The Illinois Oral HealthSurveillance System (IOHSS)Burden Document2004-2006

State of IllinoisRod R. Blagojevich, Governor

Department of Public HealthDamon T. Arnold, M.D., M.P.H., Director

Table of ContentsAcknowledgements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Why oral health? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

What is a burden document?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

What is surveillance?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

What is the National Oral Health Surveillance System? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

What is the Illinois Oral Health Surveillance System? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

What are the IOHSS indicators and its data sources? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Table 1: IOHSS Indicators by Data Sources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

What can be learned from Behavioral Risk Factor Surveillance System data? . . . . . . . . . . . . . . . . . . . . . . 4

What is shown from Pregnancy Risk Assessment and Monitoring System?. . . . . . . . . . . . . . . . . . . . . . . . . 5

What is the impact of oral cancer on Illinois as seen by the Illinois State Cancer Registry –oral and pharyngeal cancer data? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

What insights come from the Illinois Department of Healthcare and Family Services data? . . . . . . . . . . 11

What insights come from the Illinois Department of Financial and Professional Regulation data? . . . . . . . . 13

Illinois Department of Public Health, Division of Oral Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

What is monitored with the Illinois Fluoridation Reporting System data? . . . . . . . . . . . . . . . . . . . . 14

What was learned from the Dental Sealant Grant Program data? . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

What is provided by the Oral Health Needs Assessment and Planning Program data? . . . . . . . . . . 17

How is Craniofacial Anomaly Program data used?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Public Health Dental Clinics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

What is the oral health status of third grade children in Illinois? . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

How does Illinois measure against federal guidelines for oral health? . . . . . . . . . . . . . . . . . . . . . . . . 23

Appendix 1: Useful links/Data resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

Appendix 2: Acronyms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

AcknowledgementsThe Department would like to thank all thepartners and stakeholders for their support.A special thanks to the Division of Oral Healthteam at the U.S. Centers for Disease Controland Prevention (CDC) for its funding andtechnical support.

IntroductionThis document of oral health status in Illinoishas been collected and provided to you throughthe Illinois Department of Public Health’sOral Health Surveillance Program. Through acooperative agreement with the CDC, Illinoisis working to collect and analyze data on theoral health of Illinoisans. By collecting oralhealth status, access and Medicaid data, itwill be possible to monitor oral disease trendsover time and to document improvement inoral health among Illinois residents.

Why oral health?The mouth is our primary connection to theworld: it is how we take in water and nutrientsto sustain life, our primary means of commu-nication, the most visible sign of our mood, anda major part of how we appear to others. Oralhealth is an essential and integral componentof people’s overall health throughout life, andis much more than just healthy teeth. Oralrefers to the whole mouth: the teeth, gums,hard and soft palate, linings of the mouth andthroat, tongue, lips, salivary glands, chewingmuscles, and upper and lower jaws. Not onlydoes good oral health mean being free of toothdecay and gum disease, but it also meansbeing free of chronic oral pain conditions; oralcancer; birth defects, such as cleft lip andpalate; and other conditions that affect themouth and throat. Good oral health alsoincludes the ability to carry on the most basichuman functions, such as chewing, swallowing,speaking, smiling, kissing, and singing.

Because the mouth is an integral part of thehuman anatomy, oral health is intimatelyrelated to the health of the rest of the body.

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For example, mounting evidence suggests thatinfections in the mouth, such as periodontal(gum) diseases, can increase the risk for heartdisease, can put pregnant women at greaterrisk for premature delivery, and can compli-cate control of blood sugar for people livingwith diabetes. Conversely, changes in themouth often are the first signs of problemselsewhere in the body, such as infectious dis-eases, immune disorders, nutritional deficien-cies, and cancer.

What is a burdendocument?This report summarizes the most currentavailable information on the oral diseaseburden of people in Illinois. It also highlightsgroups and regions that are at highest risk fororal health problems. Comparisons are madeto national data whenever possible and toHealthy People 2010 goals when appropriate.For some conditions, national data, but notstate data, is available at this time. It is hopedthat the information will help raise awarenessof the need for monitoring the oral health bur-den in Illinois and guide efforts to prevent andtreat oral diseases and enhance the quality oflife of Illinois residents.

Describing the oral disease burden allows thestate program to share information about oralhealth needs with state policy makers, thepublic health community, and other stake-holders and interested parties. The burdendocument describes the status of oral diseases(e.g., dental caries, periodontal disease, totaltooth loss), including any disparities in oraldisease status among population groups. It alsodiscusses the ability of the state’s program tomeet these needs by including a description ofexisting oral health assets, such as professionaldental and dental hygiene education programsand any intervention programs that focus onpreventing oral diseases. It is important forthis document to include the most currentinformation; data preferably should be no olderthan five years.

What is surveillance?Surveillance is the ongoing, systematiccollection, analysis, interpretation, and dis-semination of data regarding a health-relatedevent for use in public health action to reducemorbidity and mortality, and to improvehealth. Surveillance is a process that providesinformation for action. Three key aspects of asurveillance system highlight its importance:data collection, timely dissemination of findings,and putting data to action. Data disseminatedby a public health surveillance system can beused for immediate public health action, programplanning and evaluation, and formulatingresearch hypotheses. Surveillance data can bea valuable tool to help target scarce resources.

