforts.
7. Institute tax on health insurance to raise resources to support dental public health.
8. Create national resource center/network on dental public health to provide technical assistance (TA) and consultation for state and local oral health programs.

Next Steps

Additional short-term outcomes were added and include:

• Gain an understanding and feedback from a variety of national organizations and agencies on the necessity to develop an action plan to enhance the dental public health workforce and infrastructure.

• Gain a commitment from a variety of national organizations and agencies to address issues within their own strategic plans.

• Following the National Workshop four work groups were formed to hold teleconferences and finish the process of developing actions plans.

These work groups are as follows:

Education Work Group: AAPHD—Linda Kaste (Group Coordinator), ASTDD—Lew Lampiris, APHA—Jane Steffensen, ADEA and ADHA—To Be Assigned

Research Work Group: UCSF CHP—Beth Mertz (Group Coordinator), AADR—Skip Collins, CDC—Scott Presson, NIH— To Be Assigned

Practice Work Group: Medicaid Group—Bob Isman (Group Coordinator), ADHA— Tim Lynch, ADA—Al Guay, NNOHA—John McFarland

Advocacy and Communication Work Group: CDHP—Anne DeBiasi (Group Coordinator), ACU—Kathy Westpheling, ADHA—Tim Lynch, CHCS—Carolyn Ballard, MCHOHRC—Katrina Holt, ADEA and Volunteers in Health Care—To Be Assigned

The Proceedings of the National Workshop have been posted on the ASTDD Web site at <> under projects / leadership/workshop proceedings. As the completed action plan and other materials become available, they will be posted on the ASTDD Web site and made available for organizations to use. The Workshop Steering Committee will continue to meet and decide how to advance the action plan.

Please contact Jane Steffensen, Oral Health Section Chair, at (210) 567-5567 or <> if you are interested in representing the APHA Oral Health Section and serving on a Work Group.

Prevention is a Cornerstone of the Primary Care of Children

Contributed by Oral Health Section Member:
Amos Deinard MD, MPH
Department of Pediatrics, University of Minnesota
Oral Health Section Council

Will Providing The Way Instill The Will?

The Surgeon General’s Report (2000) has eloquently described in detail the dental health crisis affecting children in this country who are covered by Medicaid or SCHIP or are from working-poor, uninsured or underinsured families who, in order to afford dental care, must find care that is offered on a sliding fee schedule. Dental caries is viewed as an infectious disease; therefore, it is theoretically totally preventable. It is recognized that administration of fluoride, either systemically or topically, is an important form of primary prevention to reduce caries formation and development. The utilization of fluoride varnish involves a simple application process with essentially no risk, it can, in theory, be placed by a trained individual. Medicaid/SCHIP children have difficulty gaining access to dental providers who can apply fluoride varnish, and uninsured families have difficulty finding sliding fee schedule care from the private sector. Consequently, other venues must be established where fluoride varnish can be applied to the teeth of high-risk children. Primary care health care providers who follow the American Academy of Pediatrics’ well-child care schedule see children at least 12 times for well-child care and perhaps many times for episodic care during the preschool-age period (birth through age 5). This venue then represents an appropriate site where fluoride varnish can be applied and the concepts of oral health care promotion and disease prevention can be included in anticipatory guidance.

Several years ago Dr. Olson Huff, a pediatrician in North Carolina, and his colleagues began a program to train primary care health care providers on the application of fluoride varnish. At his urging, Dr. Amos Deinard, Department of Pediatrics, University of Minnesota is working towards replicating North Carolina’s successes in Minnesota. The program recognizes that physicians, nurse practitioners and physician assistants (the three groups who are responsible for providing well-child care) learn a minimum amount about oral health during their professional training. In order to ascertain the extent of interest among Minnesota’s primary care health care providers to expand their knowledge about fluoride varnish application, a questionnaire was mailed to 2,750 individuals in late 2002. In addition, the magnitude of the dental crisis was described. The curriculum stresses the importance of including primary oral disease prevention and oral health promotion to the regularly practiced routine examinations by health care providers. Over 200 people expressed an interest in receiving training. To secure substantial backing, letters of support were obtained from the Minnesota Chapters of the American Academy of Pediatrics and the American Academy of Family Physicians. The Department of Human Services, which oversees the Medicaid/SCHIPs programs in Minnesota, as well as the Health Plans which are responsible for covering the care to most of Minnesota’s Medicaid/SCHIP children signaled their support of the concept by agreeing to reimburse medical providers for fluoride varnish application. There was also the opportunity to present the plan to the Minnesota Board of Dentistry. Since members of the Board are also active in the Minnesota Dental Association (MDA), information about these intentions was also communicated to the MDA.

