Child Health Annual Report (Office of Oral Health) Accomplishments and Challenges

Objective 1: By 2021, increase public knowledge about the importance of oral health over the entire lifespan by promoting health literacy materials that are readable, accurate and consistent, as well as show linkages between oral health and overall health by 12%.

Strategy 1: Continue to Increase Oral Health Awareness.

Rationale for Strategy 1: Tooth decay remains one of the most chronic diseases among children and in adults over 40 years. The First Surgeon General’s Report on oral health in 2000, by Dr. David Satcher, emphasized that “oral health is essential to the general health and well-being of all Americans and can be achieved by all Americans”.   As defined by the World Dental Federation in 2016, “Oral Health is

multi-faceted and includes the ability to speak, smile, taste, touch, chew, swallow, and convey a range of emotions through facial expressions with confidence and without pain, discomfort and disease of craniofacial complex”.

During the 2015-2016 school year, the Mississippi State Department of Health conducted a statewide oral health survey of third grade children enrolled in Mississippi’s public elementary schools. Dental professionals screened 3,972 children in 94 randomly selected elementary schools using disposable dental mirrors and penlights. 2,764 children were included in the final analysis.

Key findings from the survey found:

• Dental decay is a significant health problem for Mississippi’s third grade children with 61% have cavities and/or fillings (decay experience) and 22% with untreated dental decay (cavities).
• Many Mississippi children are attending school with infection or pain from dental disease. Six (6%) percent needed urgent dental care because of pain or possible infection. This could mean that more than 1,850 third grade children have pain or possible infection because of dental decay.
• While dental sealants are a proven method for preventing decay, the majority of Mississippi’s third grade children do not have access to this valuable preventive service. Only 34% of the third-grade children have dental sealants and African American children have poorer oral health and less access to preventive dental sealants.
• Compared to white children, African American children have a higher prevalence of decay experience and untreated decay. In addition, about 8% of African American children need urgent care because of pain or infection compared to 5% white children.
• Lower-income children have poorer oral health and less access to preventive dental sealants.
• Children not eligible for the free/reduce price school lunch program (FRL), children eligible for FRL have a significantly higher prevalence of decay experience, untreated decay and urgent treatment.

• Many children in Mississippi have limited access to regular dental care. Almost 29% of parents reported that their child had not been to the dentist within the last year including 1.5% who had never been to a dentist.
• 12.5% of parents reported that during the last year their child needed dental care but were unable to get it with the primary reasons reported being inability to afford dental care and difficulty in getting an appointment.
• Most children in Mississippi have dietary habits that increase their risk of dental decay. Almost 39% of children drink sweetened beverages with their meals including juice, juice drinks, and soda. Only 20% of parents reported that milk was the primary beverage at meals.
• Since 2010, there has been a decline in the prevalence of decay experience, untreated decay and need for urgent dental care in Mississippi’s third grade children.
• In general, children in Mississippi, compared to children from other states, have poorer oral health. Considerable progress has been made in Mississippi to meet the Health People 2020 oral health objectives; yet, more work is needed.

For the past few decades, Mississippi has consistently ranked as a state with poor oral health outcomes:

In 2018 BRFSS reported that 54.1% of the state’s adult population had visited a dentist within the past year According to CDC, only 60% of the population in the state receive Water Fluoridation.

In 2017 HRSA indicated that 80 counties out of 82 in the state have Dental Health Professional Shortage Areas, with 8 of these counties being urban and 72 rural Similarly, a statewide cross-sectional study was conducted from September 2017 to August 2018 with a convenience sample of 763 individuals to get baseline information on oral health care, knowledge, attitude and behaviors of the adults who attended various health awareness events and professional workshops.

The objectives of the survey were twofold: To identify and improve oral health perceptions, beliefs and behaviors among adults in the state of Mississippi and to address oral health barriers to care. Much has been learned about how Mississippi adult perspective towards oral health and its value to overall health.  Understanding one’s culture and belief on oral health benefit to overall health, assist us with creating a culture of health that includes oral health.