What is theNational Oral HealthSurveillance System?The National Oral Health Surveillance System(NOHSS) is a collaborative effort between CDC’sDivision of Oral Health and the Association ofState and Territorial Dental Directors (ASTDD).NOHSS is designed to help public health pro-grams monitor the burden of oral disease, useof the oral health care delivery system, andthe status of community water fluoridation onboth the state and national level. NOHSSincludes indicators of oral health, informationon state dental programs, and links to otherimportant sources of oral health information.More information about NOHSS can be foundat <www.cdc.gov/nohss>.

What is theIllinois Oral HealthSurveillance System?The U.S. Surgeon General Report andsubsequent Call to Action to promote oralhealth formed vital influence as a base for thefirst Illinois Oral Health Plan (IOHP). One ofthe key priorities of the Illinois plan (publishedApril 2002) was to develop an oral health

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surveillance system. This priority, along withthe collective wisdom of citizens, stakeholdersand policy makers, has provided the vision andguidance of this system. Since 2000, the IllinoisDepartment of Public Health, Division of OralHealth has been developing the Illinois OralHealth Surveillance System (IOHSS). IOHSSis guided by an advisory committee of key oralhealth stakeholders and epidemiology expertsthat help assure that IOHSS is addressing theneeds of the communities. The committee’sexpertise also is beneficial in the promotion ofsurveillance information at the local level.

The goal of IOHSS is to monitor Illinois-specific,population-based oral disease burden andtrends, measure changes in oral health programcapacity, and monitor and report communitywater fluoridation quality. IOHSS is modeledafter NOHSS and is funded by a cooperativeagreement with the CDC. IOHSS helps monitorthe progress toward reducing oral healthdisparities and gathers evaluation data forprogram improvement, decision-making, andpolicy development/enhancement. With IOHSS,Illinois is able to identify high-risk populations,allocate limited resources, and develop policies.

IOHSS indicators include NOHSS indicators.Additionally, the Illinois system has additionalIllinois-specific indicators. As preparations aremade for the second Illinois State Oral HealthPlan, data from the surveillance system willprovide guidance.

What are the IOHSSindicators and its datasources?IOHSS indicators are chosen so that IOHSScan comply with NOHSS and because they areneeded to make program and policy decisions.As the surveillance system evolves, the datasources and their indicators will increase orexpand to meet the needs of the communities.The decision to collect and track specific indi-cators is informed by the decision-makingneeds: Is this policy working? Are our programs

making a difference? What are the larger oralhealth problems that need to be addressed?

Table 1 provides a listing of the data sourcesand oral health indicators currently available

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for IOHSS. The sources are highlighted ingreen along with its time interval for updates.Each data element is available as an indicatorbeneath its source.

Table 1 – IOHSS Indicators by Data Sources

Illinois Department of Public Health Interval 2 yearsBehavioral Risk Factor Surveillance System% of adults with dental visit in the past year% of adults with number of lost permanent teeth% of adults who have had teeth cleaning within the past year

Illinois Department of Public Health Interval 1 yearPregnancy Risk Assessment and Monitoring System% of pregnant women who needed to see a dentist for a problem% of pregnant women who spoke with a dental/health care worker about care of gums and teeth% of pregnant women who visited a dentist or dental clinic

Illinois Department of Public Health Interval 1 yearIllinois State Cancer RegistryOral and pharyngeal cancer annual incidence rate% of oral and pharyngeal cancers detected at the earliest stagesOral and pharyngeal cancer incidence rate by county

Illinois Department of Healthcare and Family Services Interval 1 year% of children using dental services by age% of diabetic adults with a dental visit# of children (0-18 years of age) enrolled in Title XIX Medicaid for at least one month of the year# of children enrolled in Title XXI State Children’s Health Insurance Program (SCHIP) for at least one month ofthe year% of adults (18-65 years of age) enrolled in Medicaid with dental visits% of adults (65+ years of age) enrolled in Medicaid with dental visits# of dentists enrolled as Medicaid providers# of dentists with at least one paid claim# of dentists with paid claims greater than $10,000# of Medicaid billing dentists who saw 50 or more beneficiaries younger than age 21# of Medicaid billing dentists who saw 100 or more beneficiaries younger than age 21

Illinois Department of Financial and Professional Regulation Interval 1 year# of licensed dentists and dental hygienists by county# of dentists and dental hygienists licensed by the IDFPR# of dentists and dental hygienists with a license and address in Illinois

Illinois Department of Public Health, Division of Oral Health Interval 1 year# of sealants provided through Dental Sealant Grant Program# of counties with an Oral Health Needs Assessment completed# of newborns with craniofacial anomaly referred by Craniofacial Anomaly Program# of safety net clinics in Illinois by county% of people served by public water systems who receive fluoridated water

Statewide Third Grade Basic Screening Survey Interval 5 years% of children with caries experience% of children with untreated decay% of children with sealants

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What can be learned from Behavioral RiskFactor Surveillance System data?The Behavioral Risk Factor Surveillance System (BRFSS) is a state-based program that gathers,through monthly telephone surveys, self-reported information on risk factors among Illinoisadults 18 years of age and older. Established in 1984 in collaboration between the CDC and statehealth departments, BRFSS has grown to be the primary source of information on behaviors andconditions related to the leading causes of death for adults in the general population. The oralhealth questions are asked in a two-year cycle. A limitation of this survey is that BRFSS infor-mation is obtained through telephone interviews of a sample of non-institutionalized Illinoisadults 18 years of age and older in residences with a telephone. People without phones or thoserefusing to participate are not represented in the assessment. More information about theIllinois BRFSS and oral health data on a county level can be found at<http://app.idph.state.il.us/brfss/>.

