The Cross-Federal Initiative: Expanding 

Oral Health Access for Older Adults 

Older Adults and Oral Health: Inspiring Community-Based 

Partnerships for Healthy Mouths

May 15, 2013 
Agenda 

Oral Health Status and Resources from Federal Experts 

Two Innovative Community Approaches 

Question and Answer 
Division of Oral Health 

National Center for Chronic Disease Prevention and Health Promotion 

Saving Lives. Protecting People. 

Saving Money through Prevention. 

Older Adults and Oral Health: 

Inspiring Community-Based Partnerships for Healthy Mouths 

William Bailey, DDS, MPH 

RADM, U.S. Public Health Service 
Oral Health and Older Adults 

 Oral health is vital to overall health and well being 

 Disparities exist by age, race/ethnicity, poverty level 

and education 

 Unmet dental needs 

 Quality of life 

 Disparities exist between residents of long term care 

facilities/homebound and non-institutionalized 

adults 

 We are facing a ‘tsunami’ of need

 Most oral diseases are preventable 

 Barriers exist to achieving good oral health 
Barriers to Achieving Good Oral Health 

 Low utilization of professional care 

 Cost 

 Access 

 Transportation 

 Lack of perceived need 

 Poor general health 

 Difficulties with self care 

 Health literacy 
Quality of Life 

 Pain 

 Daily activities 

 Sleep 

 Diet 

 Social interaction 

 Speech 

 Physical appearance 

 Self-esteem 
Self-Reported Time Since last Dental Visit 

65 years and older 

by Sex, Race/Ethnicity, Poverty Level, and Education 

0 

10

20

30

40

50

60

70

80

<1 yr 

1-2 yrs 

2-3 yrs 

3-5 yrs 

>5 yrs 

NHANES 1999-2004 7 
Self-Reported Oral Health Status 

65 years and older 

by Gender 

NHANES 1999-2004 8 
Self-Reported Oral Health Status 

65 years and older 

by Race/Ethnicity 

NHANES 1999-2004 9 
NHANES 1999-2004 

Self-Reported Oral Health Status 

65 years and older 

by Poverty Level 

10
NHANES 1999-2004 

Self-Reported Oral Health Status 

65 years and older 

by Educational Level 

11
Prevalence of Untreated Decay 

65 years and older 

by Sex, Race/Ethnicity, Poverty Level and Education 

20.4 

16.4 15.9 

36.8 

41.2 

33.2 

23.8 

14.2 

26.2 

17.7 

14.3 

0 10 20 30 40 50

NHANES 1999-2004 12
Prevalence of Root Caries 

65 years and older 

by Sex, Race/Ethnicity, Poverty Level and Education 

17.9 

11.4 12.2 

31.2 30.5 

24.4 

18.3 

11.2 

23.6 

14.7 

8.9 

0 

5 

10

15

20

25

30

35

NHANES 1999-2004 13
Average number of teeth, 

65 years and older 

by Sex, Race/Ethnicity, Poverty Level and Education 

19.0 18.8 19.4 

15.2 

18.2 

15.6 

17.0 

20.1 

15.9 

18.1 

21.0 

0 

5 

10

15

20

25

NHANES 1999-2004 14
Prevalence of total tooth loss, 

65 years and older 

by Sex, Race/Ethnicity, Poverty Level and Education 

24.4 

29.3 

26.1 

32.8 

23.9 

44.2 

36.6 

17.3 

43.3 

28.3 

13.7 

0 

5 

10

15

20

25

30

35

40

45

50

NHANES 1999-2004 15
Total tooth loss and average number of teeth 

50 years and older by age group 

Edentulism and mean number of teeth 

90%

76% 69%

0%

20%

40%

60%

80%

100%

50–64 years 65–74 years 75 years and older

Dentate

Edentate

22 teeth 19 teeth 18 teeth

NHANES 1999-2004 
Total tooth loss and average number of teeth 

50 years and older by age group 

NHANES 1999-2004
Priorities for Public Health 

 Better data

 Strategies for homebound and long term care

residents

 Community programs focused on prevention

 Expanded safety net

 Integration of oral health into primary care

 Improved health literacy

 Enhanced communication and coordination
Older Adults and Oral Health: Inspiring 

Community-Based Partnerships 

for Healthy Mouths 

Angel L. Rodríguez-Espada, D.M.D. 