Activity 1a: Develop a written Oral Health Literacy Campaign focused on addressing the oral health needs of MS citizens throughout the different stages of one’s life.

Report Activity 1a: The American Dental Association (ADA) policy defines oral health literacy as the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate oral health decisions.  Similarly, the ADA along with other entities, recognize that by improving one’s health literacy patients become better stewards of their own health. In 2018, work towards completing a health literacy plan for oral health was underway; however, with

the loss of funding from a CDC grant, the program lost the capacity to further the employment of dedicated staff that assisted with this project. The program continues to utilize educational materials created in-house and externally like those from ADA and the National Institute of Dental and Craniofacial Research (NIDCR). The program’s epidemiologists have created State-specific fact sheets that show linkages to other chronic diseases such as Diabetes Mellitus, Human Papilloma Virus (HPV) and oral cancer, Cardiovascular disease, and Asthma. Statistically analysis on these chronic diseases are shown on the fact sheet using infographics. These fact sheets are updated annually, and we are currently working to modify various forms of these fact sheets based on the populations we are educating.

The program also continues to utilize forums like the Oral Health 2020 Network through the DentaQuest Foundation and the Association of State and Territorial Dental Directors resources to obtain further literature review on best practices for messaging to various populations. At an Oral Health 2020 Network meeting, a framing strategy regarding oral health communications was shared (Reframing Oral Health:  A Communications Toolkit) This toolkit highlights main messages that need to be made when communicating about oral health and include:

• Connect oral health to overall health
• Use the value of Targeted Justice to cue a collective and systemic perspective
• Use the value of Responsible Management to broaden the concept of prevention
• Use the Keys to Oral Health metaphor to explain systemic barriers
• Emphasize the oral health involves a broad team of professionals

With each of these recommendations, examples are given on traditional oral health messaging that has occurred and how this can be reframed now. To this end, the Office of Oral Health has been seeking various platforms where oral health information can be shared with various age groups. The program met with the publisher and a columnist from Parents & Kids Magazine.  Parents & Kids is operated by Bella Luna Productions, LLC and is Mississippi’s premiere parenting & family resource since 1991. As a resource for busy families that provide real-life solutions, sound advice, creative ideas and practical information to make lives easier no matter how big or small the family. Its informative articles and features appeal to parents—from conception through the teen years and provides families with information specific to their community. The magazine is distributed through many elementary schools throughout the State, as well as Kroger grocery stores day care centers, doctor offices, libraries, and kid-related retail shops. Additionally, PK Media, also operated under Bella Luna Productions, provides online-only content through their website and social media channels to reach parents & families however they consume their media. Parent & Kids Magazine reach is broad and covers 9000 residents in the MS Delta. In partnering with this entity, the program would be able to share about why oral health is important to kids and families. We have received several proposals and are leveraging funding to be able to publish within this magazine.

To align with the Healthy People 2020 Health Communication and Health Information Technology Objectives, there has been increased use of fact sheets, ADA materials and identification of materials that are low-cost to reproduce embracing best practices previously shared.

• HC/HIT-1:    Improve the health literacy of the population
• HC/HIT-1.1: Increase the proportion of persons who report their health care provider always gave them easy to understand instructions about what to do to take care of their illness or health condition
• HC/HIT-13: Increase social marketing in health promotion and disease prevention
• HC/HIT-13-1:  Increase the number of State health departments that report using social marketing in health promotion and disease prevention programs

We have extended our timeframe to complete a communications plan to take in consideration new Health People 2030 goals and findings from our recent MCH needs assessment.

Activity 1b: Develop a report around oral health indicators shared in our oral health surveillance plan.

Report Activity 1b: The last surveillance plan undertaken by the department occurred in April of 2015 under the leadership of the State Dental Director and partnerships with ASTDD and the substantial support from the Division of Oral Care at the Centers for Disease Control and Prevention (CDC). The surveillance plan provides the program with routinely documented population needs and measure program impact by using standard feasible methods. Data collected on oral disease, conditions, and behaviors implemented at the national and state level are reviewed and summarized. The results from the plan will assist the program in ensuring that the oral health indicators are monitored effectively and efficiently as well as increase the utility and productivity of the oral health surveillance system. The 2020 evaluation will be performed to determine the plan’s usefulness in monitoring oral health trends over time, determining the effectiveness of interventions, and the planning of future programmatic and policy initiatives.

