American Public Health Association
800 I Street, NW • Washington, DC 20001-3710
(202) 777-APHA • Fax: (202) 777-2534
comments@apha.org • http://www.apha.org

Oral Health
Section Newsletter
Spring 2010

Chair's Message

Hello again from your Section Chair.

It’s a busy time of year preparing for the Annual Meeting, reviewing proposed policies, promoting our recently passed new policies, and, of course, health care reform. There is much going on at the national and state levels in public health, and I encourage you to stay active in APHA and the Oral Health Section. Be sure to keep your e-mail up-to-date in your membership file; you can edit this information by logging on to the APHA website as a member.

Annual Meeting: I hope you are planning to attend our next Annual Meeting in Denver, Nov. 6-10, 2010. David Cappelli is once again heading up the Program Planning Committee, with help from Kathy Lituri. The program (see below) is shaping up to be quite interesting and informative. Thanks to all the Committee members who have helped David pull the scientific program together. Registration online at the APHA website opened June 1; you should have received an e-mail on June 1 announcing the opening. If you did not receive it, you may want to check your membership record to assure that it has your current e-mail address.

The Oral Health Section sessions will be in the Hyatt Regency Denver Hotel, across the street from the Convention Center. Be sure to visit our Section booth. APHA is investing in a large booth area for all the Sections/SPIGs that will be very professional and located adjacent to APHA’s main exhibit area. Make plans now to join us in Denver!

Elections: 2010 Section elections are quickly approaching. The elections begin on June 18, 2010 and end on July 23. On June 18, you will be sent an e-mail notification letting you know that the election is open for online voting. The e-mail subject line will read "APHA Voting Information Enclosed". Please do not delete this e-mail as it contains your voting instructions.

We have a wonderful slate of candidates this year. Our Chair-Elect candidate is Amos Deinard. For two Section Council seats our candidates are: Arlene Lester, Gary Podschun, Peggy Timothé, and Scott Tomar. For one Governing Council seat our candidates are: Helene Bednarsh and Lynn Bethel. I want to express my thanks to Howard Pollick, our Nominations Committee Chair, for assembling such a strong slate of candidates, and to the candidates for volunteering to serve the Section. Please review their statements online and make your voice heard by voting.

Health Reform: After all the ugliness and machinations of the political process, I was speechless as I watched President Obama sign the Patient Protection and Affordable Care Act on Tuesday, March 23. The law will bring much needed reforms to the health care system, with substantial enhancements of the public health system and for oral health.

When the major changes take effect in 2014, I believe we will have a health care system that is more fair and just. The provisions impacting oral health are broad and could be a major step forward in our efforts to improve the oral health of the public. I want to thank all of you who answered my call to contact your Congressional representatives to support the reforms. Our challenge now will be to see that the oral health and public health provisions receive appropriations in this difficult budgetary environment.

Policy development: The Section leadership has been active in reviewing the new policies proposed for consideration at the 2010 Annual Meeting. The Oral Health Section has submitted a proposed policy on fluoride varnish, and we are optimistic that we can gain Governing Council approval.  Amos Deinard has been the lead on this policy. We have also reviewed the existing policies that were up for review this year to decide if they should be retained, updated or archived. Thanks to the Section Executive Committee and others who volunteered to participate in these efforts. 

Welcome to those of you new to the Oral Health Section! Whether new to APHA or joining us as a second or third Section, we look forward to your participation as we strive to advance the public’s oral health.

I again ask that all Section members consider recruiting a new member from your sphere of colleagues and students. Existing APHA members who belong to other Sections can join Oral Health as a second or third Section for $30/year. There is also a joint membership pilot program to join both the state public health association and APHA for a reduced fee that is ongoing in Northern California, Kansas, Massachusetts and Ohio. Please let Membership Committee Chair Sandie Beebe know if you’ve successfully recruited a new member!

We encourage your involvement in Section activities, whether on a committee or by running for an office. And for those who have already served in a leadership capacity, it’s time to give some thought to getting involved again. We need you on our Committees, such as the Membership, Program Planning, Awards, and Policy; to help staff the Section booth at the Annual Meeting; and to contribute to the newsletter and the Annual Meeting program.

We depend on Section volunteers to carry on the bulk of the Section’s business. Feel free to contact me or any member of the Section leadership. Any suggestions on how we can improve the Section’s efforts and increase the value of membership are welcome.

Hope to see you in Denver.

Scott Presson, Chair

Editorial: Is Evidence-Based Practice Practical?