Dental Insurance Coverage

0

10

20

30

40

50

60

70

80

90

100

All 18-24years old

65+ yearsold

White Nonwhite

Hispanic < highschool

graduate

Data Source: BRFSS 2003

Loss of Permanent Teeth

0

10

20

30

40

50

60

70

80

90

100

All 65+ yearsold

White Non white Hispanic <Highschool

graduate

1 to 5 6 or more but not all all None

Data Source: BRFSS 2004

Based on BRFSS 2003 data, 42 percent of all Illinois adults, and 71 percent of those 65 years ofage and older, do not have any form of dental insurance.

Based on BRFSS 2004 data, 5 percent of all the adults surveyed have lost all their teeth; 11 per-cent had lost six or more but not all. Among those 65 years of age and older, 30 percent had lostsix or more teeth and 19 percent had lost all their teeth. The non-white subgroup includesblack, multiracial and other racial categories.

Pregnant women needed to seea dentist for a problem

23 2130

23 23 24 21

0

10

20

30

40

50

60

70

80

90

100

All <20 years Black White Hispanic < Highschool

graduate

LowBirthweight

Data Source: PRAMS 2003

Pregnant women visited a dentistor a dental clinic

33

1523

35

19 21

31

0

10

20

30

40

50

60

70

80

90

100

All <20 years Black White Hispanic < High schoolgraduate

LowBirthweight

Data Source: PRAMS 2003

5

Time since last dental visit

0

10

20

30

40

50

60

70

80

90

100

All 18-24 yearsold

65+ yearsold

W hit e Non white Hispanic <Highschool

graduate

<=1year 1-2 years >2 years /n ever

Data Source: BRFSS 2004

Time since teeth cleaned

0

10

20

30

40

50

60

70

80

90

100

All 18-24years old

65+ yearsold

White Non white Hispanic < Highschool

graduate

<1 year 1-2 years >2years/never

Data Source: BRFSS 2004

Twenty-six percent of adults 65 years of age and older and 39 percent of those with less than ahigh school education had their last dental visit more than two years ago or never. Sixty-ninepercent of adults 18 years of age and older had their teeth cleaned within less than a year, 12percent had their teeth cleaned in the past one or two years, and 18 percent had their teethcleaned more than two years ago or never. Twenty-five percent of Hispanics and 38 percent ofhigh school graduates reported having had their teeth cleaned more than two years ago or never.

Illinois adults have a broad range of dental care experiences and oral healthoutcomes. Adults showing particular oral health inequalities include thosewith lower education, 65 years of age and older, non-white, and Hispanic.

What is shown from the Pregnancy RiskAssessment and Monitoring System data?The Illinois Pregnancy Risk Assessment Monitoring System (PRAMS) is an ongoing population-based survey of women who have delivered a live born infant in Illinois that year. PRAMS collectsinformation from mothers about behaviors and experiences before, during, and immediatelyfollowing the birth of their baby.

PRAMS asked women about the care of theirteeth and gums during their most recent preg-nancy and found that 23 percent reportedsome type of dental problem for which therewas a need to see a dentist; 35 percent ofwomen went to a dentist or dental clinic dur-ing their pregnancy; and 34 percent reportedbeing counseled by a dental or other healthcare worker about how to care for teeth andgums. Older women with higher income andwomen with higher education levels weremore likely to have seen a dentist duringpregnancy. Prenatal and postnatal oralhealth care and educational experiences arenot equally obtained for all pregnant womenin Illinois. Those women who are young,Hispanic and with less education are particu-larly vulnerable.

What is the impact of oral cancer on Illinois asseen by the Illinois State Cancer Registry – oraland pharyngeal cancer data?Cancer of the oral cavity or pharynx (oral cancer) is the fourth most common cancer in theUnited States in African-American males and the seventh most common cancer in white males.Nearly 90 percent of oral cancer cases in the United States occur among persons aged 45 yearsand older.

Illinois State Cancer Registry (ISCR) data are collected, processed, analyzed and reported ascancer statistics (Incidence and Mortality) in Illinois by race, ethnicity and region. The data col-lected also are used for research, planning, and evaluating programs to decrease the incidence ofcancer.

There are disparities in the incidence rates oforal cancer. African-American males have thehighest rate. Females have substantiallylower incidence rates within every race/ethnicgroup as compared to males, while the ratesamong African-American women are lowerthan that of white women. During recentdecades, however, tobacco use has increasedamong women and will likely result in higheroral cancer rates over time.

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Dental/health care worker spokeabout care of gums and teeth

with the pregnant woman

3325

30 34

2128

34

0

10

20

30

40

50

60

70

80

90

100

All <20 years Black White Hispanic < Highschool

graduate

LowBirthweight

Data Source: PRAMS 2003

Illinois Oral Cancer Incidence Rate2002

0 5 10 15 20 25

All Races

Black/AfricanAmerican

White

Asian/Other

Hispanics

Non-Hispanics

MaleFemale

2002 Annual Age Adjusted Rates

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Despite advances in surgery, radiation andchemotherapy, the five-year survival rate fororal cancer has not improved significantly overthe past 25 years. More than 40 percent ofpersons diagnosed with oral cancer die withinfive years of diagnosis, although survival varieswidely by stage of disease when diagnosed.The five-year relative survival rate for personswith oral cancer diagnosed at a localized stageis 81 percent. In contrast, the five-year survivalrate is only 51 percent once the cancer hasspread to regional lymph nodes at the time ofdiagnosis, and just 29 percent for persons withdistant metastasis. Most of the oral andpharyngeal cancers are diagnosed or identifiedat the late stage.