Chief Dental Officer 

U.S. Department of Health and Human Services 

Health Resources and Services Administration 

Bureau of Primary Health Care 

May 15, 2013 

Bureau of Primary Health Care 

Overview 
Primary Health Care Mission 

Improve the health of the 

Nation’s underserved 

communities and 

vulnerable populations 

by assuring access to 

comprehensive, 

culturally competent, 

quality primary health 

care services 

20
The Health Center Program 

• > 45 years delivering comprehensive, highquality, cost effective primary care 

• > 1,100 health centers operating > 8,500 

service delivery sites 

• Provided care to approximately 20.2 million 

patients in CY 2011 in every State, DC, PR, 

USVI, and the Pacific Basin 
Health Center Program Overview 

Calendar Year 2011 

80 Million Patient Visits 

 1,128 Grantees

 8,500+ Service Sites

Over 138,000 Staff 

 9,937 Physicians

 6,934 NPs, PA, & CNMs

Source: Uniform Data System, 2011, Service Sites: HRSA Electronic Handbooks 

20.2 Million Patients 

 93% Below 200% Poverty

 36% Uninsured

 62% Racial/Ethnic Minorities

 1,087,000 Homeless Individuals

 863,000 Farmworkers

 188,000 Residents of Public Housing

22

Under 5

11%

5 to 12

13%

13 to 17, 

8%

18 to 24

10%

25 to 64

51%

65 and 

up, 7%

Health Center Serve 

All Ages

Medicaid

38%

Medicare, 6%

Other Public 

Insurance, 2%

Other 3rd 

Party, 7%

Self-Pay, 6%

State/Local/

Other

17%

BPHC 

Grants

17%

ARRA

Grants, 5%

Other Federal 

Grants, 2%

Health Center Revenue Sources
Health Center Program Overview 

Calendar Years 2010, 2011 

CY2010 

 3.8 Million Patient

 9.2 Million Dental Patient Visits

2882 FTE Dentists

1144 Dental Hygienists

5426 Dental Assistants

Total: 9452 FTE

CY2011 

 4 Million Patients (+200,000)

10 Million Dental Patient Visits (+800,000)

3095 FTE Dentists (+213)

1285 Dental hygienists (+141)

5956 dental assistants (+530)

Total: 10337 FTE (+885)

Source: Uniform Data System,2011, Bureau of Primary Health Care, HRSA 

Oral Health Services 

23
Year Male Female Total % Δ Overall Δ

2007 438,743 689,121 1,127,864

2008 469,218 735,005 1,204,223 6.70%

2009 505,146 786,102 1,291,248 7.20%

2010 524,759 807,636 1,332,395 3.20%

2011 547,293 846,640 1,395,933 4.80% 23.80%

Health Center Patients ≥ 65 

y/o from 2007 to 2011 

Source: Uniform Data System, 2011, Bureau of Primary Health Care, HRSA 24
Health Center Program 

National Presence – May 2012 

25
Health Center Grantees 

With On-Site Dental Services 

26
Health Center Program Growth: 

National Impact 2008 - 2011 

2008 2009 2010 2011 

Growth from 2008-2011 

(% Increase) 

Patients 17,122,535 18,753,858 19,469,467 20,224,757 3,102,222 (18.1%)

Sites 7,518 7,892 8,156 8,501 983 (13.1%)

Jobs 113,059 123,012 131,660 138,403 25,344 (22.4%)

Source: Uniform Data System, 2008-2011 and HRSA Electronic Handbooks 27
o Over 80% reported the overall quality of services 

received at the health center were “excellent” or 

“very good.” 

o Over 80% reported that they were “very likely” to 

refer friends and relatives to the health center. 

o Over 75% reported the main reason for “going to 

the health center for healthcare instead of 

someplace else” was because it was convenient 

(28%), affordable (25%), and provided quality 

healthcare (22%).

