For Immediate Release
Date: Jun 23rd, 2015
Contact: Dr. Robert Henry
Part II: The KDAs Dental Access Summit A Report
During the 2014 Kentucky Dental Association (KDA) General Assembly meeting, the House of Delegates established a Work Group to investigate and gather information on the “Access to Care Issue in Kentucky”. Purposely this charge was vague and was left to the workgroup to define. From the initial meeting it was determined that the workgroup would focus on two goals:
1) Collect information about what is currently being done in Kentucky to provide dental care services for people who are uninsured, underinsured or without financial resources to pay for dental care; and
2) What needs to be done to manage or improve dental access issues for the people who are uninsured, underinsured or without financial resources to pay for dental care?
A comprehensive search was done by the group to determine what dental providers in the state offer programs (including Medicaid), to people with financial or other access problems. This document “Dental Access Clinics and Programs: Contact Information by County and KDA Component Society”, is now available on the KDA website and will be updated regularly.
To address the second goal regarding “what needs to be done”, a one day conference, called the “Dental Access Summit” was held on Saturday, January 31, 2015. This conference was called an “Access Summit” in recognition of the first such conference co-sponsored by the KDA focusing on Statewide Dental Access Issues held on May 24-25, 2001. Over 70 people attended including front-line dental providers, representatives from the UL School of Dentistry and the UK College of Dentistry, leaders from the KDA, the program coordinator from Oral Health America, and other interested parties including physicians, nurses, social workers, and administrators from all over Kentucky. This report summarizes the proceedings of this conference, including providing recommendations from participants to address dental access issues in Kentucky.
The one day conference was divided into two sessions; an overview session in the morning, and a workgroup participatory session in the afternoon. In the morning the following subject matter experts spoke on their areas of expertise. We continue Part II of our report with…
Dental Access for Nursing Home and Geriatric Patients: Dr. Pam Stein
Dr. Stein began by reviewing the demographics and growth of the U.S. population. When comparing the projections of population increases in the next 40 years, it is expected that for the ages under 18 up to age 64, the U.S. population will increase by 20 to 35%. For the population over 65, the projections from 2010 to 2050 are expected to increase by 120%! In other words, currently, there are approximately 40.2 million seniors over 65 in the United States. If these projections hold true, in 2050, the number of seniors aged 65+ will expand to 88.5 million. National projections also indicate that among the older 65+ group, the seniors aged 85 and older are growing at the fastest rate and expected to increase from 6.3 million in 2015 to 16.5 million by 2045. Life expectancy is increasing. Currently, women born today can expect to live to 81.1 years of age, and men 76.3 years. The survivorship effect means that if a person lives to age 65, that women can be expected to live for an additional 20.3 years, and men for an additional 17.7 years. Similarly, if a person lives to age 75, women can expect to live an additional 12.9 years, and men an additional 11 years.
It is clear that Americans are living longer and keeping their teeth! In the 1950s, half (50%) of all Americans over age 65 had lost all of their natural teeth. In 2008, only 18% of American adults over age 65 had no remaining teeth. Although not as impressive, Kentuckians also have been trending towards keeping their teeth and fewer dentures. In 1999, 44.3% of the 65 and older in Kentucky were edentulous (no teeth). In 2008, only 23.7% of those 65 and older in Kentucky were edentulous.
What is different about access to care for older adults in our state? One thing is that elders do not visit the dentist as much as younger groups. Dental visits in 2010 are as follows: 2-17 year olds visit the dentist (at least one time a year) 78.9% of the time; those 18-64 years old visit 61.1% of the time; and those 65 and older visit 57.7% of the time (up from 37% in 1987). Why the disparity in utilization? All the following have been shown to be factors: transportation, cognitive problems, functional problems, health problems, and financial problems.
Regarding financial issues: only 22% of elders have private or public dental insurance. Most elders pay out of pocket. The average cost for dental care for 65+ adults in 2008 was $390. The percent of elders in Kentucky in 2005 with no dental insurance was 70.2% compared to adults (18-64) at 40.6%. The percent per age group that didn’t get dental care because they couldn’t afford it is approximately 9% for those 65-74 compared to 17% for those 18-64. With the median income of elders (in 2010) being $25,794 for males and $15,072 for females, the monthly annual income leaves little for disposable income. The Sources of income for elders are as follows: social security (87%), income from assets (53%), private pensions (28%), earnings (26%), and government pensions (14%). For the majority of older Americans, social security provides the main income source. The average monthly benefit for a retired older worker at the beginning of 2012 was $1,230. Since dental utilization is dependent upon income in the 65 and older population, it is not surprising that those elders that are below 100% of poverty level only visit the dentist 32% of the time, compared to those who are 400% (above poverty level) who visit 77% (as much as any other age group).