The program’s partners in this effort, ASTDD and CDC, agreed that eight major oral health indicators for public health surveillance should be included. The three indicators used for adults will be: the most recent dental visit, the most recent dental cleaning, and total tooth loss. This data will be collected from the Behavior Risk Factor Surveillance System (BRFSS), Three indicators used for third-grade students will be: the presence of treated or untreated dental caries, untreated tooth decay, or the presence dental sealants. This data will be collected using standard screening protocol measured alongside those populations that receive optimally fluoridated water from public water systems tracked by Mississippi State Department of Health Water Fluoridation Reporting System.

The program will evaluate the surveillance plan based on CDC’s framework for program evaluation, including how well the following six steps outlined in Updated Guidelines for Evaluating Surveillance Systems were implemented. Those six steps are:

• Engage Mississippi’s stakeholders;
• Describe Mississippi’s Oral Health Surveillance System (MOHSS).
• Focus the evaluation design;
• Justify and state conclusions;

• Make recommendations;
• Ensure use of evaluation findings and share lessons learned.

The evaluation will focus on providing recommendations for improving the quality, efficiency, and usefulness of the surveillance system. It will also evaluate the system’s sustainability, the timeline of the analysis of surveillance data, the dissemination and use of reports by stakeholders, and the impact on policy and legislative actions.

In August 2019, the Office of Oral Health developed a report of oral health indicators (MS Oral Public Health Surveillance 2019 Document) based on the oral health surveillance plan. The information was planned to be shared in our annual oral health stakeholder’s meeting on March 27, 2020, but it was cancelled due to the COVID-19 pandemic. This will further guide program activities as we move forward. The document is currently in the process of approval and we will share the findings in our agency webpage nd through the Mississippi oral health coalition (Mississippi Oral Health Community Alliance-MOHCA).

Activity 1c: Develop printable on-line educational materials, public service announcements and social marketing geared to target populations and health professionals (medical/dental) to promote preventive oral health services.

Report Activity 1c: Annually, oral health observances are placed on the Mississippi State Department of Health Facebook and Twitter pages. In 2019, four months were targeted for a social media campaign to increase awareness:

• January was to bring awareness of human trafficking to the dental health professional. Dental Health Professionals and Human Trafficking was placed on the MSDH Facebook page and received 110 hits.
• February was in honor of Children’s Dental Health Month. Cavities Are Sneaky: Helpful Tips was placed on our social media page and received 18 hits.
• In March we celebrated World Oral Health Day: “Everything is Connected” discussed how a healthy mouth and gums can prevent dangerous bacteria from entering your mouth and bloodstream.  Facebook and Twitter received a combined total of 25 hits.
• April covered oral cancer. Oral cancer is more common than you think received 39 hits from Facebook and Twitter.

For October, recognized as Dental Hygiene Month, the following was tweeted: When you take care of your mouth, your whole-body benefits in surprising ways, starting with lower disease risk. Find out what brushing right can do for you: https://t.co/PXRHWWvzCZ https://t.co/ruyOIWJDoF. Similarly, in collaboration with Women’s Health the following message was shared on social media to share how oral health is impacted in cancer patients: Maintaining a healthy mouth before, during and after cancer treatment is part of your overall health as a Well Woman. Make an appointment today to visit and discuss your cancer treatment with your dentist. https://msdh.ms.gov/msdhsite/_static/43,0,151.htm

The program still utilizes the five fact sheets address to the oral care of young adults. Good Health Starts with a Healthy Mouth is directed towards teens and covers the importance of oral hygiene, healthy food choices, the dangers of oral piercings and the negative effects of tobacco and alcohol on oral health.