Tobacco UseTobacco use is one of the most common risk factors for oral cancer and other conditions in themouth, such as periodontal disease, gingival recession, oral cancer, and caries. Alcohol andtobacco use are the major risk factors for oral cancer, accounting for 75 percent of all oral cancers.As per BRFSS 2004 data, statewide tobacco usage is 22 percent. Tobacco use was highest amongthe 18 to 24 age group at 31 percent.

Stage at Diagnosis for Oral andPharyngeal Cancer

1998-2002

36

64

0102030405060708090

100

Early Stage Late Stage

Oral & Pharyngeal Cancer

8

9

9

8

7

6

5

4

3

2

1

0

Historical Trends (1979-2003)

Mortality, Oral Cavity & PharynxBoth Sexes, All Ages

Deaths per 100,000 resident population

1980 1985 1990 1995 2000

Created by statecancerprofiles.cancer.gov on 09/11/2006 11:09 a.m.Regression lines calculated using the Joinpoint Regression Program.

Source: Death data provided by the National Vital Statistics System public use data file. Death rates calculated by the National Cancer Institute using SEER*Stat. Death rates are age-adjusted to the 2000 US standard population by 5-year age groups. Population counts for denominators are based

on Census populations as modified by NCI.

Key

Mortality

Oral Cavity & PharynxBoth SexesAll Ages

IllinoisWhite (incl Hisp)

United StatesWhite (incl Hisp)

IllinoisBlack (incl Hisp)

United StatesBlack (incl Hisp)

The graph, provided by the Surveillance, Epidemiology, and End Results (SEER) Web site,shows mortality for oral and pharyngeal cancers for both sexes and all ages is lower in whitesin Illinois as compared to whites nationally, whereas among blacks the mortality is higher inIllinois as compared to national figures. Generally, the oral cancer rates are improving.

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Although rates of oral cancer have been falling long-term, oral cancer is among those withrising five-year mortality rates in Illinois along with cancers of kidney, renal pelvis, and thyroidcancer. This is a small change, and it is not among those marked as significantly different fromzero (statistically).

KeyFallingRising

Created by statecancerprofiles.cancer.gov on 12/19/2007 2:42 pm.Annual Percent Change (APC) over the 5-year period calculated by SEER*Stat.Source: Death data provided by the National Vital Statistics System public use data file. Death rates calculated by the National Cancer Institute using SEER*Stat. Death rates are age-adjusted to the 2000 US standard population by 5-year age groups. Population counts for denominators are based on Census populations as modified by NCI.

# - The annual percent change is significantly different from zero (p<0.05).

All Cancer Sites

ProstateNon-Hodgkin LymphomaCervixBreast (Female)Brain & ONSColon & RectumStomachBladderUterusPancreasLeukemiaOvaryLung & BronchusEsophagusLiver & Bile DuctMelanoma of the SkinOral Cavity & PharynxKidney & Renal PelvisThyroid

-7 0 7

-7 0 7Annual Percentage Change

5-Year Rate Changes - MortalityIllinois, 1999-2003

All Ages, Both Sexes, All Races (Incl Hisp)

Falling Rising

African-American males have incidence rates of oral cancer thatare significantly higher than other population groups in Illinois.However, rural areas have the highest rates.

Healthy People 2010 Objective: 21-6 – Increase the proportion of oraland pharyngeal cancers detected at the earliest stage. Target: 50%

Healthy People 2010 Objective: 21-7 – Increase the proportion ofadults who, in the past 12 months, report having had an examinationto detect oral and pharyngeal cancers. Target: 20%

What insights come from the Illinois Departmentof Healthcare and Family Services data?In Illinois, approximately 1.1 million children are enrolled in Medicaid/State Children’s HealthInsurance Plan (SCHIP). In Illinois, Medicaid provides limited dental benefits for adult (21years of age and older) men, non-pregnant women and women eligible for pregnancy-relatedservices. As of 2005, only 33 percent of children enrolled in Medicaid/SCHIP utilized oral healthcare services during the year, and only 34 percent of active general and pediatric dentists wereenrolled as Medicaid providers, with most providing only a small volume of services.

Both children and adult Medicaid/SCHIP enrollees do not access oral health care for a variety ofcomplex reasons, including low value of oral health and lack of providers enrolled. As the tablebelow indicates, out of 2,007 dentists enrolled as providers, only 1,615 are providing services.Also as shown, adult claims are low in both the 18-65 age groups, and especially those 65 yearsof age and older, likely due to the limited services available to elderly patients.

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Indicator 2005

Number of children (0-18 years of age) enrolled in Title XIX Medicaidfor at least one month of the year 1,300,681

Number of children (0-18 years of age) enrolled in Title XXI SCHIPfor at least one month of the year 76,153

Percent of adults (18-65 years of age) enrolled in Medicaid with dental visits 15.15%

Percent of adults (65 years of age and older) enrolled in Medicaid with dental visits 4.73%

Number of dentists enrolled as Medicaid providers 2,007

Number of dentists enrolled as Medicaid providers with at least one paid claim 1,615

Number of Medicaid providers with paid claims > $10,000 873

Number of Medicaid billing dentists who saw 50 or more beneficiaries under age 21 877

Number of Medicaid billing dentists who saw 100 or more beneficiaries under age 21 732

Percent of diabetic adults (139,149 in 2005) with a dental visit 17.7%

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Percent of children (0 -20 years of age) enrolled in Medicaid/SCHIP with dental

services, 2005

0

20

40

60

80

100

Age 0-3

Age 4-5

Age 6-12

Age13-18

Age19-20

Total

Percent with dental visits Total enrolled

The number of children enrolled inMedicaid/SCHIP is highest amongthe 4-5 years of age group, whereasit’s the lowest among young childrenbetween 0 to 3 years of age.