Other utilization factors for seeing or not seeing the dentist in older age includes lack of perceived dental need. Half of elder respondents cited they did not perceive a dental need, and therefore did not need to go to the dentist. Other reasons for not seeing a dentist regularly included fear or dislike of the dentist, and other priorities (taking precedence).
Why is it important for yearly dental visits in the 65+ age group? The first priority is to have an oral cancer screening. People 65+ are 7x more likely to be diagnosed with oral cancer. The five year survival rate is about 50%. Because of oral cancer’s poor prognosis, the earlier an oral cancer can be detected, the more lives will be saved. In America, nearly one fourth of seniors 65+ haven’t been to a dentist in over five years! In Kentucky, the time since the last visit to the dentist for elders was over 30%! In 2005 the Kentucky Elder Oral Health Survey report asked elders for suggestions to improve access to dental care. In order of priority, the responses were: make dentistry affordable, mobile clinic, house calls, and handicapped-accessible offices.
How does Kentucky measure up regarding oral health of older adults? “A State of Decay”, published by the Oral Health America in 2013 ranks states based on five factors: dental provider shortage areas, community water fluoridation, state oral health plans, adult Medicaid benefits, and education. Only 13 states scored worse than Kentucky. Oral Health America Recommendations include:
· Create payment options for older adults dental plans
· Expand water fluoridation
· Improve state oral health plans
· Educate older adults, care providers and care facilities to improve mouth health of older adults
What group of older adults is most underserved dentally? Nursing home (NH) elders!
According to the Kentucky Elder Oral Health Survey (2005), NH elders: have trouble accessing basic service (51%), have no way to get to the dentist (44%), no dentist is available (15%), can’t afford dental care (25.9%), and have untreated caries (52%). While only 5% of 65+ Americans reside in nursing homes at any point in time, BUT nearly half of Americans 65 and older will spend time in a nursing home at some time in their lives. A clearer statistic is that 15% of 85 and older live in Nursing Homes at any given time, and this age group, is the fastest growing segment of the elder population. There is a heightened awareness of lack of care in NH based on a 2013 New York Times article by Catherine Saint Louis entitled “In Nursing Homes, an Epidemic of Poor Dental Hygiene”.
What are the federal and state mandates for nursing homes related to dental Care? The Omnibus Budget Reconciliation Act (OBRA) regulations are FEDERAL and apply to all facilities that accept Medicaid or Medicare. OBRA mandates that nursing home facilities:
· Meet the routine and emergency dental needs of each resident
· Assist in making appointments and provide transportation
· Promptly refer residents with lost or broken dentures to a dentist
What about Kentucky Regulations?
· Patients shall be assisted to obtain regular and emergency dental care (same as federal)
· The facility, when necessary, shall arrange for the patient to be transported to the dentist’s office (same as federal)
· An advisory dentist shall provide consultation, participate in in-service education, recommend policies concerning oral hygiene and shall be available in case of emergency.
· Nursing personnel shall assist the patient to carry out the dentist’s recommendations.
· Medical records shall include reports of dental services.
· The facility shall conduct initially and periodically a comprehensive, accurate, standardized, reproducible assessment of each resident’s functional capacity. The assessment shall include a dental assessment (usually completed by a nurse).
Current Minimum Data Set (MDS) Requirements for Oral Health Assessment:
1. Debris present in the mouth prior to going to bed
2. Has dentures or removable bridge
3. Some/all natural teeth lost-does not have or does not use dentures (or partial plates)
4. Broken, loose, or carious teeth
5. Inflamed gums (gingiva); swollen or bleeding gums; oral abscesses; ulcers or rashes
6. Daily cleaning of teeth/dentures or daily mouth care by resident or staff
The MDS is supposed to act as a trigger for action. However the research says NO!