The second fact sheet is on the benefits of water fluoridation, nature’s natural cavity fighter. The third fact sheet, From Your Mouth to Your Heart, shares study data by the 2014 Mississippi Behavior Risk Factor Surveillance System (BRFSS) and by Lars Rydén , Kåre Buhlin, Eva Ekstrand, Ulf de Faire, Anders Gustafsson, Jacob Holmer, Barbro Kjellström, Bertil Lindahl, Anna Norhammar, Åke Nygren, Per Näsman, Nilminie Rathnayake, Elisabet Svenungsson, and Björn Klinge. Originally published January 13, 2016 and found at https://doi.org/10.1161/CIRCULATIONAHA.115.020324. The fact sheet shares the strong evidence found for an association between periodontitis and myocardial infarction where a 28% increased risk of first myocardial infarction was the most common cause of tooth loss in adults.  In MS, 22% of adults diagnosed with heart disease lost all their permanent teeth, 44 % diagnosed with heart disease had not visited a dentist in the past 2 years and adults diagnosed with heart disease compared to those without heart disease were twice as likely to have tooth loss.

Oral Health & Diabetes is the fourth fact sheet created with data collected from the BRFSS which shows a connection between diabetes and tooth loss. Lastly, the fifth fact sheet, The Word of Mouth on Oral Cancer, consists of data received from the 2015 MS Cancer Registry. This fact sheet stresses the importance of early oral cancer detection in relation to the longevity of the lifespan. These five fact sheets are free to download on the MDSH website and are distributed by contracted, registered dental hygienists at community health fairs, conferences, and at high school and college health awareness events.

Also, this grant period, we disseminated more information on HPV vaccination to dentists in the community to encourage them to share this with patients as HPV types of cancer are associated with forms of oropharyngeal cancer.

Activity 1d: Partner with PHRM/ISS to provide health education, oral health materials, and referral to establish a dental home and/or receive further dental assessment/treatment to the maternity patients being seen in the clinics.

Report Activity 1d: In August of 2019, the Offices of Oral Health and Women’s Health revisited the collaborative project for PHRM/ISS in Yalobusha and Tallahatchie counties. The initial idea was to provide oral screenings to pregnant women enrolled in the program and to refer those women to dentists in those perspective communities. An assessment of the number of pregnant women in each count was done by Women’s Health with the following results based on July 2019 data:

• Tallahatchie – Charleston has 5 pregnant w omen Tallahatchie –
• Sumner has 4 pregnant women
• Yalobusha – has 5 pregnant women

We were not able to carry out this program in the way it was initially planned based on reduced staffing able to travel to the sites monthly; however, we have maintained our work together and served as a referral source in the dental care coordination aspect.

In October 2019, through this partnership, Dental Health Talking Points were created for the PHRM/ISS Case Managers to use in addition to the “Good Dental Health… A Partnership Between You & Me” flip booklet we are using from Rhode Island that also has our logo on it. The talking points come directly from the flip booklet and the power point designed from the flip booklet by pharmacy students. The Women’s Health program trained staff on health education surrounding Dental Health in order to begin implementing the tool in the field with consistency. There is a pretest and posttest component of the training and we are waiting to find out more as to how the program has been going.

Activity 1e: Increase capacity in Mississippi Head starts and Daycare centers.

Report Activity 1e: Healthy People 2020 and our state’s 2015 Third Grade Basic Screening Survey results indicated that children ages 6-9 have achieved progress in the following measures:

1. Reducing the proportion of children ages 6-9 years with untreated decay in their primary or permanent teeth and
2. Increasing the proportion of children ages 6-9 years who have received dental sealants on one or more of their permanent first molar.

The Third Grade Basic Screening Survey results provided evidence that 3rd graders in our State are getting more preventive treatments like sealants and fluoride varnish as well as receiving treatment for cavities and fillings. However, improvements are still needed to reduce dental carries experience in the primary or permanent teeth. Our partnership with the MS State Head Start Association and day care centers across the state is critical to oral health needs of children and was established to reduce the number of children developing cavities during these early childhood years. With increased efforts, screenings, education (Head Start and day care staff), and fluoride varnish application are provided by our program in head start and day-care centers across the state. An MOU was not established with the MS Head Start Association in 2018; therefore, greater efforts were placed on providing these efforts to children that attended day care facilities.