Illinois has a low number of enrolled Medicaid providers and thoseenrolled only provide a small scope of services. Medicaid enrolleesare not accessing services, especially in the very young and elderlypopulation groups. The highest utilization of services is seen in the4-5 years of age and 6-12 years of age groups, possibly due to thenew Illinois dental examination law and the statewide DentalSealant Grant Program.

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What insights come from the Illinois Departmentof Financial and Professional Regulation data?The table provides a list of dentists and dental hygienists licensed by the Illinois Department ofFinancial and Professional Regulation, sorted by county where licensed as of December 2005.The number represents only licensed dentists and dental hygienists, and does not give detailsabout their specialty and their practice status.

County DDS RDH

Adams 38 20Alexander 2 1Bond 3 8Boone 16 25Brown 1 2Bureau 14 13Calhoun 1 3Carroll 4 6Cass 3 7Champaign 98 119Christian 14 23Clark 2 7Clay 7 7Clinton 9 26Coles 26 42Cook 4069 1599Crawford 8 15Cumberland 2 6DeKalb 43 53DeWitt 4 10Douglas 7 19DuPage 995 531Edgar 7 14Edwards 1 4Effingham 18 32Fayette 7 16Ford 6 13Franklin 20 21Fulton 7 24Gallatin 0 4Greene 5 7Grundy 13 15Hamilton 1 6Hancock 6 5

County DDS RDH

Hardin 0 2Henderson 1 4Henry 14 28Iroquois 10 22Jackson 27 36Jasper 2 7Jefferson 17 13Jersey 13 19Jo Daviess 10 17Johnson 5 4Kane 260 211Kankakee 36 47Kendall 26 58Knox 22 27Lake 573 427La Salle 58 63Lawrence 3 3Lee 17 13Livingston 14 21Logan 13 15Macon 54 72Macoupin 14 31Madison 223 144Marion 16 19Marshall 1 12Mason 5 5Massac 6 14McDonough 13 9McHenry 191 258McLean 86 90Menard 3 7Mercer 2 9Monroe 21 23Montgomery 9 10

County DDS RDH

Morgan 17 6Moultrie 3 11Ogle 18 30Peoria 126 121Perry 9 30Piatt 5 24Pike 8 3Pope 2 2Pulaski 0 1Putnam 2 4Randolph 11 15Richland 7 4Rock Island 86 50Saline 9 10Sangamon 115 90Schuyler 2 2Scott 1 1Shelby 3 18St. Clair 147 94Stark 0 3Stephenson 25 44Tazewell 61 125Union 7 7Vermilion 27 35Wabash 5 8Warren 7 10Washington 5 7Wayne 4 4White 6 1Whiteside 24 25Will 299 441Williamson 27 51Winnebago 174 160Woodford 9 38

There are 102 counties in Illinois, but the three counties with the most dental licensesaccount for 84 percent of all dentists and the top three for hygienists account for 44percent of all hygienists. Of the total 9,668 licensed dentists, 8,455 reside in Illinois.Similarly, out of 6,629 licensed dental hygienists, 5,883 reside in Illinois.

Illinois Department of Public Health,Division of Oral HealthThe Division of Oral Health establishes programs designed to assure that the people of Illinoishave access to population-based interventions that prevent and reduce oral disease and promoteoral health as integral to health through organized community efforts. These oral health programsfocus on community water fluoridation, dental sealants, early childhood caries, community needsassessment, school-based fluoride mouthrinse, craniofacial anomalies, orofacial injuries, oralcancer prevention, oral health surveillance, and a variety of educational programs designed tomeet the oral health needs of specific population groups in Illinois. The goal of the Division ofOral Health is optimal oral health for all residents of Illinois.

What is monitored with the Illinois FluoridationReporting System data?Fluoridation has been recognized by CDC as one of the 10 greatest public health achievementsof the 20th century. Fluoridation is a safe, cost effective way of preventing tooth decay. Theaverage cost to the water system is approximately 50 cents per person per year. Many Illinoiscommunities began fluoridating their drinking water supplies as early as 1947. Today, morethan 91 percent of the population in Illinois receives fluoridated drinking water. There are stilla significant number of residents who may not receive the benefits of fluoride in their water,such as those living in mobile home parks and individuals on private wells. Testing of privatewells is an important step in determining if there is naturally occurring fluoride present in thewater supply. Testing kits can be obtained through the Department’s Division of Oral Health orthrough the person’s local health department.

The Illinois Fluoridation Statute was enacted in 1967 and requires all community water systemsto adjust fluoride to optimal levels (0.90 - 1.20 milligrams per liter). The Division of Oral Healthmonitors community water supplies and provides education and technical expertise to watersupply operators to ensure that fluoride levels are optimal. The Illinois Fluoridation ReportingSystem (IFRS) is a database that maintains records of fluoridation status for community watersystems in Illinois. IFRS also reports annual fluoridation status for all community water systemsto the Water Fluoridation Reporting System (WFRS) maintained by CDC and, through theIllinois Project for Local Assessment of Needs (IPLAN), to all local health departments in Illinois.