Identifying oral health problems during MDS doesn’t trigger dental treatment. Less than 3% of residents with oral debris. One theory is that perhaps some problems are not recorded because then it would require some action? Other geriatric Dental experts write about this in JADA:
Glassman et al, JADA 2010; 141-1298 writes:
· “idea of completing timely referrals nearly impossible”
· Years of declining self-care
· Resident may choose NOT to treat dental problem
· Unable to find dentist willing and available to treat their patients
During the National Nursing Home Exit Survey, only 13% of residents ever visited the dentist during their NH stay. Similarly, in a survey done at UK by Dr. Stein, NH administrators from across Kentucky were asked “what is the biggest barrier to good oral health for your residents?” The main response was “we can’t find a dentist to treat our residents”.
In 2014, the ADA launched a Long-term-care Dental campaign designed to assist state dental associations to create successful initiatives and to train more dentists to serve at facilities. This self-paced on-line continuing education course costs $475, and if interested, dentists should contact: firstname.lastname@example.org
Two successful dental delivery models for providing dental care in nursing homes come from Appletree Dental (Minnesota), and University of the Pacific (California) Virtual Dental Home. Both models focus on a “Hub and Spoke” where the Main Dental Clinic is the Hub and the nursing homes are the spokes. In this model, the dentist transports all needed equipment and supplies to the nursing home, eliminating the transportation issues. As noted in published papers: “cost of travel and personnel related cost typical for a trip to the dentist is several hundred dollars and often greater than the cost of treatment!”
Who pays for dental services in Nursing Homes? Medicare does not: this is for treatment done by certain dentists such as oral facial pain specialists and oral surgeons. Examples of dental services that are reimbursable under Medicare include: reconstructing a jaw after an accident, and extractions of remaining teeth prior to radiation treatment for jaw cancer.
Medicaid covers more than 60 percent of all nursing home residents, but the dental rates are very low. Dentists also get frustrated by the lack of daily oral hygiene and help from the nursing staff even though Kentucky state law mandates…that “Nursing personnel shall assist the patient to carry out the dentist’s recommendations.”
Shouldn’t nursing aids be helpful? In a study by Coleman from the J. Am. Geriatric Society 2006; 54(1); 138-43, the authors found:
· Only 16% of residents in nursing homes received any oral care
· Average tooth brushing time teeth brushed for residents was 16.2 seconds
· None of the nursing assistants wore clean gloves to provide oral care.
Barriers for nursing aids in helping with oral hygiene in nursing homes include: general lack of knowledge/lack of perceived need among nursing staff, higher priorities in medical duties (such as giving meds, feeding, toileting, dressing, etc.), not enough nursing assistants and care resistance (uncooperative patients). Dentists can address these barriers by providing oral health education sessions for staff. Do these education programs help? Yes! Research shows improved oral clinical outcomes from oral health educational program for nursing staff in long-term care facilities, including improved plaque scores of residents.
Successful educational programs for nursing assistants in nursing homes must include: the support of administrators and using small group instruction/hands on instruction. The instruction should include these components: care resistance strategies, proper oral hygiene tools and the importance of oral care.
The Kentucky Oral Health Coalition and its role in dental access: Lacey McNary, MSW
When we think about the oral health landscape of Kentucky – we see opportunity, systems, needs, movement, people, prevention, treatment, links to the past, and a new frontier. We see synergy, cooperation, a network. We are optimistic and hopeful, but also realistic. We are seeking to create a culture of good health through increased oral health literacy, improved access to care for all, and better integration of services into the school setting.
We would like to thank the Kentucky Dental Association for this opportunity to share the work of the Kentucky Oral Health Coalition with their members. Together, we can accomplish much more, and there is so much work to do to improve oral health in Kentucky. We believe that many of our goals align and creating a strong partnership will allow us to have rich meaningful discussions when there are issues that we do not agree upon.
The coalition recently re-emerged from a dormant period. In the 90s, University of Louisville and University of Kentucky came together to form the coalition. Many remember the summits, the fundraisers, and the hard work of the group. Kentucky is lucky to have so many public health minded professionals with passion and proactivity who kept the group going for so many years – you know who you are! After a few years, the coalition became dormant, but work continued.
In 2010, the coalition revived due to an infusion of funding and a commitment from a long-standing influential organization to house the work. Kentucky Youth Advocates, a statewide child advocacy organization, had worked on oral health issues for several years. The organization published a report on the topic in 2005 and pushed legislation to establish the kindergarten dental screening bill in 2008.