Health Center Performance 

2009 Health Center Patient Survey 

28
Primary Health Care 

Our Focus 

Primary 

Health 

Care/ 

Public Health 

Leadership 

Performance Improvement: 

- Outreach/Quality of Care 

- Health Outcomes/Disparities 

- Cost/Financial Viability 

Program Requirements: 

- Need 

- Services 

- Management and Finance 

- Governance 29
BPHC Quality Strategy 

1. Implementation of QI/QA Systems

All Health Centers fully implement their 

QI/QA plans 

2. Adoption and Meaningful Use of EHRs

All Health Centers implement EHRs 

across all sites & providers 

3. Patient-Centered Medical Home

Recognition

All Health Centers receive PCMH 

recognition 

4. Improving Clinical Outcomes

All Health Centers meet/exceed 

HP2020 goals on at least one UDS 

clinical measure 

5. Workforce/Team-Based Care

All Health Centers are 

employers/providers of choice and 

support team-based care 

Priorities & Goals

ACCESS 

COMPREHENSIVE 

SERVICES 

INTEGRATED 

SERVICES 

INTEGRATED 

HEALTH SYSTEM 

Better Care ⃘ Healthy People & Communities ⃘ Affordable Care 

1. Programs/Policies

2. Funding

3. Technical Assistance

4. Data/Information

5. Partnerships/Collaboration

Strategy Implementation

30
Patient-Centered Medical/ 

Health Home Initiative (PCMHHI) 

• Encourages and supports health centers to transform 

their practices and participate in the PCMHH recognition 

process to: 

– improve the quality of care and outcomes for health 

center populations; 

– increase access; and 

– provide care in a cost effective manner. 

• HRSA/BPHC will cover recognition process fees and 

provide technical assistance resources for practice 

transformation. 

• Participation is strongly encouraged and provides an 

opportunity for health centers to achieve PCMH 

recognition. 

31
• National Oral Health Initiatives 

http://www.hrsa.gov/publichealth/clinical/oralhealth/

• Behavioral Health Initiatives 

http://bphc.hrsa.gov/technicalassistance/tatopics/clinicalcareservices/index.html#Behavioral

• Healthy Weight Collaborative 

http://www.collaborateforhealthyweight.org/

• Million Hearts Campaign 

http://millionhearts.hhs.gov/

• Text4baby 

http://www.cdc.gov/women/text4baby/index.htm

• Viral Hepatitis Initiative 

http://www.hhs.gov/ash/initiatives/hepatitis/index.html

Primary Health Care and 

Public Health Leadership 

32
 The Bureau of Primary Health Care 

remains committed to its mission and 

continues to broaden and strengthen 

the safety net of primary health care for 

underserved communities and 

vulnerable populations provided by the 

Health Center Program across the 

Nation and throughout all life cycles

BPHC’s Commitment 

33
Angel L. Rodríguez-Espada, DMD 

Chief Dental Officer 

U.S. Department of Health and Human Services 

Health Resources and Services Administration 

Bureau of Primary Health Care 

1301 Young Street, Room 1030 

Dallas, Texas 75202 

Telephone: 214-767-3719

Email: arodriguez-espada@hrsa.gov 

34
Oral Health & Older Adults 

Laura Lawrence, Director 

Office of Nutrition and Health Promotion Programs 

Administration on Aging, Administration for Community Living 

May 15, 2013 
ACL – A New HHS Operating Division 

• Administration on Aging (AoA) 

• The Office on Disability (OD) 

• The Administration on Intellectual and 

Developmental Disabilities (ADD) 