In the Spring of 2019, however, the MOU with the MS Head Start Association was signed, and our contract registered dental hygienists have been performing screenings, education, and fluoride varnish to the children in both Head Start and day care facilities.  As of 5/24/19 through 9/11/19, 127 children were screened, received education and fluoride varnish applications. Under the category of untreated dental decay, 93 had no untreated decay and 14 had untreated decay. Under the category of treated decay, 74 had no treated decay and 20 had treated decay. Lastly, under the category of treatment category, 98 had no noticeable dental problems, 15 had early dental problems observed, and 1 had urgent dental problems were observed and an immediate dental appointment was suggested.

From 12/11/18 through 9/30/19, 858-day care children received screenings and education. Nine hundred and eight-two (982) day care children were seen. Nine hundred and fifty-four (954) received a fluoride varnish application and 28 did not. Under the treatment category, 831 had no noticeable dental problems, 115 had early dental problems observed, and 19 had urgent dental problems observed and an immediate dental appointment was suggested. Eighteen (18) children did not complete screening due to uncooperative behavior or no parental consent.

Parents of children presenting with urgent and early dental problems are sent additional letters from our office and we work to assure these children get into a dentist to receive treatment.

Objective 2: Fully integrate oral health literacy into all 9 MCH programs within Health Services at MSDH by December 31, 2019

Strategy 2: Provide oral health literacy to all MCH programs and its participants within Health Services at MSDH.

Rationale for Strategy 2: The Maternal and Child Health (MCH) Services Block Grant is a federal-state partnership program that aims to improve the health of low-income pregnant women, mothers, and children. In addition, the program aims to connect low-income families with other services and programs, such as Medicaid and the State Children’s Health Insurance Program (CHIP). MCH also provides services and programs that include non-pregnant women who are over 21 years of age.

MCH Services Block Grant funds are distributed for funding core public health services provided by maternal and child health agencies in four core categories: (1) direct health care, (2) enabling services,

3.     population-based services, and (4) infrastructure building. Within these categories, the MCH Services Block Grant supports a wide array of programs, including newborn screening, health services for children with special health care needs (CSHCNs), and immunization programs.

Providing comprehensive care that improves the overall health and well-being for the mother and child is MCH greatest objective. Oral health is a vital component in meeting this objective. Largely preventable, tooth decay remains the most common chronic disease of children aged 6 to 11 years and adolescents aged 12 to 19 years is in America. It is (tooth decay) four times more common in adolescents aged 14-17. Children with poor oral health may experience difficulties with learning, poor school attendance, or have difficulties with creating socialization skills. They may also be more likely to have greater adult health problems than those with better childhood oral health experiences.

Including health is important because studies have shown a direct association between oral infections - primarily periodontal infections- and diabetes, heart disease, and stroke. Poor oral health in pregnant mothers may be associated with adverse birth outcomes. Additionally, because tooth decay is caused by a bacterium, these bacteria can be passed on to one’s baby through kissing. It is important that interdisciplinary collaboration increase between the medical and dental providers to contribute to the improved health outcomes for mother and child.

Activity 2a: Work with the Title V director on developing activities for all other MCH programs that reflect the importance of proper Oral Care.

Report Activity 2a: The Title V director and the Oral Health director strengthened their partnership in 2018 in order to leverage expertise and funds for each program. One mutual area of concern was the children with special heath care needs component specific to oral health disparities. Both directors agreed that an oral health infrastructure and access to care needed to be addressed in a greater way to care for the needs of this population’s children, youth, parents, and caretakers.