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15

There are approximately 1,880 community water supplies in Illinois. The following is a breakdownand description of the systems:

870 Adjust (systems that adjust fluoride)618 Connect (purchase water from those adjusted systems)156 Natural (have naturally occurring fluoride)154 Exempt (systems exempt from the fluoridation statute i.e., mobile home parks and

systems with <10 lots or properties)80 Proposed (in process of becoming a water system), inactive, or no longer a water system

Population not on public water

Population on public water without fluoride

Population on public water with fluoride

91%

8.6%.4%

Illinois Population on Fluoride

Total Illinois population:Population on public water with fluoridePopulation on public water without fluoridePopulation not on public water systems

12.7 million11.6 million (91%)45,500 (.4%)1.1 million (8.6%)

Fluoridation of a community water supply is the single most effective publichealth measure to prevent tooth decay and maximum benefits are achievedwhen the levels are maintained in the optimal range. The Healthy People 2010Objective for water fluoridation is 75 percent, which Illinois surpasses, yet someresidents are not receiving community water fluoridation. They could benefitfrom the private well water testing program that includes education on sourcesof adequate fluoride.

16

What was learned from the Dental SealantGrant Program data?Evidence has shown the effectiveness of dental sealants to prevent and control dental carieswith school-based/school-linked dental sealant delivery programs. The Illinois Dental SealantGrant Program (DSGP) assists high-risk Illinois schoolchildren by granting funds and givingtechnical assistance to communities to develop and implement dental sealant programs. Sincethe program's inception in 1986, more than 978,600 dental sealants have been placed on morethan 399,600 children.

★East Side Health District

Dental Sealant Pilot Programs FY06 Dental Sealant Grant Program

★

★★★★

10

8612

2

11★

★★54

★18

★★

★

9

71

17

★13

★3 15★14

★16

FY06 County HD Programs

Yes (44)

1 - Alton Community Unit #112 - Berwyn Public Health District3 - Catholic Charities of Springfield4 - Central Illinois Dental Education & Services5 - Champaign-Urbana Public Health District6 - Chicago Department of Public Health7 - Collinsville Community Unit School District #108 - Community Health Partnership of Illinois9 - East Side Health District10 - Evanston health District11 - Livingston Project Success12 - Oak Park Department of Public Health13 - Project Success of Decatur & Macon County14 - Regional Office of Education #4615 - Sangamon County Regional Office of Education16 - Schuyler/Industry County Unit District #517 - Southern Illinois University - Alton18 - Southern Illinois University - Carbondale

It is important that schools participate in DSGP in order to help meet the oral healthneeds of underserved children. Sixty grantees cover 55 of the 102 Illinois counties.More grantees are needed, especially in the southern portion of the state.Note: Some counties have multiple grantees.

17

What is provided by the Oral Health NeedsAssessment and Planning Program data?

FY98

FY99

FY00

FY97

FY98

FY97

FY00

FY00

FY98

FY04

FY97

FY99

FY99

FY98

FY04

FY98

FY97

FY02

FY05

FY97

FY98

FY97

FY98

FY99

FY99

FY00FY97

FY01

FY97

FY98

FY03

FY04

FY00

FY97

FY07

FY04

FY04

FY98

FY99

FY99

FY05

FY97

FY04

FY99

FY00

FY98

FY03

FY02

FY98

FY00

FY98

FY98, FY00

FY98

FY01

FY00

FY97

FY04

FY97

FY06

FY02

FY97

FY98FY98

FY02

FY00

FY97

FY99, FY07

FY01, FY07

FY99

FY98

FY01, FY07

FY98

FY97

FY98FY98

FY00

FY98

Will

Pike

CookLee

McLean

Ogle

La Salle

Iroquois

Fulton

Henry

Knox

Adams

Bureau

Shelby

Livingston

Wayne

Edgar

Vermilion

Fayette

Ford

Logan

Clay

Hancock

Peoria

Kane

Macoupin

Champaign

Clark

Lake

Piatt

Madison

DeKalb

Macon

St. Clair

Sangamon

White

Marion

Christian

MasonTazewell

Morgan

Warren

Jackson

Whiteside

Greene

Jasper

Clinton

Kankakee

McHenry

Carroll

Pope

Jefferson

Randolph

Montgomery

Saline

Jo Daviess

Grundy

Woodford

Franklin

McDonough

Schuyler

Washington

Hamilton

Crawford

Stephenson

Winnebago

Brown

Scott

Kendall

Williamson

Richland

Menard

Rock Island

Lawrence

Cumberland

Coles

Mercer

Perry

Cass

Union

Bond

Jersey

De Witt

Monroe

Stark

Douglas

Effingham

Marshall

Moultrie

Gallatin

Boone

DuPage

Johnson

Henderson

Calhoun

Massac

Wabash

Pulaski

Hardin

Edwards

Alexander

Putnam

Oral Health Needs Assessmentand Planning Grant

12

3

4

2 - Oak Park (FY00)1 - Evanston (FY97 & FY03)

3 - Jamieson (FY04)4 - Champaign-Urbana (FY07)

Local Health Departmentcompleted an OHNAP

County's IPLAN includesoral health priorities

Revised 9/11/07.

The Oral Health Needs Assessment andPlanning Program (OHNAP) assists Illinoiscommunities in determining oral health statusand in helping plan comprehensive oral healthprograms to meet community needs. TheOHNAP is based on the Association of Stateand Territorial Dental Directors (ASTDD)“Seven-Step Model,” which is a systematicdata collection tool and analysis process usedby the communities to complete an OHNAP.The Seven-Step Model is translatable into anaction plan. The step-by-step model engagesthe community to provide integrated informa-tion about oral health. The process is complet-ed with development of appropriate communi-ty intervention strategies and implementationof the action plan.