36
Access to Oral Health Care 

Oral health is essential to overall health 

• Community Health Centers (CHC) play a key role in 

improving access to oral health care for vulnerable and 

underserved populations 

• The Aging Services Network (ASN) can help connect older 

adults to CHCs for oral health care, with the cost scaled to 

their ability to pay 

37
Community Health Center Coverage 

http://www.findahealthcenter.hrsa.gov/DWOnlineMap/MainInterface.aspx

38
Find A Health Center Tools 

http://www.findahealthcenter.hrsa.gov/tools.aspx

39
Aging & Disability Resource Centers 

“...Highly visible and 

trusted places where 

people of all ages and 

income levels can turn 

for information and 

options counseling”

-AoA/CMS 2003 ADRC Program 

Announcement

40
ADRC Coverage 100% of state 

population 

75-99% of state 

population 

50-75% of state 

population 

25-50% of state 

population 

1-25% of state 

population 

0% of state population 

Hawaii 

Alaska 

MT

ID

WA 

CO

WY 

NV

CA

AZ NM

MN

KS

TX

IA

WI 

IL

KY

TN

IN OH

MI

MS AL

AR

LA

FL

SC

WV VA

NC

PA

VT

RI

ME

NH OR

SD

ND

MO

OK

NE

NY

CT

MA

DC

DE

Guam 

Northern 

Mariana Islands 

GA

Puerto Rico 

MD

NJ

Over 

500 ADRCs 

covering 

75% of US 

Population 41
Eldercare Locator - 

Connection to Aging Network 

• Public service of the U.S. Administration on Aging (AoA) 

• Toll-free number (1-800-677-1116) AND website (www.eldercare.gov)

42
Eldercare Locator - Call Center Basics 

• Open 9 a.m. to 8 p.m. 

Monday – Friday (EST) 

• Information Specialists 

(bilingual) 

• Language Line 

• Assists callers in 

understanding resources 

available at the local level 

• Connects callers to 

AAAs/ADRCs/other 

specialty numbers 

43
Elder Care Locator - www.eldercare.gov 

Services Offered: 

• Search by location 

• Search by topic 

• Online Chat 

• Helpful links 

• Publications 

44
Eldercare Locator - New Media Tools 

45
46
Laura Lawrence, MBA, MHSA, LTCP 

Director 

Office of Nutrition and Health Promotion Programs 

Administration on Aging 

Administration for Community Living 

U.S. Department of Health and Human Services 

202-357-3510 

Laura.Lawrence@acl.hhs.gov 

47
Responding to Senior Oral Health Needs 

Through Community Based Partnerships

Older Adults and Oral Health: 

Inspiring Community-Based Partnerships for Healthy Mouths 

May 15, 2013 Webinar

Dental Services at Harbor Health Services, Inc’s 

Elder Services Plan 

Dr. Omar L. Ghoneim 

Corporate Dental Director 

Harbor Health Services, Inc 

oghoneim@hhsi.us

phone 617 533 2302 ext. 2278
Expanding Oral Health Access for Older Adults 

Dental Services at ESP Program, Harbor Health Services, Inc 

• Harbor Health Services, Inc. 

– Private, non profit community health agency 

– HHSI owns and operates four federally qualified 

community health centers 

– HHSI operates a WIC program 

– HHSI provides care and services through an Elder 

Services Plan (ESP), as a model of care Program of 

all Inclusive Care for the Elderly (PACE) 

– Dental Services provided at three of the sites and 

the PACE program 

49
• The Elder Service Plan (ESP) of Harbor 

Health Services Inc is a PACE model of care 

program. 

• PACE is designed to maintain frail elders in the 

community and out of nursing homes. 