With the dental provider shortages in our state, our initial work involved developing a resource guide identifying providers in the state who treat patients with special health care needs and creating a special

needs tool kit that would include anticipatory guidance, adjunct oral hygiene aids, and oral heath instructions at a minimum. One of the first steps towards these goals was the inclusion of the oral health director onto the leadership team of the CYSHCN Cares 2 learning initiative, which began in the early part of 2019.  A goal of the CYSCHN Cares 2 learning initiative in relation to oral health, is to identify the number of children with special health care needs who have a medical home and no known dental home. The teams participating in the initiative are required to collect data around the following:

• Patients receiving care in a dental home (the number of patient age 0-17 with specific health care needs receiving care in a dental home.)
• Patients referred for annual dental visits (the number of patients age 0-17 with special health care needs referred for an annual dental visit.)

Our program director has provided guidance to clinical teams regarding the oral hygiene challenges faced by many CYSHCN patients and assisted involved teams in integrating oral heath into their primary care settings. She has also provided a resource of pediatric dentists and practice locals throughout the state that can participate with the CYSCHN Cares 2 initiative. When the initiative was implemented, many participating teams expressed difficulties capturing the required data due to the lack of an electronic health record system between medical and dental, no triage protocols between medical and dental, and dental providers inability to care for patients with special health care needs or those under the age of six (6) due to facility constraints. Our director continues to work with the CYSHCN program director on a strategic plan to better address these concerns in the next learning initiative.

In September of 2019, information was obtained from the National Maternal & Child Oral Health Resource Center, Special Care: An Oral Health Professional’s Guide to Serving Young Children with Special Health Care Needs, at Georgetown University (2000) to assist our office in creating an on-line special needs tool kit for providers, parents, and caretakers. The purpose of the tool kit is to assist practicing dentists, parents and caretakers on how best to meet the dental needs of these children.  The tool kit is currently under review with an implementation date of Summer 2020.

Activity 2b: Meet with Program Directors and exchange ideas on how to integrate oral health into their programs.

Report Activity 2b: With a new State Health Officer starting in 2018, some organizational transformation has taken place at the agency. The Division of Health Services now consists of the following programs. These programs are:

1.    Pharmacy, (2) Dental Services, (3) Child/Adolescent Health, (4) Tobacco Prevention, (5) Women’s Health, (6) WIC and (7) Family Planning. As a team, program’s director meets bi-weekly to share program activities and discuss how to better coordinate the integration of their programs throughout the agency. These meetings provide insight and enables the Office of Oral Health to participate in programs that correlate with overarching goals. Similarly, the Health Services Director shares with the directors’ information about projects from other divisions within the agency and how these activities can align with our programs. The Office of Oral Health director has worked collaboratively with other directors from Children and Adolescent Health, Women’s Health, Genetics, Tobacco, WIC, Early Intervention, Reproductive Health and Asthma, a program under Health Data/Research.

Oral health provides educational materials, toothbrushes (infant, child, youth and adult), toothpaste, fact sheets, and floss to these departments as requested to ensure oral health is incorporated into their activities and/or events. In 2019, the Office of Oral Health began working with Tobacco Prevention to recruit dental providers to provide tobacco cessation counselling and to document tobacco cessation consultations via coding. Initial conversations have centered around providing Quit Line information and reimbursement coding to dental providers. Plans are also underway to register a quite line portal in the Office Oral Health for staff to utilize when they encounter citizens at community events that desire to quit smoking. Oral Health staff currently disseminates pamphlets on tobacco and oral health and tobacco and diabetes.

Early in 2019, our department began working within the Mississippi Quality Improvement Initiative: Asthma Cohort. Persons who suffer from asthma are prone to dry mouth which increases the risks of tooth decay, erosion, gum disease and fungal infections of the mouth because they are unable to produce an adequate amount of saliva. Our director is also a part of the leadership team with this initiative and conducts several learning sessions on an array of topics linked to oral care and asthma diagnosis.  In the fall of 2019, our program provided a collection of information on oral health throughout the life span to the Office of Lead Screening, a program under Child/Adolescent Health, for their Healthy Homes program.

We continue to work with the CYSHCN cohort learning sessions and the Office of Women’s health in providing educational literature and assisting with the purchase of hygiene aids and enhance oral hygiene product based on population needs.