In view of the interest expressed by health care providers to become more involved in primary prevention of dental caries, a training program was developed to be as user friendly as possible. Thus, a Web-based model was selected that would allow the learner to gain the instruction at his or her convenience without having to travel to the University of Minnesota campus for training. The Web-based training module was developed by The Phaedrus Group which had also developed the web-based HIPAA training course for the University of Minnesota. The Web-based program includes a discussion on etiology and prevention of caries, strategies for oral disease prevention, information on how to conduct oral health screening, film clips of a “Lift the Lip” examination and fluoride varnish application (the latter courtesy of the North Carolina project), and instruction about the billing process. Interest was expressed to have a format that could be taken “into the field” the web-based training module was therefore placed onto a CD-ROM. A videotape of the two film clips that are components of the web-based training module was also created. The University of Minnesota agreed to award one (1) CME credit to anyone who completes the training. Educational materials, in print format, that can be used by the health care providers to educate a) themselves, b) their staff and c) their patients’ parents about dental caries were also created and made available to trainees. Finally, to ensure that the health care providers are able to recognize oral pathology, an atlas of photographs of common oral pathology was created to include normal dentition, eruption schedules, caries, (early childhood caries (ECC); pit and fissure; smooth surface), cellulitis, toothbrushing technique, dental sealants, fluorosis, gingivitis, newborn conditions, and trauma.

To inform the primary care medical provider community of the availability of these materials, the Web-based training program was announced on <>, through a series of e-mails to a) those who had expressed interest in the 2002 mail survey; b) the listservs of the American Academy of Pediatrics and the American Academy of Family Physicians; c) a dental listserv administered by Dr. Robert Weyant, University of Pittsburgh; d) the listservs of the Ambulatory Pediatric Association and the American Association of Physician Assistants; e) the listserv and newsletter of the Minnesota Third District Nursing Association (which includes nurse practitioners); and f) the listserv and newsletter of the Minnesota Chapter of the American Academy of Physicians. These announcements have been released twice. To date the Web site has had over 3,500 entries, Continuing Education credit has been sought by over 120 individuals, the CD-ROM and videotape have been requested by over 170 individuals and the atlas and print materials have been purchased by over 120 individuals.

What has been accomplished, from a primary prevention perspective, is the creation of an approach to prevent dental caries in at-risk children. What remains to be determined is whether having a system of training generates the will among primary medical providers to take advantage of the training and begin to include primary prevention of dental caries among the services offered to children. Later this year, the same listservs and newsletters used to announce the availability of the training will be used to determine how many health care providers have incorporated this material into their menu of services and with what success and response. For those who have not yet incorporated the training, further inquiries to determine potential barriers will be made with the goal of finding solutions to overcome the barriers. The identification of barriers will then be addressed so that others will be encouraged to go through the training process and incorporate primary oral disease prevention and oral health promotion into their daily responsibilities.

CDC Announces New Goals and Organizational Design

On May 13,2004, the Centers for Disease Control and Prevention (CDC) Director Dr. Julie Gerberding announced new goals and integrated operations that will allow the federal public health agency to have greater impact on the health of people around the world. The restructuring evolved from the Futures Initiative, a strategic development process that included hundreds of CDC employees, other agencies, organizations, and the public.

The CDC will align it’s priorities and investments under two overarching health protection goals: ,1) Preparedness: People in all communities will be protected from infectious, environmental, and terrorists threats. 2) Health Promotion and Prevention of Disease, Injury and Disability: All people will achieve their optimal lifespan with the best possible quality of health in every stage of life. The CDC agency is also developing more targeted goals to assure an improved impact on health at every stage of life including infants and toddlers, children, adolescents, adults, and older adults.

Four newly formed Coordinating Centers will enable the CDC to leverage its resources and respond more quickly to public health threats and emerging issues as well as chronic health conditions.