Because of these successes, work on children’s health issues, and our reach across the state, Kentucky Youth Advocates (KYA) was approached by the DentaQuest Foundation to convene a new iteration of the coalition. KYA has been able to secure additional funding partners, such as the Foundation for a Healthy Kentucky, is also supported through membership dues. The Kentucky Oral Health Coalition is a part of the 36 statewide coalitions across the country in partnership with the American Network of Oral Health Coalitions (ANOHC).
What do we want to see in Kentucky?
· All children in Kentucky are healthy
· Better oral health access for children
· Surrounding children with adults who know about the importance of oral health
· Networked and connected system of oral health in KY.
What prevents Kentuckians from maintaining optimal oral health? A number of factors including: lack of transportation, geography, cost, office hours, payment, priority, and number of dentists.
Figure 2: Facts about Oral Health in Kentucky
Kentucky has the fifth highest rate of “toothlessness” in the country among adults 65 and older.
A 2012 national study by the Pew Center on the States gave Kentucky a grade of D for its ability to provide dental sealants to children.
Only 60% of Kentucky adults reported visiting a dentist or dental clinic in the previous 12 months in 2012.
The 2012 Kentucky Health Issues Poll (KHIP) found 1.7 million Kentucky adults lack dental insurance.
Importance of oral health to overall health:
Good oral health is critical to good overall heath and while tooth decay and other dental diseases can have long lasting impacts on long-term health and employability, millions of Americans go without needed dental care because they can’t find a dentist, can’t afford care, lack dental insurance, or are unaware of the importance of dental care.
Seriousness of the problem:
Tooth decay is a transmissible bacterial infection and cavities are a symptom. Tooth decay is often established by the time a child enters preschool, can be passed on from parent to child, and can lead to serious, sometimes life-threatening infections in the body.
Dental cavities are the most prevalent chronic disease among U.S. children, with over 40% of all children experiencing tooth decay by the time they reach kindergarten. Untreated tooth decay and gum disease are linked to serious health problems, including premature births in pregnant women, failure to thrive, and chronic conditions like heart disease, diabetes, and stroke. According to the Pew Center on the States, Kentucky was given a “C” grade in providing oral health care to children. According to the Pew Center on the States, Kentucky was given a “D” grade in providing overall oral health prevention.
Costs to society:
In 2013, Kentucky Hospital Emergency Departments treated roughly 28,000 dental cases including treating dental caries, abscesses and dental disorders. 2010 data show that treating abscesses, alone accounted for almost $3 million in ER billing.
Importance of Oral Health
• In the USA, dental care remains the greatest unmet health need among children.
• KY ranks 45th in the percentage of children with untreated dental decay (34.6%)
• KY was given a grade of “C” in children’s oral health by the Pew Center on States report
• In 2012, only 40% of KY children enrolled in Medicaid or KCHIP received even a single dental service
• KY ranks 5th in the nation for “toothlessness” (25% of adults age 65 and older have had all their natural teeth removed).
Good oral health is also an integral component of optimal childhood LEARNING. Children free from dental pain and infection can focus on their schooling. Access to preventative dental services significantly improves school attendance and developmental growth.
The Kentucky Oral Health Coalition
The Kentucky Oral Health Coalition (KOHC) is a group of people, organizations, funders, and other stakeholders who are working together to improve the oral health of Kentuckians. We are doing that by convening a guiding coalition of experts in several disciplines who have credibility, power, influence, and experience. Our coalition includes members who are dentists, hygienists, education leaders, family resource center staff, parents, foundations, health department staff, higher education faculty, nurses and doctors, among others. The KOHC is a young, but strong voice in Kentucky.
Figure 3. Oral Health as a Social Justice Issue
• Everyone should have the same opportunities to live a healthy life
• A person in poor oral health is not healthy
• It’s our responsibility to advocate for and mobilize the many who don’t have access to oral health care and prevention
• Nobody should suffer from a chronic disease that is completely preventable
• Until we all have an equal opportunity to live healthy lives, we will live in an unjust society
The priorities of the coalition currently include improving oral health awareness of all Kentuckians, expanding school based oral health services, and increasing access to Medicaid services. We believe that many of the policy changes needed to achieve these priorities are in alignment with the Kentucky Dental Association, which is an exciting proposition.