• ESP program is responsible for the 

comprehensive care, including dental services, 

for 410 frail elders at our PACE program in 

Mattapan, MA 

Expanding Oral Health Access for Older Adults 

Dental Services at ESP Program, Harbor Health Services, Inc 

50
• History of PACE 

– Origins date to 1978 in San Francisco’s Chinatown 

– Attempt to care for elders 

– Currently approximately 30,000 ESP programs in 

the US 

– PACE program at HHSI originated in 1996 

– HHSI recognized that additional care and services 

were needed to adequately care for elders in the 

communities served 

Expanding Oral Health Access for Older Adults 

Dental Services at ESP Program, Harbor Health Services, Inc 

51
• Structure of ESP program 

– Provider based capitated program 

– Comprehensive managed care program that combines 

Medicaid and Medicare 

– ESP is both the provider and the insurer 

– Responsible for providing all health care services to its 

participants

– Strong interdisciplinary team of clinicians 

– Emphasis on care coordination and care planning 

– Contracts for specialized services when needed 

– Assumes clinical oversight and financial responsibility for all 

services

Expanding Oral Health Access for Older Adults 

Dental Services at ESP Program, Harbor Health Services, Inc 

52
• Participant eligibility criteria for PACE include: 

– Age 55 or older 

– Need nursing home level of care 

– Live in designated service area 

– Participant is determined to be able to live safely in the 

community 

• Age range of 410 participants at ESP: 55 to 105 years of age. 

• Most participants, once enrolled, remain in the program for the 

rest of their lives. 

Expanding Oral Health Access for Older Adults 

Dental Services at ESP Program, Harbor Health Services, Inc 

53
Framework of Dental Services at ESP 

• Portable Dental Equipment and 

armamentarium 

• Scheduling 

• Support from ESP team members 

• Scope of services provided 

• Managing emergencies and patient demand 

Expanding Oral Health Access for Older Adults 

Dental Services at ESP Program, Harbor Health Services, Inc 

54
• Breakdown of services by category 

161 patients July 2010 through End of March 2013 

Expanding Oral Health Access for Older Adults 

Dental Services at ESP Program, Harbor Health Services, Inc 

CATEGORY % OF SERVICES PROVIDED

DIAGNOSTIC 36.3

PREVENTIVE 25.0

RESTORATIVE 26.7

ENDODONTICS 0.30

PERIODONTICS 0.30

FIXED PROSTHETICS 0.60

REMOVABLE PROSTHETICS 6.60

ORAL SURGERY 3.20

ADJUNCTIVE, MISC 1.00

55
• Practice Management Metrics 

– Treatment Plan Completion: 43% 

• Goals, per Dentaquest: 

– 50-60 % = GOOD 

– 40-50% = SATISFACTORY 

– <40% = AVERAGE 

– Percentage of Patients in Recare, recall: 56.2% of patients 

have had a periodic exam within the past year 

Expanding Oral Health Access for Older Adults 

Dental Services at ESP Program, Harbor Health Services, Inc 

56
Overall outcomes for ESP 

• The hospital 30 day re-admission rate for MassPACE programs 

was 16.7% vs. the national average of 19.3%. 

• Potentially Avoidable Hospitalizations for PACE participants 

was 44% lower than duals receiving custodial nursing home care 

• 54% lower than aged and disabled clients in home and 

community based waiver programs. 

• Over 80% of MassPACE participants score as high risk for falls 

but less than 2% are hospitalized due to an injury from a fall. 

• Over 80% of MassPACE participants live in the community 

even though 100% of them are scored as needing nursing home 

level of care. 

Expanding Oral Health Access for Older Adults 

Dental Services at ESP Program, Harbor Health Services, Inc 

57
Keys to success: 

• Strong, interdisciplinary team 

• Care coordination of all care needs for participants 

• Care coordinating team meets daily 

• Care team planners, the participant and participant’s 

family members/health care proxies meet once a 

week. 