The new Coordinating Centers and their Directors are:

Coordinating Center for Infectious Diseases, led by Dr. Mitchell Cohen, includes the National Center for Infectious Diseases, the National Immunization Program, and the National Center for STD, TB, and HIV Prevention.

Coordinating Center for Health Promotion, led by Dr. Donna Stroup, includes the National Center for Chronic Disease Prevention and Health Promotion and the National Center for Birth Defects and Developmental Disabilities.

Coordinating Center for Environmental Health, Injury Prevention, and Occupational Health, led by Dr. Henry Falk, includes the National Center for Environmental Health, the Agency for Toxic Substances and Disease Registry, the National Center for Injury Prevention and Control, and the National Institute for Occupational Safety and Health.

Coordinating Center for Health Information and Services, led by Dr. James Marks, includes the National Center for Health Statistics, a new National Center for Health Marketing, and a new National Center for Public Health Informatics.

Office of Global Health - Dr. Stephen Blount will lead this office.

Office of Terrorism Preparedness and Emergency Response – Mr. Charles Schable will lead this office.

Dr. Gerberding said the time is right to move forward with these changes. “CDC is very strong and credible agency that has - and will always - base its decisions on the best of science. The time for change to enhance your impact is when you’re at your best and for CDC that time is right now.”

Dr. Gerberding and executive leaders throughout CDC will be moving forward to implement these changes by Oct. 1, 2004, the start of the next fiscal year.

-- News release reprinted from <>.

New Surgeon General's Report Expands List of Diseases Caused by Smoking

U.S. Surgeon General Richard H. Carmona today released a new comprehensive report on smoking and health, revealing for the first time that smoking causes diseases in nearly every organ of the body. Published 40 years after the surgeon general's first report on smoking -- which concluded that smoking was a definite cause of three serious diseases -- this newest report finds that cigarette smoking is conclusively linked to diseases such as leukemia, cataracts, pneumonia and cancers of the cervix, kidney, pancreas and stomach.

According to the report, smoking kills an estimated 440,000 Americans each year. On average, men who smoke cut their lives short by 13.2 years, and female smokers lose 14.5 years. The economic toll exceeds $157 billion each year in the United States --$75 billion in direct medical costs and $82 billion in lost productivity.

In 1964, the Surgeon General’s report announced medical research showing that smoking was a definite cause of cancers of the lung and larynx (voice box) in men and chronic bronchitis in both men and women. Later reports concluded that smoking causes a number of other diseases such as cancers of the bladder, esophagus, mouth and throat; cardiovascular diseases; and reproductive effects. Today’s new report, The Health Consequences of Smoking: A Report of the Surgeon General, expands the list of illness and conditions linked to smoking. The new illnesses and diseases are cataracts, pneumonia, acute myeloid leukemia, abdominal aortic aneurysm, stomach cancer, pancreatic cancer, cervical cancer, kidney cancer and periodontitis.

Statistics indicate that more than 12 million Americans have died from smoking since the 1964 report of the surgeon general, and another 25 million Americans alive today will most likely die of a smoking-related illness.

The report's release comes in advance of World No Tobacco Day, an annual event on May 31 that focuses global attention on the health hazards of tobacco use. The goals of World No Tobacco Day are to raise awareness about the dangers of tobacco use, encourage people not to use tobacco, motivate users to quit and encourage countries to implement comprehensive tobacco control programs.

The report concludes that smoking reduces the overall health of smokers, contributing to such conditions as hip fractures, complications from diabetes, increased wound infections following surgery, and a wide range of reproductive complications. For every premature death caused each year by smoking, there are at least 20 smokers living with a serious smoking-related illness.

The report concludes that quitting smoking has immediate and long-term benefits, reducing risks for diseases caused by smoking and improving health in general. "Within minutes and hours after smokers inhale that last cigarette, their bodies begin a series of changes that continue for years," Dr. Carmona said. "Among these health improvements are a drop in heart rate, improved circulation, and reduced risk of heart attack, lung cancer and stroke. By quitting smoking today a smoker can assure a healthier tomorrow."

In addition to the 960-page printed report, The Health Consequences of Smoking, the U.S. Department of Health and Human Services released a new interactive scientific database of more than 1,600 key articles cited in the report, available through the Internet <>. The database can be used to find detailed information on the specific health effects of smoking as well as to develop customized analyses, tables and figures.

