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Children’s Oral Health in Rural Kentucky · Talking FACS

0:01
Welcome to talking facts and thank you for tuning into Kentucky smiles on talking facts.
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A podcast collaboration between the University of Kentucky College of dentistry and the U.
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K.
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College of Agriculture,
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Food and Environment.
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Cooperative Extension service,
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Kentucky smiles offers listeners information on maintaining oral health advancements and dental treatments research and more.
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Hello and welcome to Kentucky smiles on talking facts.
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I am your host,
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Mindy McCulley family consumer sciences extension specialist for instructional support at the University of Kentucky.
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Today we are highlighting Children's dental health much and I am pleased to welcome Dr Nicky Stone,
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dental outreach director for UK's North Fork Valley Clinic in Hazzard.
0:45
Welcome DR Stone,
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Nice to be here.
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Thank you.
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I am excited about the things that you all are doing in Perry County and the eastern part of the state.
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And so our topic today is Children's oral health in rural Kentucky.
0:59
So let's just start by talking a little bit about the history of the program that you direct.
1:04
So when and why did U.
1:05
K.
1:05
Open a regional dental health program?
1:08
Well,
1:09
surprisingly there have been very few studies on oral health in Kentucky.
1:14
Maybe the first really big one ever was done uh in 2001.
1:20
And they found of course that Kentucky,
1:23
like most other health issues was was pretty poor in Children's oral health,
1:28
but specifically it was worse in the Appalachian counties.
1:32
Um so around that same time There was the UK Center of Excellence in Rural Health that had been in Hazzard since I think 1990.
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But they were planning on building a new building for that.
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So the at that time the the chief of the division of Dental Public Health at UK Raynor Mullins asked if they could kind of expand that building a little bit,
1:57
expand the footprint enough to include a dental suite.
2:01
And somehow how Rodgers and the folks that were planning that agreed to that.
2:06
And so that is how we got a regional dental program in Kentucky.
2:11
It's kind of like right right time,
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right place.
2:13
Right.
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Exactly.
2:14
Exactly.
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They had the data showing that we really needed it and then they had the building going up and the plant,
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you know was still in the planning phase.
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So they were able to add that.
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And that was 2004.
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So it's been open since 2004.
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So you're getting really close to your 20 year anniversary,
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aren't you?
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That's exciting.
2:33
And I know that you have been collecting data for all all of those years.
2:37
And so what are what are you seeing?
2:40
Well it was actually pretty shocking at the very beginning we did um what they considered like the baseline data and me coming into this program,
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I've been a dentist in southeast Kentucky for 10 years.
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But when they started using the word research,
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I got kind of scared and wanted to run away.
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But they told me no,
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no this is surveillance research.
3:00
We're just going to collect data and watched the trends and then try to do some interventions to try and help.
3:05
So the the national data at that time for Children with untreated tooth decay.
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So like open cavities in their mouth.
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In the United States it was like a 26%.
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And then when they did the study of Kentucky It was like a 29%.
3:20
So a little bit worse than the nation.
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Eastern Kentucky was somewhere around 30%.
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But that covered you know the whole Appalachian region and it was just maybe a few schools and we were told at that time that they they suspected that tooth decay was was much worse in certain little pockets.
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And that's what we actually found.
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We found that the tooth decay rates here in Perry County were 69 minutes,
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literally seven out of every 10 kids that we looked at had open cavities in their mouth.
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And so we kind of compared that to some other national data and found out that there was only one place in the United States that was worse than that.
4:00
And that would be like the Alaskan native,
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you know,
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way up north had no dentist and if they get a dentist maybe once a year they had to fly in.
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So I mean it was as bad as it could be.
4:11
We had to call it the second highest tooth decay rates in the nation but that was only by 1%.
4:16
They only beat us by 1%.
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It's not a statistic we wanted to be.
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I think it shocked not only us,
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but even the folks at U.
4:26
K.