Given its current attention, one would think that Evidence-Based Practice was a new concept that burst forth upon the health care scene like Archimedes’ “Eureka!” One would expect that the rising tide of evidence would submerge practices proved ineffective, which is, after all, the standard that preceded EBP. Hasn’t effectiveness always been the hallmark of good practice? Is there any difference between effectiveness and EBP? Well, yes, there is. EBP is concerned with the effect of evidence on practice, whereas effectiveness is in the province of evidence.

To be sure, evidence has had some effect in dentistry. There has been some technical tinkering. Composites supplanted silicates. Gutta percha conquered silver points. This implant plants better than that one. Better materials but not necessarily better practicing.

What of patterns of practice? Following are some examples of Non-Evidence-Based Practice:

  • Routine full-mouth radiographs on all “new” patients.
  • Routine six-month recall examination. 
  • Routine six-month and/or annual bitewing radiographs.
  • Routine six-month and/or annual prophylaxis, regardless of demonstrable need.
  • Coronal polishing in the absence of otherwise unremovable stains.
  • Prophylactic removal of wisdom teeth.
  • I-V sedation/general anesthesia for simple procedures, including M3 extractions.
  • Routine cephalographs for routine orthodontic cases ― always before, frequently after completion.

Others could name other examples, but I am out of practice.

Actually, there has been some progress. Some, perhaps many, but probably not all state Medicaid programs pay only for annual examinations and prophylaxes, even when prophylaxis is, for most children, merely coronal polishing. Medicaid, like some dental insurance plans, also have stated policies excluding prophylactic removal of third molars and I-V sedation and GA for routine procedures. But one wonders how effective they are, particularly against the aggressive demands of oral surgeons or patients.

These are interesting clinical issues, but isn’t there a major category that may in fact override Evidence-Based Practice, namely, Economic-Based Practice? Is it realistic to expect that GPs, much less pediatric dentists, would stop doing and charging for worthless coronal scalings, aka child prophylaxis, or place a caries-free kid on 18-month recall, which is what EBD calls for, when examinations and prophylaxis represent a major source of their income? Would oral surgeons provide prophylactic third molar extractions as an altruist service to prevent all the pathology they believe is out there? Would GPs stop removing and replacing long-standing, serviceable amalgam fillings with disposable composites, if it didn’t represent a quick buck?

In short, can Evidence-Based Practice that does not take into account Economic-Based Practice be practiced?

Jay W. Friedman

Welcome to the Oral Health Section

Between January and March of this year, 12 new members have enrolled in our Oral Health Section! They come from across the country. A warm welcome to all:

 

David Charles Averill, DDS                   South Burlington, Vt.

Beth Barksdale, Student/Trainee          Augusta, Ga.

Amber Joy Dalton, RDH, MPH               Knoxville, Tenn.

Clara Dorsainvil-Simon, BS                  Brooklyn, N.Y.

Lela Hobby-Burns, Student/Trainee      Longmeadow, Mass.

Corey Danyall Lawson, MPH                Kinston, N.C.

Okuji Michael, DDS, MPH, MBA             San Francisco

Jonathon David Shenkin, DDS, MPH      Augusta, Maine

Anuj Suri, BDS, MDS                          Forest Hills, N.Y.

Tamanna Tiwari, BDS, MDS                 Forest Hills, N.Y.

Samba Younan, Student/Trainee          Monroeville, Pa.

Mary E. Young, RDH, MHA                   Seattle

 

It is always a privilege to have new members joining our Oral Health Section, not least student/trainees, whose interest reflects the vitality of our Section. As of March 31, we had 280 members. Our growth is essential to promoting oral health in the overall broadening of current public health issues.

 

We look forward to meeting our new members at our 138th Annual Meeting in Denver, Nov. 6-10. We encourage current and new members to become involved in our activities. We are always open to your opinions, your involvement, and the sharing of your expertise in our public health pursuits.

Sandie Nagel Beebe, RDH, PhD

APHA Oral Health Membership Chair

 

Is Dentistry a Profession?

Thanks to Sharon Melanson for posting on DentPubHealthListServe, May 8, 2010, the references to three provocative articles (listed below) in the 2004 Journal of the Canadian Dental Association by Jos Welie: Is Dentistry a Profession?

