SUMMARY OF FINDINGS Brighton, Colorado September 11 and 12, 2009 “I feel pretty, happy, and . I can smile! ” COMOM Patient February 2010 TABLE OF CONTENTS Introduction . .. 2 Patient Population. 3 Exit Interviews. 3 COMOM Dental Site and Patients’ Home Location . 4 Demographic Characteristics. 5 Dental Care . 7 Dental Insurance . 9 Dental Pain . 11 Dental Procedures . 12 • Overview – Dental Procedures Performed and Donated Fees • Overview – Patients Undergoing Dental Procedures • Radiographic/Diagnostic Imaging • Preventive • Restorative • Endodontics • Periodontics • Prosthodontics • Oral and Maxillofacial Surgery Tobacco Use . 21 Further Dental Care. 24 Oral Health Instruction . .. 24 COMOM Experience for Patients . 25 Patient Messages . 29 Appendices . 30 A: Patient Treatment Form B: Patient Interview Form C: Dental Procedures Performed and Donated Fees D: Contributors E: Volunteers F: Brighton COMOM Images -1- INTRODUCTION Dental care is unaffordable for many individuals. Among these individuals, it is common to find severe decay, infection, and pain. Oral disease is progressive and cumulative, and becomes more complex over time. It can affect the ability to eat, and how a person looks and communicates. Oral health is inseparable from general health, and can affect self-esteem and compromise a person’s ability to work at home, at school, or on the job. In September 2009, the Colorado Dental Association held a two-day Colorado Mission of Mercy (COMOM) in Brighton, Colorado. Colorado has now joined the growing number of states in which volunteer dentists, dental hygienists, dental assistants, and an array of other volunteers commit their time to provide free oral healthcare services to individuals who otherwise cannot afford care. Building on experience from the COMOMs held in Alamosa, Colorado in 2007, and in Loveland, Colorado in 2008, the Adams County Regional Park Complex was transformed into a large-scale dental clinic. Patients were treated on a first-come, first-serve basis. They waited their turn to see a dentist for an initial evaluation and to prioritize needed dental services. As dentists and dental hygienists became available, patients were guided to areas of the dental clinic where they underwent preventive, restorative, endodontic, periodontic, prosthodontic, and surgical procedures. Upon completing their dental care, patients were asked to participate in an exit interview. Bilingual volunteers were available throughout the clinic experience to assist Spanish-speaking patients. As shown in Table 1, the success of the Brighton COMOM was due in large part to the nearly 800 individuals who volunteered their services. (Appendix E displays listing of volunteers.) Table 1. Brighton COMOM Volunteers Dentists 134 Dental Assistants 115 Dental Hygienists 70 Dental Lab Technicians 30 Dental Billing Coders 18 Dental Equipment Specialists 7 Dental Students 19 Predental Students 17 Dental Assistant Students 40 Dental Hygienist Students 38 Nondental Health Professionals 19 (massage therapists, medical assistants, nurses, paramedics, pharmacists, pharmacy techs) Community Workers 285 TOTAL 792 The intent of this report is to provide a summary of the demographic, dental health, and clinical characteristics of patients attending the Brighton COMOM event, and to also delineate their perspectives of the clinic experience. This information can serve as a framework for informing future planning of COMOM events. -2- PATIENT POPULATION* During the COMOM two-day event in Brighton, 1,291 patients, documented via treatment forms, were seen by dental healthcare professionals; 1,235 underwent evaluation and treatment, and 56 underwent evaluation only. (Appendix A displays the treatment form.) The reasons given by patients for undergoing only evaluation, and not going onto treatment, are shown in Table 2. Table 2. Reasons for Patients Choosing Not to Undergo Dental Treatment Not feeling well Family member needing to be taken home Unable to wait (e.g., needing to go to work) No treatment needed (e.g., young children) Too afraid Refusal of treatment EXIT INTERVIEWS* Of 1,235 patients undergoing treatment at COMOM, 1,174 participated in exit interviews; a 95 percent response rate. The interview was comprised of 25 questions, asking patients about their pain status and the time frame of their most recent dental care, insurance status, demographic factors, and about their COMOM experience including whether they received oral health education. Bilingual volunteers conducted exit interviews with Spanish speaking patients. (Appendix B displays the exit interview questionnaire.) *Throughout the report, findings will be displayed with a denominator (N=X,XXX). The denominator will vary. It will represent the number of patients with data available related to the particular issue being examined. -3- COMOM DENTAL SITE AND PATIENTS’ HOME LOCATION The Brighton COMOM was held in Adams County. Most patients attending the 2009 COMOM lived in close proximity to the dental clinic with 324 patients living in Adams County, and 306 living in neighboring Denver County (Figure 1). The distance traveled from home to the COMOM event ranged from 3 to 643 miles (average 29 miles), with 51 percent of patients traveling 20 miles or less. The vast majority of patients (97 percent) lived in communities classified as urban with only three percent living in communities classified as rural.