4:26
At the College of dentistry.
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Nobody really expected it.
4:29
I don't think that that bad.
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And probably they had been seeing a lot of Children but they hadn't been seeing those Children who had the open cavity so they didn't know that.
4:40
You know what you're saying is exactly right because you know like I said I came back home after graduating from dental school and I have been practicing here in these counties in years and I had never seen these Children and I worked in a you know a safety net type dental clinic where we were dealing with Medicaid kids frequently.
4:59
We actually did some school outreach at that time and did some exams.
5:03
But these were the kids that obviously we're not getting any care.
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They their parents were unable or unwilling,
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something was going on and they were not making it to the dental offices.
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So the dentists including myself in the area just had no idea that the decay rates were that bad.
5:21
So I'm guessing that over those 17 years now that you have made some great strides.
5:27
Yes.
5:28
And you know that has shocked me almost as much as how bad it was.
5:32
I had no idea coming into this that it kind of just took what was happening in research where they would call these like evidence based practices or gold standards of practices and you just implemented them.
5:46
And you just consistently hit that every single year for a period of time.
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We have watched those decay rates come down down down down down 23% point drop.
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That's in the elementary,
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in the preschool age group.
6:00
It was even more dramatic because you're reaching them at an earlier age and I think the interventions at an earlier age have a bigger impact.
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So 27% point drop in in that population.
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The other thing we found was that besides tracking just open cavities,
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we also tracked what we called urgent dental needs.
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So these were kids who actually were in pain,
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had visible,
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you know infection like an abscess or had we called rampant to decay,
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which was a high percentage of all the teeth decay.
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And so that rate when we started was 22% and I think the national rate at that time was four.
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So that was really bad.
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And then,
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so that has come down also over the years from 22% down to 6%.
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All wonderful news.
6:45
Yeah,
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I can just imagine.
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So those numbers that you're giving me are those tangible benefits.
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But what are some of the intangible things that are not so easy to measure?
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I'm glad you asked that that's something that we have presented this data for several years,
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you know at the conferences and things like that.
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And after a while I said there's other things we really need to talk about a poster to talk about this,
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but we have found that Children who have gone through this program,
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you know,
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and just come out,
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we have a mobile unit,
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It's a Ronald Mcdonald care mobile.
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So it's really fun.
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It's got beautiful graphics.
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Um,
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we're doing preventive things like fluoride and sealants and exams.
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Um,
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and education and we try to make it as fun as possible.
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But these Children have significantly less fear and anxiety about going to the dentist,
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you know,
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when I was little,
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that was one of the most dreaded things that can happen because it is,
7:38
but these kids don't seem to have that fear.
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And that has been a really big thing for me.
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We also have noticed other things like changes in their educational attainment.
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So the first year we went out when we did that initial data,
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I took the bar charts,
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you know,
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that show the different schools in Perry County to the superintendent.
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He immediately noticed that the two schools with those lowest to decay rates were the two schools that had the highest standardized test scores.
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I would not have noticed that,
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you know,
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if he hadn't pointed it out.
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So we started noticing these friends in,
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you know,
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the,
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the lower the tooth decay rates,
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the better those kids can concentrate and learn in school.
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And then the final one that I think really we should talk about a lot more is the fact that kids actually need their teeth,
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not just for eating and but for smiling and for talking and for something that,
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that we can't measure,
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which is like their self esteem.
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You know,
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there,
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how they feel about themselves with cavities,
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Even a six year old,
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I've had a six year old come to me,
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you know,
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and say,
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can you take away the brown and make it white because the other kids call me,
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snaggle to just hit me in the heart strings and just think that that's a big part of it is that self esteem that comes from poor oral health and we want to make a change in that too well.
9:02
And I know that,
9:03
um,
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you've mentioned all of these intangibles.
9:07
There's also cultural beliefs around teeth.
9:11
You want to talk about that a little bit.
9:13
Yeah,
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definitely.