Challenges 

Expanding Oral Health Access for Older Adults 

Dental Services at ESP Program, Harbor Health Services, Inc 

58
Healthy Smile – Healthy You!

Responding to Senior Oral Health 

Needs through 

Community Based Partnerships 

Presented by

Donna Bileto, MA, CIRS-A 

Community Service Specialist 

Northwestern Illinois Area Agency on Aging 

Becky Cook Kendall, BS 

Executive Director 

Rockford Health Council 

Betty Hillier, LNHA, RCAL, CCNC-C, CASP 

Assistant Administrator 

Presence Saint Anne Center 

Cate Osterholz, LNHA 

Assistant Administrator 

Presence Cor Mariae Center 
Northwestern Illinois Area Agency on Aging - 

NIAAA 

• Northwestern Illinois Area Agency on Aging 

(NIAAA) is a non-profit organization serving older 

persons and caregivers in northwestern Illinois. 

• NIAAA is funded through the federal Older 

Americans Act, the State of Illinois General Revenue 

Funds, grants, and donations. 

•NIAAA's Mission is to enable older persons to live 

with dignity and independence. 

•NIAAA collaborates with agencies, businesses, 

faith communities and individuals to improve the 

quality of life for older persons and their caregivers. 

60
• Local Initiative 

• Link to funded agencies 

serving older adults 

• Title III-B Older 

Americans Act Funding 

Northwestern Illinois Area Agency on Aging - 

NIAAA 

61
Objectives

• What is a Healthy Community Study? Community 

Needs Assessment? 

• What is the benefit of a community needs 

assessment? 

• Creating a collaborative effort to meet an unmet 

need. 

Healthy Smile – Healthy You!

Responding to Unmet Needs a Community 

Benefit Initiative 

62
Healthy Community Study 

What is it? 

•Process of gathering, analyzing and reporting 

information to discover unmet needs 

•A plan to develop, target and deliver essential 

community prevention and primary care 

services 

•Periodic assessment of the health of the 

community 

63
Healthy Community Study 

Benefits 

• Collect valuable information to help target 

community benefit, outreach 

• Connect community stakeholders, 

• Build trust with a commitment to create 

change 

• Break down “silos”

64
Healthy Community Study 

Challenges 

• Planning team may not agree with “experts” 

or data 

• Assuring that all the “right people” are at 

the table 

• One determined individual, set in their 

ways, can wreck the process 

• Patience and commitment 

65
Intervention 

66
Building the Coalition 

67
Build Partnerships 

• Established program for seniors to have 

cleanings and exams at Rock Valley College 

school of dental hygiene program. 

– Northern Illinois Area Agency on Aging, Federal 

Grant

• Recruit volunteer dentists from Winnebago 

Dental Society. 

• Organized presentations for senior housing. 

68
First....Educate

Create educational 

material directed to 

seniors and 

available to 

community. 

69
Increase Access 

Goal 

 Increase seniors citizens opportunities to be treated by 

dentists at clinic. 

Outcome

• Starting in 2012 - 10 additional appointments set aside for 

seniors. Appointments will be for patients needing their 

dentures fixed, fillings or extractions. 

A federally Qualified Health Center. Championing the needs of the 

underserved and providing healthcare for all, regardless of their ability to 

pay, to eliminate disparities in healthcare. 

70
Senior Oral Health Coalition - 

Accomplishments 

• In 2011 the coalition provided 9 seniors citizens access to 

dental care and provided $428 in preventative dental care. 

• In 2012 the coalition provided 13 seniors citizens with access 

to dental care and provided over $3300 in preventative & 

restorative dental care. 

• Educated 380 seniors citizens on oral health. 

• Completed 70 oral cancer screenings. 8 with suspicious 

lesions. 2 with required urgent care. 

• Presented community educational workshops at 2 low income 

senior housing facilities. (Approx. 75 seniors) 

• Provided and distributed free dental supplies to seniors. 

71
• Continue to explore larger grant opportunities. 

• Develop a process for measuring effectiveness of program. 

• Review the communities inventory of seniors needing 

preventive and restorative oral health care. 

• Utilize volunteer dentists. 

