Dental Tribune U.S. Edition

Dental Tribune U.S. Edition | February 2012XX XXXXX Smokers less apt to go to a dentist Dental Tribune U.S. Edition | March 2012A2 6 percent of dental care national- ly, and dental practices and their patients are not part of a larger provider organization pushing for improvements; and •Incentives to implement quality improvement programs are few. However, increasing costs, inadequate access to care, and profound disparities are creating new pressures for the oral health delivery system to focus on value instead of volume of services. “With the current focus on quality improvement in health care, we need to make sure that oral health isn’t left behind,” said Alice Warner, program officer at the W.K. Kellogg Foundation. “Right now, 37 percent of African Ameri- can children and 41 percent of Hispanic children have untreated tooth decay, compared with 25 percent of white chil- dren. We need to do better by all our children and this report provides ideas that can help lead the way.” Oral health costs making dental services unaffordable for many Dental expenses are now among the highest out-of-pocket health expen- ditures for consumers. In 2008, they accounted for $30.7 billion or 22.2 per- cent of total out-of-pocket health ex- penditures, second only to prescription medications, according to the Bureau of Labor Statistics. The keys to better access and quality are better measurement of oral health- care outcomes and promoting innova- tion at the systems level, said Glassman, who suggests the pathway to better measurement will involve: •Increased use of electronic health records to make collection and analysis of data easier; •Development and use of mea- sures of oral health outcomes •Development and use of diagnos- tic coding systems on oral health outcomes of populations; •Innovation in payment, monitor- ing and incentive mechanisms tied to the oral health of the pop- ulation served; •Improvements in oral health de- livery that include using chronic disease management strategies, delivering care in nontraditional settings, developing new types of allied dental professionals and engaging non-dental profession- als in delivering services; and •Use of telehealth technologies to reach people in geographically remote areas. “The DentaQuest Institute is working closely with clinical partners to imple- ment quality improvement strategies that emphasize prevention and disease management in dental care,” said Dr. Mark Doherty, executive director of the DentaQuest Institute. “We have begun to see success applying a disease man- agement model to the care of chronic disease.” About the DentaQuest Institute The DentaQuest Institute, is a not-for- profit organization focused on improv- ing efficiency, effectiveness and qual- ity in dental care. It works with clinical partners across the United States to de- velop and implement more effective ap- proaches to preventing and managing oral diseases. For more information about the Den- taQuest Institute and its programs, visit www.dentaquestinstitute.org. The Den- taQuest Institute is supported by Den- taQuest, a leading oral health company, administering prevention-focused den- tal benefits to nearly 15 million individ- uals across the United States. About the W.K. Kellogg Foundation The W.K. Kellogg Foundation, founded in 1930 by breakfast cereal pioneer Will Keith Kellogg, is among the largest phil- anthropic foundations in the United States. Based in Battle Creek, Mich., WKKF engages with communities in pri- ority places (Michigan, Mississippi, New Mexico and New Orleans), nationally and internationally to create conditions that propel vulnerable children to real- ize their full potential in school, work and life. To learn moreabout the WKKF you can visit www.wkkf.org or follow it on twit- ter at @wk_kellogg_fdn. (Source: W.K. Kellogg Foundation and DentaQuest Institute) Paul Glassman, DDS, MA, MBA, director of the Pacific Center for Special Care at University of the Pacific Arthur A. Du- goni School of Dentistry. “The biggest problem now is we are developing many measures, but they need to be con- nected to performance of the system. This report provides an opportunity for a new dialogue on how best to collect and use data to improve quality and in- crease access to affordable dental care.” Glassman said the factors driving the focus on quality improvement in oral health care — and the need to align pay- ment incentives with health-care out- comes and value for patients — are the same ones driving the overall health- care quality movement: •Rising costs of oral health care; •An increasing understanding of the unwarranted variability pro- duced by the oral health system; •Evidence of profound health dis- parities in spite of scientific ad- vances in care; and •Increasing awareness of these problems in the age of consumer empowerment. The report also outlines the systemic barriers that have slowed change: •Limited evidence of best practice for most dental procedures has led to widespread variation in clinical decisions by dentists; •Government pays for only about “ REPORT, page A1 The Centers for Disease Control and Prevention reports that far more smokers than nonsmokers say ‘cost’ is why they don't see a dentist. The percent saying ‘fear’ is the main reason are identical regardless of smoking history . Photo/Dignity, www.dreamstime.com According to a study released by the Centers for Disease Control and Preven- tion (CDC), smokers go to the dentist less often than non-smokers. The CDC looked at 2008 survey re- sponses from more than 16,000 adults between the ages of 18 and 64. More than a third of smokers in the study said they have three or more den- tal problems, ranging from stained teeth to jaw pain, toothaches or infected gums. The CDC said this was more than dou- ble the reports of these dental ailments the non-smokers admitted to. The report also found that 20 percent of the smokers said they have not been to a dentist in at least five years. This was compared with only 10 percent of the group of nonsmokers and those who were former smokers. Robin Cohen, a CDC statistician who co-authored the new report, said smok- ers seem to be aware their dental health is worse, but are not doing anything to help. According to the findings, the main reason for those who have not gone to see a dentist was because of cost. More than 50 percent of smokers said they haven’t gone to a dentist because they can’t afford it, compared with 35 percent of those who do not smoke. An equal percentage of current smok- ers, former smokers and "never smokers" did not visit the dentist for an oral health problem because they were afraid. Another CDC survey found smok- ing rates are higher among those with low incomes. It said about 30 percent of Americans with incomes below the fed- eral poverty level say they are current smokers, while less than 19 percent of people with higher incomes are smokers. (Source: Centers for Disease Control and Prevention) In mouth, smoking zaps healthy bacteria, invites pathogens According to a new study, smoking causes the body to turn against its own helpful bacteria, leaving smokers more vulnerable to disease. Despite the daily disturbance of brush- ing and flossing, the mouth of a healthy person contains a stable ecosystem of healthy bacteria. New research shows that the mouth of a smoker is a much more chaotic, diverse ecosystem — and is much more susceptible to invasion by harmful bacteria. As a group, smokers suffer from higher rates of oral diseases — especially gum disease — than do nonsmokers, which is a challenge for dentists, according to Purnima Kumar, assistant professor of periodontology at Ohio State University. She and her colleagues are involved in a multistudy investigation of the role the body’s microbial communities play in preventing oral disease. “The smoker’s mouth kicks out the good bacteria, and the pathogens are called in,” said Kumar. “So they’re al- lowed to proliferate much more quickly than they would in a non-smoking envi- ronment.” The results suggest that dentists may have to offer more aggressive treatment for smokers and would have good reason to suggest quitting smoking, Kumar said. “A few hours after you’re born, bacteria start forming communities called bio- films in your mouth,” said Kumar. “Your body learns to live with them, because for most people, healthy biofilms keep the bad bacteria away.” ” See SMOKING, page A3 NEWS