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Oregon Dental information

By Kim Bartholomew, BSN, BS, RN posted 10-13-2019 13:56

Hello-It was suggested that I put updated dental information in this area as a blog.  Here it is!  I can offer one more exciting tidbit here that I did not list in my original post- Rebecca Aalberg, Dental Practice Manager at the OHSU Graduate Medical Education Program,  has confirmed that OHSU does indeed offer a limited number of same day spots for pediatric dental emergencies!   This is likely new information for most school nurses.

Moda has changes policies a bit- they now have an $800 max for uninsured students.  They will check for OHP and deny students who are covered by any kind of dental insurance. 

 A few weeks ago,  I was given an invite to attend Dr Hicks, US Asst Surgeon General's presentation on the state of dental health in the US. since I am on the Oregon dental health coalition. I attended via livestream.  I also am a committee member of OrHOC representing schools  and attended two weeks ago.   I do these things so that you don't have to... 

Here is some of the general information that I thought would interest OSNA members:

Huge disparity in dental home access, cavities and significant dental decay based on race and socioeconomic status still persists.  Less than 20% of providers take state insurance/ medicaid.  In Oregon, depending on region, 55-70% take no state insurance patients. Some that do limit number that they will take.  Not a shocker that they do not want to take poor paying insurance .  Should be obliged to serve the community if you attend our partially publicly funded public school. State and feds increasing reimbursement rates.

Dentists are the top prescriber of opiods- a 65% increase from 2010-2015.  1/3 of all opiods are prescribed by dentists

OHSU has put out  prescribing guidelines for opiods for dentists.  Remember that this is often the first time that teens have had exposure to opiods. Developing brain... higher future potential for abuse ....

OHSU now has a training program for dental students sharing evidence based information which shows that there is little need for opiods for dental events.

OHSU also has a required 10 week rural clinical rotation program.  All senior dental students must do this.  This is a godsend to some of the rural communities.  The senior dental students have incredible expertise- they are just shy of experience that licensed dentists have. They provide several million dollars of dental service to the rural communities where they serve.

OHSU ECHO program- model of interdisciplinary team members who can teleconference with remote providers to share their expertise and influence practice decisions.  Rural dentists do not have access to the same amount of support that urban dentists have.

There is an enormous need for rural dentists and little draw to setting up a rural practice due to financial constraints.  The average dentist graduates with $287k in loans.  There are some loan forgiveness programs but minimal.

HB 4143 passed in 2018  Requires prescribers of controlled substances to register in the Prescribing Drug Monitoring Program.  About 70% of prescribers have done so- not all.

Attributed to HPV--Oral cancer surpasses cervical cancer now!  12k vs 10k cases. Vaccine now suggested for 27-45 years of age as a catch up immunization now. Old recommendation was through age 26

HB 2220 Oregon is the first state to add vaccine administration to the dentist scope of practice.  A head scratcher at first until the data is presented- 27 million do not see a primary care provider each year.  Dental care may be their only way into the health care system and we do not want to miss this opportunity.  Several other states have come to us to see if they can replicate this in their state.

Flouridation = we are 48th in the nation.  Portland is the largest unflouridated city in the country.  There are two known things that deduce decay- flouridation of water and dental sealants.

2017 Oregon Smile survey is just about out.  I saw the ppt at the OrHOC meeting but do not have a copy yet.  This survey also includes weight data- 65% of Oregon kids are healthy weight, 2% underweight. The remaining 30+% is split almost evenly between overweight and obese kids.

There are various ongoing pilot programs designed to serve the needs of communities with higher disease and lower access by expanding the teledentistry practice.  I had one of the sites at AHP two years ago but it was very expensive for VG to do this.  Hygienists have expanded scope and can fill cavities on site with this teledentistry program.  X rays taken and dentist interprets from office. Hygienists then permitted to fill. I loved having this but insurers did not want to pay for services rendered inside school walls.  Exact same service would be paid for if within the walls of the dental clinic requiring parent to take time off of work and student removed from school to do.

The cavity rate in Washington County is 44% of kids in the 2017 smile survey (Eastern Oregon has an abysmal 68%! rate). Professionals actually looked in the mouths of kids to get this data.  19% had untreated decay and 5% had rampant decay.  This is awful considering that every kid in Oregon is covered by insurance.  Cover all kids was passed to ensure that every kid has insurance- coverage does not equal access!

Non dental-
20% of 8th graders are vaping and 27% of 12 graders vape.
About 1 in 11 using cannabis in vape
1241 cases of measles cases across 31 states so far this year
Obesity is affecting national security- 2 in 5 are obese
Huge percentage of young adults are too fat to join the military- cannot pass basic physical fitness tests. This is potentially putting our national safety at risk.
Kim Bartholomew, RN
Beaverton School District Nurse
Oregon Director, National Association of School Nurses