Priorities

Tracking Oral Health Needs
The current oral health status of underserved populations in Massachusetts is troubling.  Underserved populations are the most impacted by oral diseases, and lack access to oral health services as is documented in the newly released
The Oral Health of Massachusetts Children. As we begin the 2008 year of grantmaking and partnerships, the Foundation will continue to engage partners who understand the oral health needs of our communities and who are committed to addressing those needs through results-oriented strategies. To shift our resources to a systems change approach, we will work with these partners on creative results-oriented programs to improve oral health through a targeted grantmaking approach.  The four goals listed below are the way in which the Foundation organizes its systems change approach to improving oral health.  We look forward to collaborative partnerships and encourage innovative programs to seek support through the Foundation’s grants program.

ACCESS (Please see types of grants with associated guidelines)
Goal: To reduce oral health disparities through better access to preventive oral health care.

Supporting Facts:

• Many rural areas of Massachusetts lack easy access to dental care providers.¹
• Sixty-nine percent of cities/towns in Massachusetts have no dentist.²
• The most commonly cited reasons for not seeking oral health care among older adults (sixty-five and older) are the lack of perceived need and the lack of transportation.³
• Sixty-five percent of cities/towns in Massachusetts have no pediatric dentist.⁴
• Dental care is the most common unmet treatment need among children.⁵
• In Massachusetts, 33% of community health center dental programs, new patients waited three months or more to be seen for their first appointment.⁶
• In about one-half of community health center dental programs, existing patients waited five weeks or more to be seen for their next appointment.⁷
• Hispanic and African-American children have twice as much untreated tooth decay as Caucasian children.⁸
• Eighty percent of childhood tooth decay is found in only twenty-five percent of the population—and disproportionately among low-income and minority children. ⁹
• When only private dental insurance is considered, adults aged sixty-five and older are least likely to be covered, with rates as low as 10 percent.¹⁰
• Working age adults (eighteen to sixty-four) are four times more likely than their privately insured counterparts to be unable to get dental care when they need it.¹¹

Through access grants, the Foundation will continue to help reduce current gaps and continue to expand the oral health component of the oral health care safety net in Massachusetts. The Foundation supports a strong safety net system as a critical ingredient to increasing access for underserved populations.

PREVENTION (Please see types of grants with associated guidelines)
Goal: To reduce the incidence of dental disease through evidence-based public health interventions.

Supporting Facts:

• Dental caries (tooth decay) is the single most common chronic childhood disease, more common than asthma.¹²
• Living in a fluoridated community from birth reduces tooth decay by as much as forty percent.¹³
• Only 53% percent of parents of Head Start children in Massachusetts report having a dentist for their children.¹⁴
• Dental sealant programs provide sealants to high risk children among vulnerable populations who are less likely to receive private dental care, such as children eligible for free or reduced-cost lunch programs.¹⁵
• School-based sealant programs address the unmet dental care needs of children seen and assure quality of care by providing follow-up evaluation and repair of the sealants placed through the program.¹⁶
• It is not uncommon for a sealant program to find 30-50% of the children screened in need of dental care (e.g., restorative, orthodontic) that is beyond the scope of the sealant program.¹⁷
• Some families may place a low priority on seeking dental care for their children in light of other competing demands.¹⁸
• Sealants are an efficient use of resources when used in populations with higher-than-average disease incidence rates and when sealants are placed on teeth at highest risk for caries.¹⁹
• The Task Force on Community Preventive Services found that school sealant programs are effective in reducing tooth decay and should be included as part of a comprehensive population-based strategy to prevent or control tooth decay in communities.²⁰
• Fewer children from low-income families receive preventive treatment (sealants).²¹

Through prevention grants, the Foundation seeks to reduce the prevalence of oral health disease through evidence-based public health interventions that are tailored to meet specific population needs.  The Foundation will fund community-based organizations that will work to reduce dental disease in communities of documented need.

AWARENESS
Goal: To increase public understanding of the importance of good oral health as a component of overall health.

Supporting Facts:

• There is increasing evidence that shows the connection between oral health and overall health.²²
• The economic and social impact of poor dental care is evident in missed school days and employee absenteeism.²³
• While children’s oral health does not (and may never) rival such priorities as the economy, environment or safety, it has emerged as a legitimate, consistent priority among children’s issues.²⁴
• Improving kid’s oral health ranked slightly higher in issue priority for 2007 than did preschool education for all kids or improving the number of quality after-school programs.²⁵
• Significant numbers of respondents moved from thinking improvement in children’s oral health should be a high priority to rank it an extremely high priority.²⁶
• Most MA residents (66%) believe, "Brushing and flossing are not enough. Regular dental visits and preventive treatment for kids are critical to good oral health."²⁷
• A smaller percentage (21%) believes, "If kids take good care of their teeth by brushing and flossing, their mouths will be healthy and cavity free."²⁸

The Watch Your Mouth Campaign has had a yearly opinion survey conducted for the last three years to evaluate the campaigns impact and guide the media strategy. These findings from the survey data designed to measure movement in public thinking since July 2005. Analysis is based on the results of 400 telephone interviews with residents of Massachusetts, conducted July 12 – 13, 2007.

Over the course of the Watch Your Mouth campaign, communications has moved public understanding of this issue toward collective responsibility. Survey respondents have become more likely to recognize that for good oral health “"Brushing and flossing are not enough. Regular dental visits and preventive treatment for kids are critical to good oral health." In addition, survey respondents are increasingly likely to see the connection between good oral health and good overall health.

These gains in public understanding are among the most important campaign effects.

There is also increasing clarity that dental health is related to overall health. In Massachusetts, half of survey respondents (50%) point to health problems as the main reason to be concerned about children with poor oral health, while far fewer prioritize pain (14%) or cosmetics and self esteem (7%).

Through awareness, the Foundation is committed to supporting communication approaches that prompt public support and collective action for policy changes to improve oral health, strengthen the public’s recognition of the connection between oral health and overall health, and support the public’s understanding for the need for dental care and preventive measures to advance oral health.

CULTURALLY COMPETENT WORKFORCE
Goal: To enhance the existing public health workforce to meet the diverse needs of residents.

• There are significant racial disparities in oral disease.  Blacks are four times as likely to have untreated tooth decay as whites.  Black survival rates for oral cancer are approximately half that of whites.²⁹
• In 2000, African Americans and Hispanics comprised about twenty-five percent of the nation’s population, but only about ten percent of the student makeup of dental schools.³⁰
• Improving oral health includes increased provider access and wider diversity of the dental workforce.³¹
• Increasing the number of minority dental health professionals is a key strategy in eliminating racial and ethnic health disparities.³²
• Fewer Non-Hispanic Black children receive preventive treatment (sealants).³³
• There are significant disparities in untreated cavities among racial and ethnic minority children.³⁴
• One in ten racial and ethnic minority children suffer oral pain.³⁵

The Foundation will support programs and partnerships with organizations to promote culturally competent oral health care, reduce racial and ethnic disparities through systemic approaches, and increase equitable oral health outcomes for populations and communities experiencing disparate oral health outcomes. One key area of need is that of an increased public oral health workforce adequately trained in cultural competency as one crucial way to address the existing disparities.

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