The Department’s Division of Oral Healthleads state planning efforts through thestatewide oral health plan, and provides train-ing, technical assistance, and quality assur-ance to local health departments.

The Illinois Project for Local Assessment ofNeeds (IPLAN) is a community health assess-ment and planning process conducted everyfive years by local health jurisdiction.Communities identify oral health as one oftheir priorities under IPLAN. Access, oralhealth education and oral disease preventionwere the most common priorities listed underOHNAP proposals among Illinois communitiesthroughout the eight years of the program.

Counties that participate in either IPLAN or OHNAP utilize the data for planninginterventions, policy development, and health promotion. Most importantly, data areused to help bring needed resources to their communities.

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How is Craniofacial Anomaly Program data used?Craniofacial anomalies (cleft lip and cleft palate) are one of the most common congenital anomalies.These conditions may occur as isolated defects or as part of other syndromes. The Department’sAdverse Pregnancy Outcomes Reporting System (APORS) and electronic birth certificates reportidentifies craniofacial anomalies, along with other birth data to the Department’s Division of VitalRecords. The Department’s Division of Oral Health receives this data and operates an educationaloutreach program to families of children with this disease. The Craniofacial Anomaly (CFA)Program has three components: (1) education of parents of infants with craniofacial anomalies;(2) the development and distribution of educational materials for health professionals, includinghospital staff; (3) education programs at local health agencies, pediatrician and dental offices,and 0-3 programs. Since the program's inception in 1986, it has served more than 4,500 families.The educational outreach of the program has increased the reporting of these anomalies to anaverage rate of 1.3 per 1,000 births from an initial rate of 0.67 per 1,000 births.

Based upon the request, the data collected in the Illinois CFA Program is reportable in manyformats. The CFA Program collects ethnicity, race, type of anomaly, source of report, and geographicand hospital data. The geographic data elements are being used to improve the program.

Counts of craniofacial anomalies referred by the CFA Program by race/ethnicity

0

50

100

150

200

250

2000 2001 2002 2003 2004

WhiteBlackAsianOtherUnknownHispanic

19

020406080100120140160

Cleft lip

Birth by number of craniofacial anomalies, by year

20002001200220032004

Cleft palate Cleft lip andpalate

Bilateral cleft lip

Bilateral cleft palate

Bilateral cleft lip and

palate

The Department is piloting local community health information sharing with familiesin fiscal year 2007. Community partners are from the local health agencies and thebirthing hospitals network in Illinois.

The mission of the CFA Program is to reduce the long-term disabilities and traumasuffered by children and families affected by the craniofacial anomalies by assuringcomplete and coordinated care.

Public Health Dental ClinicsSafety net dental clinics provide a much-needed service to Illinois communities. The mission ofa safety net clinic is to provide oral care to underserved populations, such as those with lowincomes, Illinois Department of Healthcare and Family Services beneficiaries, the uninsured,and underinsured. These Illinois dental clinics provide a variety of services. Without theseimportant services and providers, many Illinois residents would suffer from untreated dentalproblems. More are needed to ensure that underserved populations receive necessary oral healthservices, especially in the southern portion of the state, where there are very few clinic locations.

20

What is the oral health status of third gradechildren in Illinois?The Department’s divisions of Oral Health and Chronic Disease Prevention and Control, collaboratedto conduct the Healthy Smile Healthy Growth assessment for the 2003-2004 school year. Informationcollected included caries experience, cavitated lesions (cavities), treatment need, presence of sealants,and body mass index calculated from height and weight measurements. A total of 6,630 childrenwere screened from the 9,000 eligible third-grade children from the sampled schools in Illinois.

Fifty-five percent of the third-graders have had dental caries experience that includes treatedand untreated cavities. Of the 55 percent with caries experience, 30 percent have untreatedcavities (cavitated lesions). Four percent of the children with untreated cavities need urgentdental treatment, indicating pain, abscess or severe decay. The numbers are higher amonglower income, rural, and minority populations.

21

Percentage with caries experience, cavitated lesionsand urgent treatment need by urbanicity

55

30

4

47

25

62

7

47

23

2

59

32

5

64

6

0

20

40

60

80

100

IL Urban Rural Collar Chicago Cook

Caries experience Cavitated lesionsUrgent treatment needed

2

37 38

The disparities among disease rates exist by income stratification. Family socioeconomic statusor income information is typically not available from schools. Use of free and reduced meals(FRM) information as a proxy for income, which is known to be strongly associated with oralhealth, helps protect family privacy, but allows targeting of oral health programs to schools withhigh FRM participation (not individual students). The disease rates and the treatment needsare higher among those who participate in the FRM programs.

Dental sealants are protective coatings applied onthe chewing surfaces of teeth to prevent caries. Theestimated percent of children with a dental sealanton a permanent molar in Illinois was 27 percent ascompared to only 12 percent among Chicago children.The rural counties have 37 percent of third graderswith a dental sealant.

Healthy People 2010 Target for sealants is 50 percent.

More information on this survey can be requestedfrom Illinois Department of Public Health, Divisionof Oral Health.

22

Caries experience, cavitated lesions and urgenttreatment need by free and reduced meals participation

64

34

7

46

21

20

20

40

60

80

100

Yes No

Caries experienced Cavitated lesionsUrgent treatment need

Percentage with Sealants

273737 34

12

23

010

20

30

4050

6070

80

90

100

IL Urban Rural Collar Chicago Cook

HP 201050%

How does Illinois measure against federalguidelines for oral health?Healthy People 2010: The U.S. Department of Health and Human Services coordinates an effortto create a set of national health goals to be reached by the year 2010. The Illinois Oral HealthSurveillance System monitors Illinois’ progress toward Healthy People 2010 objectives. The fol-lowing is the table of the Healthy People 2010 Oral Health Objectives along with Illinois’ statuson meeting these objectives. NA stands for data not available.