The KOHC has a strong theory of change that includes a belief in the power of networks and collaboration. We see so much room for better collaboration because Kentucky has rich resources all across the state. The resources that I am talking about are people who are doing amazing things to improve oral health. We contend that creating a big tent of passionate and committed voices is the key to systems change. If we can harness the “on the ground” energy from every county we believe that we can get some important “stuff” done. The “stuff” that we are referring to for the next couple of years includes, but is not limited to the following:
1. Revisiting the kindergarten screening: Is the current system and process working? The KDHC wants to ensure that this is not just a piece of paper that creates a barrier to staying in school, but that it works to improve outcomes for children. Currently (2013-2014) over 50% of Public School Kindergarteners in Ky. Receive a Dental Exam.
2. Instituting a regular updated oral health surveillance system. Kentucky has not had an oral health surveillance in over a decade. We can’t change what we don’t measure. Many other states have a surveillance system in place to measure outcomes. Children surveyed in 2001, adults surveyed in 2002, older Kentuckians in 2005.
3. Adoption of a state oral health. Many states have a state oral health plan. It is critical to know what data shows are the problems to address, what research says could solve those problems, what is happening in the state, and what we can all rally around as priorities.
4. Increase the number of dentists who serve low income Kentuckians and the number of low income Kentuckians who are treated. The KDHC wants to see increased transparency in the MCO process, decreased barriers for dental professionals and families in getting care, and more children who have access actually get the treatment they need.
5. Improve oral health literacy among Kentuckians. Through discussion with parents and stakeholders in Kentucky, we believe that there needs to be a strong sustained effort to create a better understanding and awareness of the importance of oral health and how to have optimal oral health.
6. Reduce the percentage of children with untreated dental decay by 25% and increase adult dental visits by 10%. Kentucky’s dental problems have long been a source of ridicule, and have real and detrimental impacts on schoolchildren, the workforce and families. In fact, Kentucky ranks 41st in annual dental visits, 45th in the percentage of children with untreated dental decay (34.6%), and 47th in the percentage of adults 65+ missing 6 or more teeth (52.1%). Gov. Beshear proposes to tackle this problem with a number of strategies, including:
· Increase pediatric dental visits by 25% by the end of 2015.
· Partner with Managed Care Organizations to encourage increased utilization of dental services.
· Create public-private partnerships to increase to 75% the proportion of students in grades 1-5 receiving twice yearly dental fluoride varnish application.
· Increase by 25% the proportion of adults receiving fluoride varnish during an annual dental visit.
· Increase by 25% the percentage of adults receiving medically indicated dental preventive and restorative services, including fillings and root canals, in accordance with evidence-based practices.
· Partner with stakeholders to increase the number of dental practitioners in Kentucky by 25%.
7. Shaping our Appalachian Region (SOAR) goals:
· Recommendations include: workforce strategies, oral health literacy, Medicaid policy, Dental Health Coordinators (CDHCs), Public Health Dental Hygienists (PHDHs)
· Dental Care Models utilizing new dental auxiliary teams/protocols supported by teledentistry
8. Working with the KDA.
§ Incentivize comprehensive school-based oral health treatment delivery models.
§ Add health literacy curriculum in all K-12 classes to include oral health.
§ Allowing dental treatment to be accomplished the same day that a dental examination code is recorded
§ Appoint a “DENTAL COORDINATOR or DIRECTOR” whose primary responsibility will be to reduce conflicts and overlaps in dental services provided by public funding.
§ Develop a mechanism for Kentucky to participate in the Kentucky Information.
§ Implement a tax on high sugar content soft drinks to increase revenue for dental education.
§ Increase state support for and investment in higher education in the health sciences.
§ Increase pipeline activities to recruit Kentucky residents into Kentucky dental schools·
§ Lift the cap on enrollment of Kentucky
§ Implement a rural tax credit for dental practitioners.
§ create a tax incentive for practitioners who treat Medicaid patients.
9. Health Care Institute: National Center on Health/Head Start Collaborative
The Oral Health Institute (OHI) was established in 2005 with the objective of creating and evaluating training programs that will teach Head Start parents how to best manage the dental health needs of their children. Dr. Ariella Herman, Senior Lecturer at the UCLA Anderson School of Management, is the research director of the Oral Health Institute. Through her studies, she found that many Head Start parents are oftentimes misinformed on several dimensions of their children’s dental health and possess little time and means to become better educated about the dental health care needs of their children. Coupled with soaring dental health care costs and rising Medicaid spending contributing to the health care crisis in the United States, UCLA Anderson launched this nationwide dental healthcare training program to help alleviate some of these issues.