The database will be continually updated as new critical studies are published, allowing the surgeon general to determine on a regular basis whether the evidence supports a new definitive conclusion about smoking-caused disease. "Using this technology, once a threshold of danger is met, we can quickly alert the American people of new information related to smoking," Dr. Carmona said.

The report found that for a number of diseases and conditions associated with smoking, the evidence is not yet conclusive to establish a causal link. For these illnesses, which include colorectal cancer, liver cancer, prostate cancer, and erectile dysfunction in men, additional studies are needed to reach the threshold of evidence required by the Surgeon General's strict causal criteria to declare that they are causally related to smoking. These criteria were introduced in the 1964 report and have been updated in the 2004 report using new uniform standards.

To help communicate the report findings as widely as possible, Surgeon General Carmona also unveiled a new animated Web site for the public showing the hazards of smoking and the benefits of quitting: <>. In addition, a full-color, easy-to-read summary of the report has been developed for the public.

Copies of the full The Health Consequences of Smoking: A Report of the Surgeon General and related materials are available from the Centers for Disease Control and Prevention, Office on Smoking and Health, (800) CDC-1311, <> and on the surgeon general's Web site at <>.

--News release reprinted from <>.

IOM Report Calls for National Effort to Improve Health Literacy

90 Million Americans are Burdened with Inadequate Health Literacy

On April 8, 2004, a new report from the Institute of Medicine (IOM) of the National Academies says that nearly half of all American adults – 90 million people – have difficulty understanding and using health information, and there is a higher rate of hospitalization and use of emergency services among patients with limited health literacy. Limited health literacy may lead to billions of dollars in avoidable health care costs.

More than a measurement of reading skills, health literacy also includes writing, listening, speaking, arithmetic, and conceptual knowledge. Health literacy is defined as the degree to which individuals have the capacity to obtain, process, and understand basic information and services needed to make appropriate decisions regarding their health.

"Health literacy is fundamental to quality care," said David A. Kindig, professor emeritus of population health sciences, University of Wisconsin, Madison. "The public's ability to understand and make informed decisions about their health is a frequently ignored problem that can have a profound impact on individuals' health and the health care system. Most professionals and policy-makers have little understanding of the extent and effects of this problem."

A concerted effort by the public health and health care systems, the education system, the media, and health care consumers is needed to improve the nation's health literacy, the report says. If patients cannot comprehend needed health information, attempts to improve the quality of care and reduce health care costs and disparities may fail.

Limited health literacy affects more than just the uneducated and poor, the report says. At some point, most individuals will encounter health information they cannot understand. Even well educated people with strong reading and writing skills may have trouble comprehending a medical form or doctor's instructions regarding a drug or procedure.

Health literacy skills are needed for discussing care with health professionals; reading and understanding patient information sheets, consent forms, and advertising; and using medical tools such as a thermometer. Over 300 studies indicate that health-related materials cannot be understood by most of the people for whom they are intended.

Individuals are increasingly responsible for managing their own health care, the committee noted. They are assuming new roles in seeking information, measuring and monitoring their own health, and making decisions about insurance and options for care. Patients' health often depends on their ability and willingness to carry out a set of activities needed to manage and treat their disease. This self-management is essential to successful care of chronic diseases such as diabetes, HIV, and hypertension. Patients with chronic illness who have limited health literacy are less knowledgeable about disease management and less likely to use preventive measures.

Limited health literacy is not a problem that starts and ends with patients, the committee added. Health systems are becoming increasingly complex, involving new technologies, scientific jargon, and complicated medical procedures and forms. All of these aspects of the health system can be confusing to patients. Moreover, care providers frequently need to communicate with patients who have different language and cultural backgrounds. Culture and ethnicity may influence patients' perceptions of health, illness, and the risks and benefits of treatments. Differing cultural and educational backgrounds between a patient and provider also contribute to problems in the patient's comprehension.

Health care systems should develop and support programs to reduce the negative effects of limited health literacy. Responsibility for improving health literacy must be borne not only by the health system, but also by educators, employers, community organizations, and other groups with social and cultural influence.

The report recommends that health knowledge and skills be incorporated into the existing curricula of kindergarten through 12th grade classes, as well as into adult education and community programs. Furthermore, programs to promote health literacy, health education, and health promotion programs should be developed with involvement from the people who will use them. And all such efforts must be sensitive to cultural and language preferences.