* Figure 1. Patients’ Colorado County of Residence (N=1,282) Sedgwick Logan Weld Larimer Moffat Jackson Phillips Routt Morgan Grand Boulder Yuma Rio Blanco Broomfield Washington Gilpin Denver Adams Eagle Clear Arapahoe Garfield Summit Creek Jefferson Elbert Kit Carson Pitkin Douglas Lake Park Mesa Delta El Paso Cheyenne Chaffee Teller Lincoln Gunnison Fremont Kiowa Montrose Crowley Ouray Pueblo San Miguel Saguache Custer Hinsdale Bent Prowers Otero Dolores San Juan Mineral Huerfano Alamosa Rio Grande Montezuma Las Animas Baca La Plata Costilla Archuleta Conejos Adams (324) Boulder (31) Logan (6) Fremont (2) Denver (306) El Paso (16) Morgan (5) Pueblo (2) Broomfield (14) Delta (3) Cheyenne (1) Douglas (14) Garfield (3) Park (1) Arapahoe (182) Los Animas (10) Alamosa (2) Phillips (1) Larimer (143) Weld (122) Jefferson (90) (An additional three patients were identified as residing outside of Colorado: Kansas=1, Missouri=1, Wyoming=1; one other patient had an unknown address.) * Rural-Urban Commuting Area (RUCA) codes were used to classify rural and urban areas. (For further information see <http://depts.washington.edu/uwruca/index.php >.) -4- DEMOGRAPHIC CHARACTERISTICS GENDER Of the 1,224 patients undergoing treatment with gender data available, 56 percent were female and 44 percent were male. AGE The average age of treated patients was 35 years with a range of 2 through 88 years. As displayed in Figure 2, the age group of 21 through 30 years had the highest percentage of patients attending the COMOM event. Figure 2. Treated Patients by Age (N=1,225) 30% 25% 312 22% 20% 275 17% 14% 210 169 11% 10% 12 9 5% 4% 56 2% 52 <1% 19 3 0% <10 11-20 21-30 31-40 41-50 51-60 61-70 71-80 81-90 Age in Years -5- ETHNICITY /RACE Of the 1,139 treated patients with ethnicity/race data, most were of Hispanic origin (50 percent) or were White non-Hispanic (40 percent) – (Figure 3). Figure 3. Treated Patients by Ethnicity/Race (N=1,139) American Indian or Alaska Native 17 1% Asian 21 2% Black or African American 53 5% Hispanic or Latino 575 50% Native Hawaiian or Other Pacific Islander 2 <1% White Non-Hispanic 453 40% Multi-Racial 16 1% 0% 20% 40% -6- DENTAL CARE Dental health is an important part of a person’s overall health. As a general recommendation, individuals should be seen by a dental health professional every six months. Regular visits allow a dentist to find early signs of decay and disease, and treat problems at a manageable stage. Of treated patients, only 14 percent saw a dentist within six months of the COMOM event. On average, the last time patients saw a dentist was 4.0 years (range one week through 40 years), with five percent of patients never seeing a dentist. (Figure 4). Only six percent of these patients had their teeth cleaned within six months. On average, the last time patients had their teeth cleaned was 5.1 years prior to COMOM (range one week through 40 years), with nine percent of patients never seeing a dental hygienist for care. Figure 4. Treated Patients – Receipt of Dental Care (N=1,087) Last time saw dentist Six m onths or less 156 14% More than six months 931 81% Never 63 5% Last time teeth cleaned (N=1,133) Six m onths or less 69 6% More than six months 962 85% Never 102 9% 0% 20% 40% 60% 80% -7- REASONS FOR NOT SEEKING DENTAL CARE As displayed in Figure 5, patients indicated that that the two major reasons for not seeing a dentist were not being able to afford dental care (82 percent) and not having dental insurance (71 percent). Figure 5. Treated Patients – Major Reasons for Not Seeking Dental Care (N=1,093) Cannot afford to pay 899 82% No dental insurance 778 71% Afraid / Don't like 53 5% receiving dental care Too busy 42 4% Didn't think I needed to go 31 3% 0% 20% 40% 60% 80% * Patients were able to provide more than one reason for not seeing a dentist, consequently percentages total more than 100%. -8- DENTAL INSURANCE Access to dental care is difficult for many individuals, and lack of dental insurance is a factor. As displayed in Figure 6, the vast majority of patients who were treated at COMOM did not have dental insurance (96 percent). On average, patients with dental insurance saw a dentist 2.6 years prior to the Brighton COMOM; those patients without dental insurance saw a dentist 4.0 years prior. (Figure 7) On average, patients with dental insurance saw a dental hygienist to have their teeth cleaned 3.3 years prior to the COMOM event; those patients without dental insurance saw a dental hygienist 5.4 years prior.