9:14
I think that it was very common in this area and probably other places too,
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not just here in Appalachia,
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but this belief that baby teeth are really not that important if they are decayed,
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who cares,
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they're gonna fall out soon anyway,
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don't worry about it.
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So that has been a little bit more of a challenge to educate,
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to kind of re educate,
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not,
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not just parents,
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but also,
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you know,
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teachers had certain staff,
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We just try to layer those messages and the kids themselves,
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you know,
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to understand that This tooth has a cavity,
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you may actually have it for three more years or even six more years if it's a back tooth and you're six years old,
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you may not lose that to your 12,
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6 years with a cavity that size.
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It's gonna eventually hurt might abscess.
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And then there's this bacteria level that builds up in the mouth that affects whether the permanent teeth as they start coming into the mouth.
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Some of those baby teeth still there with that bacteria,
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it's gonna cause a cavity in that permanent tooth before sometimes before it even fully comes in,
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you know,
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through the gums.
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So those are some of those uh,
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I guess you'd call them old wives tales that we've been trying to kind of change the cultural beliefs on that and that has taken some time.
10:27
But I think that that's starting to,
10:29
Well I know one of our guests that we had earlier in the month talked about the importance of going to the dentist as soon as those baby teeth erupt and I know,
10:38
I mean my Children are 25 and 27.
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That is not something that we were told as new parents.
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I think maybe first year,
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maybe not even until the second birthday or something.
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And so I'm excited that that's something that we are telling parents now and pediatricians are telling parents bring the dentist into that,
10:59
that health team early.
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That is something that even when we started this program in 2004,
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the american pediatric Association of pediatricians,
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their actual policy was still to say wait till you're three years old to go to.
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So that has been a big change.
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And so we say,
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you know,
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first birthday or first to you know,
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whichever one comes first,
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have your first visit.
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So 1st 1st 1st.
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Well I think that's wonderful too.
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So we have been living with this wonderful thing called the COVID-19 pandemic for the last feels like forever.
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Um So what effect has that had on your program?
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Well,
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dental offices like abruptly closed when it first happened,
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we had no idea what was gonna happen for a while or how soon we were gonna be able to open back up.
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Um And it took several months even after that with some of the new PPE,
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like the N 95 masks and some of the newer things,
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we had to do some dental offices for up to a year really before probably getting back to what we would consider like full capacity.
12:09
Um because you had people waiting in their cars,
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you were only bringing one patient at a time.
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I mean there was just a huge change in how dentistry was provided,
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but also at the same time you had kids who were used to a routine of getting up in the morning,
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hopefully brushing their teeth,
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going to school and having,
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you know,
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regularly structured mealtimes coming home and maybe brushing their teeth before they went to bed.
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And then Covid hit everybody was at home and it just kind of turned into chaos.
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So I think we lost the routine aggression a couple of times a day the way we used to,
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and then we had kind of this unlimited ability to snack,
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it's affected us as adults to.
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But for the kids,
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I think that a lot of them were,
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you know,
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able to munch on sugary snacks or drinks sugary drinks,
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you know,
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several hours during the day.
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And it took us a little while really to get back into a routine where schools were open enough for us to consistently go out with our outreach program.
13:06
So this fall,
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we reanalyzed the data for the first time since pre Covid.
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And we were very saddened by what we found,
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Those two decay rates that had come down down,
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down,
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down down,
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you know,
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by 23% points had kind of taken a little upturn.
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So they're back up eight more percentage points.
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So we,
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we lost,
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you know,
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we lost a little bit,
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they're the worst part of it was those urgent rates that had come down from 22 down to six Actually went way back up.
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So they doubled.
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So we're at 12% on the urgent need now.
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Um,
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I'm part of a statewide group.
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The Kentucky Primary Care Association has all of the dental clinics that are safety net and have outreach programs like ours across the state,
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we meet periodically and we met last week and we found out that this is not something that's just we're seeing just here in our area.