The extent and consequences of limited health literacy in the United States are difficult to define because of limited data. The U.S. Department of Health and Human Services and other government and private funding agencies should support multidisciplinary research in this area, the committee said. Furthermore, public and private funders should develop and test new methods of measurement that can establish baseline levels of health literacy and monitor change over time.

This study was sponsored by the American Academy of Family Physicians Foundation, California HealthCare Foundation, Commonwealth Fund, W.K. Kellogg Foundation, MetLife Foundation, National Cancer Institute, Pfizer Corp., and the Robert Wood Johnson Foundation. The Institute of Medicine is a private, nonprofit institution that provides health policy advice under a congressional charter granted to the National Academy of Science.

Copies of Health Literacy: A Perspective to End Confusion are available from the National Academies Press; tel. (202) 334-3313 or (800) 624-6242, or on the Internet at <>. The cost of the report is $47.95 (prepaid) plus shipping charges of $4.50 for the first copy and $.95 for each additional copy.

--News release reprinted from <>.

New Blood Pressure Guidelines for Children and Adolescents

Blood Pressure Tables for Children and Adolescents from the Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents are expected to be available late summer 2004. The updated blood pressure (BP) tables for children and adolescents are based on recently revised child height percentiles and also include the BP data from the 1999-2000 NHANES. This latest report follows the May 2003, release of The National Heart, Lung, and Blood Institute (NHLBI) new clinical practice guidelines for the prevention, detection, and treatment of high blood pressure. The guidelines, which were approved by the Coordinating Committee of the NHLBI’s National High Blood Pressure Education Program (NHBPEP), feature altered blood pressure categories, including a new “prehypertension” level–which covers about 22 percent of American adults or about 45 million persons.

The new guidelines streamline the steps by which doctors and health professionals can manage their patients with high blood pressure. “The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure,” appeared in the May 21, 2003, issue of The Journal of the American Medical Association (JAMA).

High blood pressure is a major risk factor for heart disease and the chief risk factor for stroke and heart failure, and also can lead to kidney damage. It affects about 50 million Americans–one in four adults. Treatment seeks to lower blood pressure to less than 140 mm Hg systolic and less than 90 mm Hg diastolic for most persons with hypertension (less than 130 systolic and less than 80 diastolic for those with diabetes and chronic kidney disease). To raise awareness about the dangers of high blood pressure, NHLBI has developed special Web pages and educational materials for health care professionals, patients, and the public. These include an updated “Your Guide To Lowering High Blood Pressure” Web page, which can be found at <>.

Information and resources regarding National High Blood Pressure Education Month are available at <>. The guidelines and related information are available at <>.

To interview an NHLBI spokesperson about the new guidelines, call the NHLBI Communications Office at (301) 496-4236. NHLBI press releases and other materials, including those related to high blood pressure, are available online at <>.

Full report expected in late Summer, 2004

ADA Reports

Ante Partum Dental Radiography and Infant Low Birth Weight
JAMA April 28, 2004

Lead author Philippe Hujoel, PhD, of the University of Washington concludes that dental radiography during pregnancy is associated with low-birth-weight babies delivered at full term. This recently published research reinforces the American Dental Association’s long-standing recommendation that dentists use both abdominal aprons and thyroid collars, whenever practical, to minimize radiation exposure. The ADA recommendations for using leaded aprons and thyroid collars were first published in 1989 and reinforced in updated guidelines in 2001. The ADA also recommends that pregnant women postpone elective dental radiographs until after delivery; however they acknowledge that there may be times when an x-ray may be required during pregnancy for diagnosis and treatment of oral disease. Maintaining good oral health during pregnancy is important to both the expectant mother and their baby. Women should inform their dentist if they are pregnant, might be pregnant, or plan to become pregnant.

ADA Reports Provide Checkup on Dental Medicaid Programs

The American Dental Association (ADA) developed a Compendium in 2003 called State Innovations to Improve Access to Oral Health Care for Low-Income Children to record the activities states have pursued in an effort to improve access to oral health care for children enrolled in Medicaid and the State Children's Health Insurance Program. To assist oral health stakeholders in advocating for improvements to dental Medicaid programs, in 2004 the ADA published a series of policy briefs highlighting state innovations to help state legislators understand the necessity of improving dental Medicaid services. These Policy Briefs outline ways to improve the reimbursement and administration of the Medicaid program, expand outreach efforts to families and dental providers, and improve public awareness about the importance of oral health. The Policy Briefs are based on information published in the Compendium.