Excerpts:
      “…the dental profession can be defined as the collective of oral health care experts who have jointly and publicly committed to altruistically provide their expertise in the service of all patients with important oral health needs and are in turn trusted by the public to do so.”
      “By definition, dentistry does not qualify as a profession when and to the extent that the interventions performed are purely elective instead of medically indicated. It therefore behooves dentists who focus their practices on esthetic interventions to clearly state that they are not professionals. Doing so does not mean they are incompetent, dishonest or otherwise immoral. It simply means that the ethical structure of their practices differs from that of professional dentists.” [emphasis added]

Click on the following links to access the articles:
Part 1: http://www.cda-adc.ca/jcda/vol-70/issue-8/529.pdf  
            Professionalism Defined
Part 2: http://www.cda-adc.ca/jcda/vol-70/issue-9/599.pdf  
            The Hallmarks of Professionalism
Part 3: http://www.cda-adc.ca/jcda/vol-70/issue-10/675.pdf
            Future Challenges

Dentists in Politics & Public Health

The photograph below features Cheddi Jagan, DDS (1918-1997), President of Guyana, at the April 1996 reception in the President’s House in Georgetown hosting a delegation of Health Volunteers Overseas/Dentistry who contributed to the first meeting of the Guyanese Dental Association. Dr. Eugenio Beltran presented the results of the 1995 National Oral Health Surv-

Eugenio Beltran, Cheddi Jagan, Rosalie Warpeha  (Photo & text courtesy of Eugenio)

ey of School Children.

At Cheddi’s left is Sister Rosalie Warpeha, DDS (1942-2006), known as “Sister Doctor.”  Rosalie was a Marist Missionary Sister who received her dental degree from the University of Minnesota. She was a member of a “dental family” that included her father and one brother. Her brother was the Chief Dental Officer of Jamaica and was the champion behind the successful Jamaican national salt fluoridation program. 

One other dentist was elected president of a foreign nation: Dr. Héctor Campora was president of Argentina for a few months in 1973. He resigned to allow Juan Domingo Perón and his third wife Isabel Perón to run for President and Vice President of Argentina after Peron’s exile.                              

For a brief biography of Sister Doctor Rosalie, click here.

 

For a biography of Cheddi, click on:

 http://www.cheddijagan.com/2009/07/15/biography-of-cheddi-jagan/

 

 

The Dentist Who Changed World History

Dr. Maurice William was born in Russia in 1881 and emigrated to the Unied States as a child. Early on a socialist and eventually "Casting about for a career, William was advised: 'Become a dentist, comrade. Under the most perfect system of society, there will still be rotten teeth.'”

In 1920, he published The Social Interpretation of History, a book that found its way to China and contributed to Sun Yat-sen’s developing principles of social and economic reform that  led to the revolutionary overthrow of the ancient Chinese imperial regime. 

For a brief history of a pioneering dentist who had the courage to put his money where his mouth was [he self-published] and had a vision of, if not a perfect, at least a better world, click on http://www.international.ucla.edu/print.asp?parentid=2813.

Items of Interest

Dental Therapists and Patient Satisfaction

“Patients attending therapists were found to have a significantly higher level of overall satisfaction…than those attending appointments with dentists.” Click here for the report from the British Dental Journal.

 


A Cautionary Commentary on Spurious Conclusions

Conclusion: “The evidence provided by the present study does not support the hypothesis that treatment of periodontal disease during pregnancy in this population prevents preterm birth, foetal growth restriction, or pre-eclampsia.”

 “So, is there really no relationship between periodontal disease and preterm or low birthweight? Or did the scientists just ask the wrong question?” asks Richard Neiderman.

Click here for the abstract of the study & Richard’s excellent commentary.

 


Unassisted Smoking Cessation: A Success Story

From: Chapman S, MacKenzie R (2010). The Global Research Neglect of Unassisted Smoking Cessation: Causes and Consequences.

What Message Should Smokers Get about Cessation?

 

There is good news about cesssaton: in a growing number of countries, there are more ex-smokers than smokers.


Up to three-quarters of ex-smokers have quit without assistance (“cold turkey” or cut down, then quit), and unaided cessation is by far the most common method used by most successful ex-smokers.


A serious attempt at stopping need not involve using NRT [Nicotine Replacement Therapy] or other drugs or getting professional support.


Early “failure” is a normal part of trying to stop. Many initial efforts are not serious attempts [but might be considered “rehearsals for eventual success”].


NRT, other prescribed pharmaceuticals, and professional counseling or support also help many smokers, but are certainly not necessary for quitting.
 