The objectives of the Oral Health Institute are:
o To provide training and information to participating Head Start agencies for the successful implementation of dental health care literacy programs to their families.
o To enable Head Start parents to become better caregivers to their children by improving their dental health care knowledge and parenting skills.
o To empower Head Start parents to become better-informed decision makers for the dental health care needs of their children.
o To enhance the self-esteem and confidence of the Head Start parents in meeting their parental objectives.
o The OHI’s methodologies of training have been proven to make valuable, long-term differences in the lives of families! The best part about the training methods is that they can be individualized and customized to meet the needs and learning styles of the parents/families that you work with. In addition, the methods are culturally sensitive and allow for the inclusion of strategies and “fun” activities that will ensure persons of all cultures and ethnicities are fully engaged in the learning process.
10. Smiles for Life: On line oral health information and curriculum for training all ages.
There are many ways to get involved in the Kentucky Oral Health Coalition:
o Become a member today. You can find out more at http://kyoralhealthcoalition.org/.
o Talk to a KOHC member about the coalition. Check out our website to view members.
o Participate on a workgroup to address the priorities laid out above.
o Consider how you can better incorporate serving low income families at your practice.
o Partner with your local school or school district to serve more children.
o Contact KDA or KOHC for ways to create awareness about oral health in your community. We both have many tools and resource to share with you.
In the afternoon, participants were divided into groups of between 15-20 persons, each. The workgroup leaders solicited recommendations to improve access issues in Kentucky. The top recommendations from each of the four work groups are listed.
Summit Workgroup Recommendations
Group A: Organizations and collaborations with the KDA
Dr. John Thompson and Lacey McNary, Group leaders.
Ms. Melissa Nathanson, Recorder
1) Surveillance to show need (DATA)
Comment: it has been over 10 years since the previous statewide oral health surveys for children, adults, and elders. The time is right to repeat these surveys.
2) Educate Dentists first
3) Get folks to value oral health care (so they show up for appointments)
4) Find legislators who are sympathetic to oral health issues
5) KDA collaborate with KDHA to promote oral health education
GROUP B: Affordable Care Act, Children and Medicaid
Drs. Raynor Mullins and Ken Rich, Group leaders
Ms. Sandy Challman, Recorder
1) Increase Medicaid Fees
2) Develop infant oral health program
3) Tele-dentistry for access to decrease costs
4) Expand public health hygienist
GROUP C: The Future of Mission Clinics “Free Dentistry” in Kentucky
Drs. Bob Henry and Karl Lange
Mr. Huston Hastie, Recorder
1) Better coordinate with dental schools and dental hygiene schools across the state to state to utilize students and clinical services
a. Offer class credit for rotations/internships in service for mission clinics
2) Provide state-wide location for donated dental equipment and supplies (for free clinics)
3) References for resources that are available and what are:
a. Services offered
b. Financial support
c. Statewide locations
4) Identify and refer patients
a. Coordinate treatment plan
b. Treatment facilities available
GROUP D: Geriatric and Long Term Care Patients: Issues and Solutions
Drs. Pam Stein and Mike Mansfield, Recorder
1) LONG TERM
a. Legislate consequences for OBRA violations
b. Hiring/appointment of “Oral Care Champion”
c. Educate top down administrators
d. Mandate MD/APRN/PA involvement in oral care/exam
a. Awareness for educational resources for older adults i.e. toothwisdom.org
b. Target locations older adults like to gather for education (garden club, Rizpah, senior center)
c. Access/awareness of transportation services, esp. in rural areas
1. Promote hiring/appointment of “oral care champion” in LTC facilities to reinforce OHI
2. Access to care/ transportation
3. Increase awareness to educational resources for older adults regarding Toothwisdom.org
4. KDA/Component; OH manuals for LTC
Conclusion: These recommendations should be reviewed for appropriate action by the target organization or individual. The Summit Workgroup will submit resolutions for action or support on the topics listed above that the KDA will want to support.
Dental access is a complex topic and only through collaboration, communication, and working together will any positive change take place. This summit was another beginning of such an effort, and the KDA is committed to being involved in providing leadership and support in this process.
Save the Date
November 20, 2015 - Louisville, KY
Statewide Oral Health Summit