State oral health surveillance is crucial to documenting oral health disparities and implementing strategies to achieve oral health equity. During the 1990s no state had the capacity to collect and analyze a broad array of oral health data, compare the data across states and nationally, or create an oral health surveillance system. With funding primarily from the Centers for Disease Control and Prevention, the Association of State and Territorial Dental Directors has 1) helped develop national and state surveillance systems and the annual Synopses of State Dental Public Health Programs, 2) created Basic Screening Surveys to collect comparable data on children (preschool, K and 3rd grade) and older adults, 3) provided direct TA to states using two oral epidemiologists, and 4) created more than 25 resource documents for state oral health programs. In 2016, 47 states had submitted qualified date to the National Oral Health Surveillance System on 3rd graders and 13 on Head Start preschoolers, some for multiple years. Twenty-six states now have an oral health surveillance system that meets a 2013 Council of State and Territorial Epidemiologists’ definition, when only 7 states met the definition in 2014. State oral health programs report consistently using the resources and information from more than 20 webinars or workshops on oral health needs assessment, surveillance and use/display/dissemination of data since ASTDD began providing resources in 1997. ASTDD consultants provide on average 400 hours of TA to about 20 states each year. This presentation will discuss additional details about accomplishments and outcomes.

I will present and discuss new innovative collaborations to improve the oral health for those with disabilities. The oral health of over thirty five million Americans with disabilities plus those globally can be improved through commitment, compassion and innovation. The establishment of new collaborations, use of social media, telehealth and the adoption of a value based approach to care delivery must be better understood by community health care providers, administrators and leaders. The integration of oral health into primary care is essential for the successful improvement of whole person health. Those with intellectual and developmental disabilities, the elderly, and those with disabilities living in rural communities are particularly at risk. The developing public -- private collaborations have proven to positively impact the dental and medical communities willingness to work together. Insurance companies have also realized that investing in preventive oral health services will improve the overall health of their members while reducing ER and OR visits and ultimately cost. The furthering of these efforts will depend on the leadership skills and willingness of local public health providers, administrators and leaders to better understand the emerging healthcare system they are working within.

Oral Health (OH) is integral to overall health and well-being. Pregnancy is a unique period of a woman’s life, characterized by complex physiological changes that may adversely affect OH. Estimates indicate that 40% of pregnant women have periodontal disease and dental caries rates are high among low-income pregnant women. Though OH care is safe throughout pregnancy and covered by Medicaid (until delivery) in the state, only 1 in 4 Medicaid-enrolled pregnant women (26%) statewide had a dental visit in 2016. In response to these disparities, medical and dental organizations developed practice guidelines for OH care during pregnancy; however prenatal providers still do not routinely address OH with their patients. Additionally, knowledge gaps regarding oral disease prevention information during pregnancy among dental and prenatal care providers have been reported. This presentation describes a prenatal OH program that was developed in a university-based women’s health clinic in partnership with the state's Department of Health, Office of Oral Health’s Perinatal and Infant Oral Health Quality Improvement program. The development and implementation of this model will be discussed including interprofessional education activities for dental hygiene students and medical students, and dental screenings, OH education and case management services to connect obstetric patients to a dental home. The program’s goals focus on raising awareness of the importance of OH during pregnancy and increasing access to and utilization of OH care services. This innovative program embraces health professions’ up-to-date learning competencies while addressing the OH and overall health care needs of this vulnerable population.

Food insecurity is the limited access to adequate food due to lack of resources. In 2016, 8.0% of U.S. households with children were food insecure. Food insecurity has negative impacts including poor school performance, stunted social skills and associations with outcomes like depression. This study investigates the relationship between food insecurity and oral health among U.S. children. This study used 2016 National Survey of Children’s Health data for children 1-17 years old (n=45,272). Households who sometimes or often could not afford enough to eat in the past year were considered food insecure. Oral health outcomes were teeth condition, cavities, toothaches and bleeding gums. Chi-square tests and logistic regression models were used to explore this relationship. Characteristics assessed included gender, age, race, poverty, and education. Approximately 6.8% of households reported food insecurity. Compared with their counterparts, children in food insecure households had a significantly higher prevalence of cavities (23.8% vs 10.7%, P<0.01), toothaches (9.7% vs 3.0%, P<0.01), bleeding gums (6.1% vs 1.6%, P<0.01), and fair or poor teeth condition (16.0% vs 4.6%, P<0.01). Adjusted weighted logistic regressions showed that food insecurity was significantly associated with each oral health outcome. The strongest relationship observed was children in food insecure households being 2.6 times more likely to experience bleeding gums than children in food secure households (odds ratio=2.6, 95% C.I.=1.5, 4.4). This study revealed significant oral health disparities among children in food insecure households. Practitioners should consider the impact of food insecurity on oral health when designing programs to achieve oral health equity.