14:00
It's statewide.
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So all of them were reporting,
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you know,
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our urgent rates have basically doubled,
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you know,
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and air to decay rates are much higher than they were.
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So we are actually trying to come up with some educational materials.
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Hopefully we can get those concepts back into the minds of parents were working with the Kentucky Oral Health Coalition.
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Maybe the extension agency can help us distribute this information.
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But we want parents to remember that to try and get back into that routine twice a day brushing twice a day.
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Makes a bigger difference than anything else in the universe of the industry.
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You can you can bring them to a dental office and we can do all kinds of things,
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but if you don't do that regular brushing and then cutting back on those sugary snacks drinks.
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I know that how important those are just from having raised two Children of my own.
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So I'm interested though,
14:52
that you said that you are seeing these upticks across the state.
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Do you think it's also something that we're seeing in other states as well?
15:00
Or maybe they're not looking at it because they aren't as concerned as we have been because of our history?
15:06
Well,
15:06
that that may be true,
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but and you know,
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there have been many more webinar type dental continued education courses over the last couple of years.
15:16
You know,
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we used to have these in person conferences that everybody kind of quit doing that during covid.
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But I have heard from other states that they're noticing similar trends as well.
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And I think that it's just the problem is that we don't have a whole lot of data right now because we're having a hard time reaching the patients and getting the data and as things do kind of level off hopefully soon and get a little bit more back to normal.
15:43
And we do get more data.
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That data that I was just mentioning was from one county from from the fall.
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But I think that as we do more of state statewide surveys or national surveys,
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we're gonna find that probably similar everywhere.
15:59
So I know that your program has won several state national awards.
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So let's just talk about those a little bit before we wrap up and what the future looks like for your program.
16:08
Yeah,
16:08
we um we've really been thrilled.
16:11
Like I said,
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I didn't know what it was like to have a data driven research type dental clinic.
16:19
Um but you know,
16:20
the fact that we were able to start collecting data and watching that and watching those rates come down and really just taking what they call evidence based practices.
16:32
So those preventive practices that we know have worked in other research studies and we just kind of layered a whole bunch of those on top of each other.
16:40
And I think that that cumulative effect has made a difference.
16:43
But the Kentucky Institute of Medicine,
16:47
you were just,
16:47
they actually recognized us as one of five model dental programs in the day early on.
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So that was really wonderful.
16:55
Um a really big one was the robert Wood johnson Foundation,
16:59
which is a national group.
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They sought out 25 what they call promising practices in prevention in the nation.
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And ours was chosen as one of those.
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So that was really wonderful.
17:11
There is a national rural health association that featured us in their compendium of like rural best practices that work.
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So specifically rural situations and programs.
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And that was an honor.
17:25
The biggest one I think for us came maybe right before Covid,
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I think it was the year before Covid hit.
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We won the state,
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what's called the Sargent Shriver Award,
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Excellence in Community Service.
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Uh he was,
17:41
he married into the Kennedy,
17:44
the founder yeah.
17:45
Of the Head start program and some other things.
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But we won the state award and then we thought this is great.
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And then a couple of months later we were asked to come to the regional conference in Atlanta and found out that we won the regional award which is all the southeastern states.
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And then a couple of months later we actually won the national version of the Sargent Shriver Community.
18:08
Excellent.
18:09
That's exciting to me.
18:10
That was probably the biggest one because that's a huge honor.
18:14
And you know,
18:15
with Head Start programs,
18:17
they consistently list for oral health and frustrations with getting care for kids with dental issues As their # one concern.
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So,
18:28
and that's probably why it made it to the level that it did with the award.
18:33
You know,
18:33
with those Head Start kids,
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They're very young and a general dentist is not usually where they're going to get the care they need.
18:41
They usually have to have the specialty care.
18:43
So we were able to partner with one of the pediatric dentists in the region.
18:48
Before that partnership,
18:50
we had 80 kids who had those urgent dental needs.