 

For the full report, click on:  http://www.plosmedicine.org/article/info:doi%2F10.1371%2Fjournal.pmed.1000216

 

[A summary was published in the March 2010 Public Citizen’s Health Research Group Health Letter. To subscribe ― and you should ― go to www.citizen.org/hrg]

 


Give Thumb Suckers a Break

While it might seem logical to stop children from thumb sucking around age 3 or 4, is it possible without physical restraint? The plethora of medieval devices (application of bitter, foul-tasting, anti-finger-licking sticky liquids and sprays; tying on gloves and thumb shields; cementing palatal rakes in the mouth) suggests that not even physical restraint is very successful. Besides, not all thumb-sucking children develop malocclusions. Is it fair, then, that they should all be subjected to this trauma? A more reasonable approach is to ignore NNS [non-nutritive thumb or finger sucking] at this early age and even later if there is no evidence of a developing malocclusion, such as an open bite. For the complete article in DrBicuspid.com, click on: http://www.drbicuspid.com/index.aspx?d=1&sec=nws&sub=rad&pag=dis&ItemId=304276&wf=487.

 


Do You Smell a Rat?

Neil Johnson, working in the labs of Frey and Leah R. Hanson, PhD, at Regions Hospital in St. Paul, Minn., found that lidocaine or Xylocaine, sprayed into the noses of laboratory rats, quickly traveled down the trigeminal nerve and collected in their teeth, jaws, and mouths at levels 20 times higher than in the blood or brain. The approach could provide a more effective and targeted method for treating dental pain/anxiety, trigeminal neuralgia (severe facial pain), migraine, and other conditions, the scientists say. For the full olfactory experience, click on:

www.sciencedaily.com/releases/2010/05/100513104818.htm  


U.S. Dentist Shortage Predicted/Crushing Debt on Graduation

As if there isn’t already a shortage of dentists, a study sponsored by Delta Dental Plans Association predicts that retirement and career changes could outpace dentist school graduation by 2012. For a summary report and Related Reading visit:

www.drbicuspid.com/index.aspxsec=sup&sub=pmt&pag=dis&ItemID=304110 

 


Kansas School Board Bans Sugary Beverages, Foods in School Vending Machines

One board member voted against the ban, saying he didn't support it because students will cross the street from the school and purchase bigger sodas and bigger bags of chips. A good point; so perhaps the stuff should be banned from all stores within, say, 10 miles of schools?  Click here for this item.


A 2008 Report on Medicaid Coverage of Adult Dental Services Before the “Recession”

“As of early 2008, 45 states, including the District of Columbia, provided some type of coverage of dental benefits to at least some Medicaid-enrolled adults. However, this coverage ranged from comprehensive dental care to coverage limited to emergencies, or coverage for only certain categories of enrollees. Our snapshot indicates that there may be an increasing recognition of the importance of oral health to overall health.”

See: www.nashp.org/sites/default/files/Adult%20Dental%20Monitor.pdf  

Most States Fail Children’s Dental Health Care

The Cost of Delay: State Dental Policies Fail One in Five Children, as reported by the Pew Children’s Dental Campaign.

 

An estimated one in five low-income children in America goes without dental care each year, often due to lack of access.  Many children suffer from more serious health risks and chronic school absence as a result of untreated dental health problems that could have been prevented with the proper care. 

In our report, we assessed and graded all 50 states and the District of Columbia, using an A-F scale, on whether and how well they are employing eight proven and promising policy approaches at their disposal to ensure dental health and access to care for children.  These policies include preventative measures (such as sealants and fluoridation), expanded access to Medicaid, and innovative workforce models.

Only six states merited “A” grades: Connecticut, Iowa, Maryland, New Mexico, Rhode Island and South Carolina We awarded 33 states and the District of Columbia a grade of “C” or below. Nine of those states earned an “F,” meeting only one or two policy benchmarks: Arkansas, Delaware, Florida, New Jersey, Hawaii, Louisiana, Pennsylvania, West Virginia and Wyoming

This report serves as a warning sign — and a wake-up call — for policy-makers to take action.  If you have any questions about the report, please contact Andy Snyder, Senior Associate, Pew Children’s Dental Campaign, at (202) 552-2155.  The report can be found at: www.pewcenteronthestates.org/costofdelay

Shelly Gehshen

Director, Pew Children’s Dental Campaign

 

[posted on dental-public-health@list.pitt.edu, Tuesday, Feb. 23, 2010]

 

 

Report on the Findings of the Oral Health Component of the Canadian Health Measures Survey, 2007-2009

Did you know that there are more dental hygienists (20,900) than dentists (19,200) in Canada?

Did you know that there are 2,200 denturists?

And 300 dental therapists?

Did you know that there are only 47 specialists, 66 clinical dentists, 152 dental therapists and 453 dental hygienists in the public service, representing 0.017 percent of the dental workforce?