• Education 

2013 Strategic Plan 

72
Donna Bileto, MA, CIRS-A 

Community Service Specialist 

Northwestern Illinois Area Agency on Aging 

dbileto@nwilaaa.org 

Becky Cook Kendall, BS 

Executive Director 

Rockford Health Council 

bckendall@rockfordhealthcouncil.org 

Betty Hillier, LNHA, RCAL, CCNC-C, CASP 

Assistant Administrator 

Presence Saint Anne Center 

Betty.hillier@presencehealth.org

Cate Osterholz, LNHA 

Assistant Administrator 

Presence Cor Mariae Center 

Catherine.osterholz@presencehealth.org 

Contact information 

73
Resources 

• CDC http://www.cdc.gov/oralhealth

• HRSA http://www.hrsa.gov/publichealth/clinical/oralhealth/

– Find A Health Center 

http://findahealthcenter.hrsa.gov/Search_HCC.aspx

• AoA http://go.usa.gov/2Dgd

– Eldercare Locator www.eldercare.gov

• NIH http://www.nidcr.nih.gov/OralHealth

• Harbor Health Services, Inc. http://www.hhsi.us/

• NIAAA http://www.nwilaaa.org/
75
Appendix – Text Descriptions 

Slide 7 

Multi-Bar Graph showing the self-reported times since last dental visit of people age 65 years and older. 

Variables have been broken down into Sex, Race/Ethnicity, Poverty Level, and Education. 

Race: 

Male 

 <1yr 56

 1-2yr 8 

 2-3yr 5 

 3-5yr 6 

 >5yr 23

Female 

 <1yr 54

 1-2yr 9 

 2-3yr 6 

 3-5yr 7 

 >5yr 23

Race/Ethnicity:

White NH 

 <1yr 58

 1-2yr 8 

 2-3yr 5 

 3-5yr 6 

 >5yr 21

Black NH 

 <1yr 38

 1-2yr 14

 2-3yr 5 

 3-5yr 11

 >5yr 30

Hispanic 

 <1yr 38

 1-2yr 10

 2-3yr 9 

 3-5yr 9 

 >5yr 29

Poverty Level:

<100% FPL 

 <1yr 30

 1-2yr 9 

 2-3yr 7 

 3-5yr 13

 >5yr 39

100%-199% FPL 

 <1yr 41

 1-2yr 9 

 2-3yr 7 

 3-5yr 8 

 >5yr 33

>200% FPL 

 <1yr 67

 1-2yr 9 

 2-3yr 5 

 3-5yr 5 

 >5yr 13

Education Level:

Less than HS 

 <1yr 35

 1-2yr 11

 2-3yr 6 

 3-5yr 10

 >5yr 36

High School 

 <1yr 53

 1-2yr 8 

 2-3yr 6 

 3-5yr 7 

 >5yr 24

More than High School 

 <1yr 71

 1-2yr 9 

 2-3yr 4 

 3-5yr 3 

 >5yr 11
Slide 12: 

Prevalence of Untreated Decay 

65 years and older 

by Sex, Race/Ethnicity, Poverty Level, and Education 

Sex

 Male: 20.4 

 Female: 16.4 

Race/Ethnicity 

 White NH: 15.9 

 Black NH: 36.8 

 Hispanic: 41.2 

Poverty Level 

 <100%FPL: 33.2 

 100%-199%FPL: 23.8 

 >200%FPL: 14.2 

Education 

 Less than HS: 26.2 

 High School: 17.7 

 More than HS: 14.3 
Slide 13: 

Prevalence of Root Caries 

65 years and older 

by Sex, Race/Ethnicity, Poverty Level, and Education 

Sex

 Male: 17.9 

 Female: 11.4 

Race/Ethnicity 

 White NH: 12.2 

 Black NH: 31.2 

 Hispanic: 30.5 

Poverty Level 

 <100%FPL: 24.4 

 100%-199%FPL: 18.3 

 >200%FPL: 11.2 

Education 

 Less than HS: 26.6 

 High School: 14.7 

 More than HS: 8.9 
Slide 14: 