18:54
one of those first years We went out,
18:57
which is huge.
18:59
That's a lot of kids at age 2-5 with cavities and only eight of them.
19:06
By the end of that school you were able to get the care they needed because they were having to drive,
19:10
you know,
19:10
two hours away in Lexington or somewhere for care.
19:14
It just wasn't happening partnered and we had a local pediatric dentist named DR Seth Hyden.
19:21
He was willing to drive to hazard and see those kids in our hospital.
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So we partnered with the hospital.
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His program and the head starts was kind of like a little four way partnership.
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And at the end of that second year after we've partnered,
19:35
65% of the kids got all the care they needed.
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So that just shows the power of the partnership.
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So local partnerships make a difference.
19:44
And now we have a pediatric dentist here in Hazzard,
19:47
um DR Andrew Farmer and that's made an even greater impact just having someone here right in right in town well.
19:56
And I know that the more partnerships that we can highlight that really does help to bring the importance of working together because we don't have all of the resources in the rural parts of the state that we have in the big cities.
20:12
And so if we can work together,
20:13
then we can make things more available to our local folks that they that they need.
20:20
Absolutely.
20:21
And I've been thrilled you know,
20:22
that that UK was willing to invest in this area and bring up,
20:26
you know,
20:27
the first regional dental program here.
20:29
They have since started a regional dental program in Western Kentucky as well.
20:32
So that's great.
20:34
That's great.
20:35
So how can other programs across the state learn from your wonderful efforts and possibly replicate those so that more Children can benefit from this type of an outreach program,
20:45
You know,
20:45
at,
20:46
after we started watching those decay rates come down and saw that this actually worked really excited.
20:53
And we have actually encouraged and you know,
20:57
just tried to mentor some of the other programs around the state.
21:00
Um at this point,
21:01
that group that I mentioned before,
21:03
the Kentucky Primary Care Association,
21:05
there were actually 11 partners across the state who are doing some form of outreach.
21:10
We are now in,
21:11
you know,
21:12
collectively,
21:13
all of us in the group are in,
21:15
I think it's 75 of the 120 counties.
21:19
My my big dream would be for every,
21:23
every school to have some kind of an outreach program.
21:26
You know,
21:26
and it doesn't have to be a federally funded center,
21:30
it could be a dentist in a county who says I'm gonna adopt this elementary school and this head start,
21:37
you know,
21:38
they're the closest one and just,
21:40
you know,
21:41
go in and do some exams on those kids and find out what's going on and then have,
21:47
have a little bit of a partnership,
21:49
you know,
21:49
with with us.
21:50
It's usually the family resource workers in the school.
21:53
They're so helpful.
21:55
They know the kids,
21:56
they know the families,
21:57
they know the need and they help us,
21:59
you know,
21:59
to case manage those kids and get the care that they need.
22:02
So that's my big dream is that every county in Kentucky would have an outreach program.
22:07
That sounds wonderful.
22:09
Dr Stone,
22:10
thank you so much for taking the time to share with me today about your wonderful program.
22:14
And I know that you have provided links to your website and to some other documents,
22:19
which I will definitely put in the show notes so that people can access those materials.
22:23
Thank you so much.
22:24
I appreciate the opportunity to talk about it.
22:27
It's a wonderful outreach and I have been fascinated with all that you've had to share and hopefully get through Covid and and regain some of those losses.
22:37
Yes,
22:38
definitely.
22:39
Yes,
22:39
we we do want to see you back on that downward downward spike again to our listeners.
22:45
You have been listening to Kentucky smiles on talking facts which is available wherever you get your favorite podcast.
22:53
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22:57
Our goal is to provide you with knowledge to support your oral health needs.
23:01
If you have suggestions for future topics,
23:04
please message us on the UK College of Dentistry facebook page at facebook dot com forward slash u Ky dentistry or visit our website at UK healthcare dot u k y dot e d u forward slash dentistry.
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