23

Objective

Reduce the proportion of children with dental cariesexperience.

Reduce the proportion of children and adults withuntreated dental decay.

Increase the proportion of adults who have neverhad a permanent tooth extracted because of cariesor periodontal disease.

Reduce the proportion of older adults who have hadall their natural teeth extracted.

Reduce periodontal disease.

Increase the proportion of oral and pharyngealcancers detected at the earliest stage.

Increase the proportion of adults who, in the past 12months, report having had an examination to detectoral and pharyngeal cancers.

Increase the proportion of children who havereceived dental sealants on their molar teeth.

Increase the proportion of the U.S. populationserved by community water systems with optimallyfluoridated water.

Increase the proportion of children and adults whouse the oral health care system each year.

Increase the proportion of long-term care residentswho use the oral health care system each year.

Increase the proportion of low-income children andadolescents who received any preventive dentalservice during the past year.

HP 2010 Target

Age Group Percent

IllinoisAge or Population

Group Percent

Preschool 11% NAElementary 42% Third grade 55%Adolescents 51% NAPreschool 9% NAElementary 21% Third grade 30%Adolescents 15% NA

Adults 15% NA

Adults 42% Adults 56.3

Older Adults 20% 65+ 18.8

Gingivitis 41% NA NA

Destructive PD 14% NA NA

Adults 50% NA NA

Adults 20% NA NA

Elementary 50% Third grade 27%

Adolescents 50% NA NA

All ages,residents on 75% All ages, residents 75%public water on public water

All ages 56% NA NA

Long-term careresidents

25% NA NA

< 19 years at orbelow 200% FPL 57%

Does your state haveYesa system?

Does your state havea system to address Yesthis objective?

Increase the number of states that have a system for recording and referring infantsand children with cleft lips, cleft palates, and other craniofacial anomalies to craniofacialanomaly rehabilitative teams.

Increase the number of states that have an oral health surveillance system. An oral healthsurveillance system should contain, at a minimum, a core set of measures that describe thestatus of important oral health conditions to serve as benchmarks for assessment.

Rural Healthy People 2010 provides information about rural health conditions identified aspriorities by rural health leaders. Oral health is named by more than 50 percent of the nationaland state experts as the rural health priority after access and mental health.

Appendix 1: Useful links/Data resources

Illinois Oral Health Planwww.ifloss.org/OralHealth/

Safety Net Dental Clinic in Illinoiswww.ifloss.org/Resources/documents/ClinicsListforWebsite.pdf

A Compendium of Community Efforts to Improve Oral Health in Illinoiswww.ifloss.org/Resources/documents/iflosscoalition_finallowres4-05-05.pdf

IFLOSS: Coalition of Communities Working Together to Improve Oral Health in Illinoiswww.IFLOSS.org

Illinois Oral Health Burden Documentwww.idph.state.il.us/HealthWellness/oralhlth/BurdenDocument.pdf

U.S. Centers for Disease Control and Prevention National Oral Health Surveillance Systemwww.cdc.gov/nohss

Healthy People 2010 Chapter 21 Oral Healthwww.healthypeople.gov/document/pdf/Volume2/21Oral.pdf

Association of State and Territorial Dental Directorswww.astdd.org

Surgeon Generals Report on Oral Healthwww.nidcr.nih.gov/sgr/oralhealth.htm

National Call to Action to Promote Oral Healthwww.nidcr.nih.gov/AboutNIDCR/SurgeonGeneral/NationalCallToAction.htm

Behavioral Risk Factor Surveillance Systemwww.cdc.gov/BRFSS/

Illinois Behavioral Risk Factor Surveillance Systemhttp://app.idph.state.lil.us/brfsss/

Economic Contribution of the Dentistry Profession in 2004www.imakenews.com/eletra/go.cfm?z=iadr%2C114614%2Cb4RhSJDk%0D%0A%2C724108%2Cb73jFrD>

Rural Healthy People 2010www.srph.tamhsc.edu/centers/rhp2010/publications.htm

24

Appendix 2: Acronyms

APC Annual Percent ChangeAPORS Adverse Pregnancy Outcomes Reporting SystemASTDD Association of State and Territorial Dental DirectorsBRFSS Behavioral Risk Factor Surveillance SystemCDC U.S. Centers for Disease Control and PreventionCFA Craniofacial AnomalyDSGP Dental Sealant Grant ProgramFPL Federal Poverty LevelFRM Free and Reduced Meals ProgramFY Fiscal YearHD Health DepartmentHP Healthy PeopleIDFPR Illinois Department of Financial and Professional RegulationsIFLOSS Illinois Oral Health CoalitionIFRS Illinois Fluoridation Reporting SystemIOHP Illinois Oral Health PlanIOHSS Illinois Oral Health Surveillance SystemIPLAN Illinois Project for Local Assessment of NeedsISCR Illinois State Cancer RegistryNA Not AvailableNCI National Cancer InstituteNOHSS National Oral Health Surveillance SystemOHNAP Oral Health Needs Assessment and PlanningONS Other Nervous SystemPD Periodontal DiseasePRAMS Pregnancy Risk Assessment and Management SystemSCHIP State Children’s Health Insurance ProgramSEER Surveillance Epidemiology and End ResultsWFRS Water Fluoridation Reporting System

25

IISG07-1226