Average number of teeth, 

65 years and older 

by Sex, Race/Ethnicity, Poverty Level, and Education 

Sex

 Male: 19.0 

 Female: 18.8 

Race/Ethnicity 

 White NH: 19.4 

 Black NH: 15.2 

 Hispanic: 18.2 

Poverty Level 

 <100%FPL: 15.6 

 100%-199%FPL: 17.0 

 >200%FPL: 20.1 

Education 

 Less than HS: 15.9 

 High School: 18.1 

 More than HS: 21.0 
Slide 15: 

Prevalence of total tooth loss 

65 years and older 

by Sex, Race/Ethnicity, Poverty Level, and Education 

Sex

 Male: 24.4 

 Female: 29.3 

Race/Ethnicity 

 White NH: 26.1 

 Black NH: 32.8 

 Hispanic: 23.9 

Poverty Level 

 <100%FPL: 44.2 

 100%-199%FPL: 36.6 

 >200%FPL: 17.3 

Education 

 Less than HS: 43.3 

 High School: 28.3 

 More than HS: 13.7 
Slide 17: 

Total tooth loss and average number of teeth for age 50 and older by age groups: 

50-64 years

 White NH: 23 (90% Dentate)

 Black NH: 19 (87% Dentate)

 Hispanic: 21 (94% Dentate)

 >200%FPL: 23 (93% Dentate)

 <or=200%FPL: 20 (83% Dentate)

65-74 years

 White NH: 20 (77% Dentate)

 Black NH: 16 (74% Dentate)

 Hispanic: 18 (73% Dentate)

 >200%FPL: 21 (83% Dentate)

 <or=200%FPL: 17 (66% Dentate)

75 years and older 

 White NH: 19 (70% Dentate)

 Black NH: 14 (57% Dentate)

 Hispanic: 15 (58% Dentate)

 >200%FPL: 19 (82% Dentate)

 <or=200%FPL: 17 (58% Dentate)
Slide 41: 

ADRC Coverage 

Over 500 ADRCS covering 75% of US Population 

100% of state population 

• MN

• SD

• WY

• AZ

• NM

• OK

• AR

• LA

• IN

• KY

• TN

• GA

• SC

• FL

• WV

• OH

• PA

• MA

• NH

• VT

• GU

• HI

• MP

75-99% of state population 

• WI

• IL

• NV

50-75% of state population 

• AK

• TX

• NC

• NY

25-50% of state population 

• WA

• OR

• CA

• UT

• CO

• MS

• AL

1-25% of state population

• ND

• IA

• MO

• KS

0% of population 

• ID

• NE

• PR

• WI

• MI
Slide 66: 

Flow chart showing the oral health activities: planning, implementing, completed and follow up items. 

Oral Health 

Health Problem: 

1. Oral Health Compromising General Health

a. Target Group or Population: Convene a group or oral health and general medicine

practitioners (Planning Stage – 3 or more months away from implementation)

i. Intervention: Beginning stages

b. Target Group or Population: Promote Oral Health Literacy (Planning Stage – 3 or more

months away from implementation))

i. Intervention: Conversations begun with local Health Literacy committee

2. Lack of Sufficient Oral Health Services

a. Target Group or Population: Support continuation and expansion of the Healthy Smiles,

Healthy Kids program for children’s dental care (Implementing Stage – programs have

been implemented and progressing toward goals)

i. Intervention: School dental program very successful in 2011-12 school year;

added high schools to provide access for all levels of student in 2012-13

b. Target Group or Population: Support Senior Oral Health Coalition and merge into the

RHC Oral Health Work Group to provide representation (Implementing Stage –

programs have been implemented and progressing toward goals)

i. Intervention: Senior Oral Health Coalition is at the table of the RHC Oral Health

Work Group.

ii. Senior Oral Health partnership has replicated many strategies from pediatric oral

health initiative.