The ADA Publications are available at
<> and are

State Innovations to Improve Access to Oral Health Care for Low-Income Children

Series: Policy Briefs
• Introduction: Increasing Access to Medicaid Dental Services for Children through Collaborative Partnerships
• Administration: Medicaid Program Administration
• Outreach: Enhancing Dental Medicaid Services and Care Coordination
• Finance: Medicaid Reimbursement Per Region – Using Market Place Principles to Increase Access to Dental Services.
Finance: New England
Finance: Mid-Atlantic
Finance: South Atlantic
Finance: East North Central
Finance: East South Central
Finance: West North Central
Finance: West South Central
Finance: Mountain Finance: Pacific

Obituary - In Memorium: Dr. Keith Heller

Dr. Keith Heller, Assistant Professor, Preventive and Community Dentistry, University of Iowa College of Dentistry died April 26, 2004 after a long battle with congestive heart failure. Keith Heller was born August 5, 1955 in Detroit, Michigan.

Dr. Heller received a dental degree in 1981, a MPH in 1992 and doctorate in public health in 1996 from the University of Michigan. He was a member of the Ameircan Board of Public Health Dentistry and was board certified in public health dentistry.

He served in a public health clinic in Monroe, MI, private practice in Jackson, MI and Beaver, PA; in the Pediatric Dentistry Department at Mott Children’s Hospital in Flint, MI; and as a research investigator at the University of Michigan. Dr. Heller joined the faculty of the University of Iowa College of Dentistry in 2001.

Survivors include his wife Elizabeth Jones and his son Andrew of Iowa City, Iowa.

Mark Your Calendars

June 9-12, 2004
American Dental Education Association
Allied Dental Leadership Development Conference

Vancouver, British Columbia
For more information visit: <>

June 12-15, 2004
American Dental Education Association
37th Annual Allied Dental Program Directors’ Conference

Vancouver, British Columbia
For more information visit: <>

June 16-19, 2004
National School - Based Health Care Convention

New Orleans, Louisiana
For more information visit: < >

June 16-19, 2004
HRSA Primary Health Care
Health Care for the Homeless (HCC) Conference

New Orleans, Louisiana
For more information visit: <>

June 23-30, 2004
American Dental Hygienists’ Annual Session

Dallas, Texas
For more information visit: <>

July 14-16, 2004
NACCHO Annual Conference

“Shaping Our Potential: Competencies, Capacities, and Core Functions in Local Public Health”
Saint Paul, Minnesota
For more information visit: <

July 20-21, 2004
Oral Health America

“Partnering for Success: Developing and Expanding Public-Private Partnerships"
Chicago, Illinois
For more information contact: Brad Hutchins, 312-836-9900, <>

July 24-30, 2004
Disparities in Health in America: Working Towards Social Justice

University of Texas, MD Cancer Center, Houston, Texas
For more information visit: <>

Sept. 10-13, 2004
FDI World Dental Congress 2004

New Delhi, India
For more information visit: <>

Sept. 13-14, 2004
Elders’ Oral Health Summit

Boston University School of Dental Medicine
Department of General Dentistry
For more information visit: <>

Sept. 19-21, 2004
National Association of Community Health Centers Annual Conference

San Francisco, California
For more information visit: <>

Sept. 28 – October 1, 2004
ASTHO & APHL Annual Conference

“Communication, Cooperation, Coordination – Building Bridges in Public Health”
St. Paul, Minnesota
For more information visit: <>

Sept. 30 – Oct. 3, 2004
American Dental Association

Orlando, Florida
For more information visit: <>



Share with your colleagues news about your programs, policies, practices, courses, and any successes! For details on submissions please e-mail Magda de la Torre, Editor at <>

Oral Health Section Leadership - 2003-2004

For complete listing of APHA Oral Health Section Leadership, please view the APHA Oral Health Section Winter 2003 Newsletter or contact Oral Health Section Newsletter Editor Magda de la Torre at <>.