The Vermont Department of Health (VDH) is pleased to submit this proposal for both components of the cooperative agreement, State Actions to Improve Oral Health Outcomes (CDC-RFA-DP18-1810). Although some progress on oral health indicators for certain age groups has been made in recent years, longstanding oral health disparities remain. Despite the documented relationship between oral health and a person’s overall health, the medical and dental health care systems remain steadfastly separate.
The purpose of this project is to improve oral health, reduce oral health disparities, and decrease prediabetes and diabetes and comorbid diseases in Vermont. We will implement evidence-based strategies based on four focus areas: school sealant programs (SSPs), community water fluoridation (CWF), oral health surveillance, and medical/dental integration, with an emphasis on diabetes. We will target populations disproportionately affected by oral diseases and/or prediabetes or diabetes by using data from Vermont’s 2018 State Health Assessment, which uses a health equity lens to present information, maps, and data trends that highlight health disparities and inequities in Vermont.
SSP strategies include the transition of our current school-linked sealant program where children are linked to local dental offices to receive care, to a school-based model where preventive oral health care services are delivered directly to children in school settings. CWF strategies include educating the public, water treatment professionals, and decision makers on the benefits of CWF. Oral health surveillance strategies include updating the Vermont Oral Health Surveillance System plan and data, disseminating the data, and using the data to make informed decisions. Medical/dental integration strategies include integrating the oral health and diabetes programs, educating medical and dental providers and the public on the relationship between oral health and diabetes, and increasing prediabetes and diabetes screenings and bi-directional referrals among medical and dental providers. We will evaluate the impact of these programs for continuous quality improvement.
The Oral Health and Diabetes programs have a core infrastructure and systems with adequate and competent staff to accomplish the activities proposed in this grant. We will continue to rely on our strong partnerships to achieve outcomes. Recently the Governor, the Secretary of the Agency of Human Services, and the Commissioners of the Vermont Department of Health and the Department of Disabilities, Aging, and Independent Living have expressed strong interest and willingness to support oral health initiatives. Given the current political climate in Vermont and the strong work of our programs, we are well poised to address these issues.
By the end of the grant period, we expect to achieve short, intermediate, and long-term outcomes, including expanded SSP enrollment and the integration of VDH’s Oral Health and Diabetes programs. Intermediate outcomes include increasing the proportion of Vermonters served by community water systems who receive optimally fluoridated water, the dissemination of oral health surveillance data, and increasing integration of oral health into primary care practice and of diabetes screening into dental practices, including bi-directional referrals and increased screening rates for prediabetes and diabetes. Long term outcomes include a decrease in disparities in oral health and diabetes and a decrease the incidence and prevalence of dental caries, prediabetes, diabetes, and comorbid diseases in Vermont.