With increased use of vaping and electronic cigarette use, we have purchased additional oral health educational tools to display at community outreach events. We have similarly worked with the Office of Tobacco Control to request literature through their office with a range of topics like tobacco use and chronic disease; tobacco and oral health in addition to tobacco use and vaping.

Strategy 3: Increase the number of Women Infants and Children (WIC) centers and health departments where oral health education is provided by regional oral health consultants.

Rationale for Strategy 3: Inadequate access to oral health care is a significant concern for low-income children and their families, as it affects both oral and overall health. Per the Mississippi Medicaid 2018 report, as of December 2018, 344,279 children were Medicaid-enrolled and entitled to free, comprehensive dental screenings under the Early and Periodic Screening, Diagnostic and Treatment benefit. These visits involve at a minimum service for the relief of pain and infections, restoration of teeth, and maintenance of dental health. The Office of Oral Health knows that ensuring mothers receive oral health care services and education will increase the likelihood that her child or children will start good oral health habits at an earlier age. Through the federal Women, Infants and Children (WIC) program, low income pregnant, breastfeeding, and postpartum women and their children up to age five are eligible to receive supplemental food, health care referrals as needed, nutrition education, and breastfeeding support, delivered at WIC sites.

Because WIC sites serve people from low-income families who have the least access to oral care, the Office of Oral Health regional oral health consultants provide oral health information and education in a more accessible format for WIC participating pregnant women and children under age five. Our activities are supported by the 2015 Burden of Oral Disease in MS report which released findings that

indicated that 44% of adults did not visit a dentist or dental clinic within the past year. Seventy-one (71%) percent of pregnant women had not visited a dentist or a dental clinic during their most recent pregnancy. Fifty-four (54%) percent of women had not had their teeth cleaned in more than 12 months. White women were more likely (40%) to have visited a dentist or dental clinic during their most recent pregnancy than black women (25%).

Activity 3a: Provide updated Successful Partners in Reaching Innovative Technology (SPIRIT) training to all ROHCs (regional oral health consultants).

Report Activity 3a: There are no updates for this objective. No additional oral health consultants were hired during the reporting period; therefore, SPIRIT training was not needed

Activity 3b: Synchronize protocol on data input and retrieval from the SPIRIT system

Report Activity 3b: The initial agreement between WIC and the Office of Oral Health was for the S.P.I.R.T. system to calculate the number of WIC participants that receive oral health education; however, in 2018, both programs realized that the synchronization of protocol on data input and retrieval from the S.P.I.R.I.T. system was not possible unless an addition to the program is purchased. A different data collection method was established by the oral health director. Regional oral health consultants collect sign in sheets of the participants that receive oral health education at their respective WIC facilities when visited. These sign in sheets capture the participants name, child/children age (if applicable), pregnancy information (are you pregnant, are you seeing a dentist, are you breastfeeding), dental home information (have you had a dental visit in the last six months, do you have a dental home) and contact information (may we contact you about finding a dentist, phone number or other form of contact). The sign in sheets are sent to the main campus for MSDH, where participant information is recorded by the program’s epidemiologists.

Annually, we work to improve how the reports that measure the impact of the program participants are analyzed. To better assist the needs of the oral health consultants and the communities they serve, monthly meetings are held to provide an opportunity for any issues or concerns to be addressed regarding the services they provide.

We are working to update this form with our policy and evaluation team.

Activity 3c: Increase by a minimum of 2 the number of WIC sites each ROHC provides oral health education.

Report Activity 3c: Per the Center for Healthcare Strategies, inadequate access to oral health care is a significant concern for low-income children and their families, as it affects both oral and overall health. In 2018, the nation’s estimated 30 million Medicaid-enrolled children were entitled to free, comprehensive dental screenings and care under the Early and Periodic Screening, Diagnostic and Treatment benefit. Unfortunately, less than half of these children receive any dental service each year. Children that receive early preventive dental visit by age one has lower lifetime dental costs and fewer dental procedures than those initiating

care later (Nowak, Casamassio, & Scott, 2014). Providing young and/or mothers with oral health care services is important and ensuring they receive this information increases the likelihood that their children will start good oral health habits at an earlier age.