The results from the Oral Health Component of the CHMS demonstrate that, overall, Canadians have very good oral health:

―Three of every four Canadians visit a dental professional annually.

Two out of every three Canadians with natural teeth do not need

    dental treatment.

“There is always room for improvement. Results from the survey indicate that 17 percent of Canadians report that they did not make an appointment to see a dental professional due to the cost in the past 12 months. In another question from the survey, 16 percent responded that they avoided getting all their recommended treatment done due to the cost in the past year.”

 

Yet, did you know that, despite that overall good level of oral health, 4.4 percent (1,490,280) of the population ages 40-59 is edentulous, accelerating to 21.7 percent (7,349,790) by ages 60-79?  Hmmmmm.*

All this and much more in the Canadian [Oral] Health Measures Survey.

 

Click here for the Summary Report, and/or here for the Full Report.

 

* Comparable figures in the United States: Edentulism in 45-64 year-olds, 10 percent; in 65-74 year-olds, 25 percent.

[From the 1998 National Health Interview Survey, National Center for Health Statistics]

Oral Health Section Annual Meeting Program

Registration is now open for the 138th APHA Annual Meeting Nov. 6-10, 2010 in Denver. You can now register, request hotel accommodations, and explore the schedule of events online at http://www.apha.org/meetings/eventschedule/.   

Oral Health Section Schedule of Events:

Sunday, Nov. 7

8:00 a.m.-11:30 a.m.  206.0 Oral Health Section Executive Committee Business Meeting

2:30 p.m.-5:30 p.m.    260.0 Oral Health Section Executive Committee Business Meeting

4:30 p.m.-5:30 p.m.    Poster Sessions:

2072.0 Education Models for Health Professionals that Improve Oral Health

2073.0 Expanding Workforce Models and Programs to Improve Oral Health

2074.0 Reducing Risk, Expanding Prevention, and Enhancing Oral Health Promotion

Monday, Nov. 8

10:30 a.m.-11:30 a.m.  Poster Sessions:

3088.0 Improving the Oral Health for Children and Adolescents

3089.0 Oral-Systemic Disease Linkages

3090.0 Oral Health Issues Among Vulnerable Populations

12:30 p.m.-2:00 p.m.  3234.0 Social Justice in Oral Health: Ensuring Access to Care for People with HIV

2:30 p.m.-4:00 p.m.    3337.0 Should Food Stamps be used to Purchase Soda?

4:30 p.m.-6:00 p.m.    3412.0 Oral Health Report Cards: Friend or Foe

6:30 p.m.-8:00 p.m.    347.0 Oral Health Section Award Ceremony

8:15 p.m.-10:00 p.m.  Oral Health Section Dinner

Tuesday, Nov. 9

8:30 a.m.-10:00 a.m.    4053.0 Addressing Oral Health Disparities to Improve Oral Health Equity for the Underserved

10:30 a.m.-12:00 p.m.  4115.0 Social Justice: Implications for Oral Health

2:30 p.m.-4:00 p.m.     4304.0 Theoretical Models Used in the Oral Health Disparity Centers

4:30 p.m.-6:00 p.m.     4377.0 Advances in Health Literacy: Current Research and Practice

6:30 p.m.-7:30 p.m.     428.0 Oral Health Reception

7:30 p.m.-9:00 p.m.     447.0 Oral Health Section Business Meeting

Wednesday, Nov. 10

8:30 a.m.-10:00 a.m.    5071.0 Cavity Free at Three: An Oral Disease Prevention Program for Infants and Todlers in Colorado

10:30 a.m.-12:00 p.m.  5126.0 Oral Health Provisions in the Health Care Reform Legislation

12:30 p.m.-2:00 p.m.    5178.0 Oral Health Interventions to Improve Access to Dental Care for Children 

 

APHA Initiatives on Transportation and Public Health

As we all appreciate, our health is profoundly affected by our transportation decisions and options. Limited opportunities for physical activity, higher exposure to poor air quality, higher incidences of adult and childhood obesity and greater prevalence of asthma and cardiovascular disease are a few of the inequities brought by poor transportation policies.

As part of our effort to enhance crosscutting activity and knowledge among various APHA members and sections, APHA is developing advocacy materials and helpful information related to the links between transportation and public health. If anyone is interested in learning more about this initiative, sharing success stories or lessons learned, or establishing a new Forum on Transportation and Public Health, please reach out to us! Interested members are asked to contact Eloisa Raynault at eloisa.raynault@apha.org