Oral Health Literacy:
A Pathway to Reducing Oral
Health Disparities in Maryland
2011 Maryland Oral Health Summit:
Pathways to Common Ground and Action
October 20, 2011
Alice M. Horowitz, PhD
Dushanka V. Kleinman, DDS, MScD
SCHOOL OF
PUBLIC HEALTH
Remember
• Efforts to improve quality, reduce costs
and reduce oral health disparities cannot
succeed without simultaneous
improvements:
• In oral health literacy of the public, health
care providers and policy makers; and
• Ensuring the user friendliness of our dental
facilities.
Health Literacy is:
the interaction between skills of individuals
and demands of the healthcare system(s)
IOM Report 2004
Oral Health Literacy - Defined
“The degree to which individuals have the
capacity to obtain, process and understand basic
oral health information and services needed to
make appropriate health decisions.”
Healthy People 2010
Importance of Literacy Skills
Literacy influences one’s ability to access
information and to navigate the highly
literate environments of today’s society.
influences
Oral Health Literacy
is Associated With:
• Knowledge and understanding of
preventive measures
• Frequency of dental visits
• Severity of dental caries
• Oral health and quality of life
What’s the Problem?
• Health literacy varies by race, ethnicity,
level of education, and poverty level.
• The lower the health literacy the more
likely the individual will have poor health,
use fewer preventive procedures and use
costly ER services.
• Less likely to manage chronic health
conditions.
National Assessment of Adult Literacy 2003
Maryland’s Approaches to
Meet This Challenge
• Establish state needs
• Determine what the public knows and does regarding
caries prevention & early detection
• Determine the public’s perceptions of providers
communication skills
• Determine what health providers know and practice
regarding caries prevention & early detection
• Determine communication techniques of healthcare
providers
Health Literacy Fits in the Oral
Health Plan
• A major topic in Maryland’s oral health
plan is oral health literacy & education
What We Have Done to Date:
• Phone survey of MD adults 18 years of age
and older. KOP’s about caries prevention &
their perception of dental staff
communication skills.
• Focus groups of MD adults 18 years & older
• [4 in English; 2 in Spanish]
• Surveyed physicians, dentists, dental
hygienists and nurse practitioners. KOP’s
about caries prevention & use of
communication techniques.
What We Have Done (Con’t)
• Focus groups/interviews of all four
provider groups
MD Adults’ Understanding of
Caries Prevention
• 97.9% said they had heard of fluoride
• Only 58% knew the purpose of fluoride
• 64.9 % had heard of dental sealants
• Of those, only 46% knew their purpose
• Only 23% could identify an early sign of
tooth decay
Perceptions of Communication
Skills of Dentist & Staff
• AA were significantly more likely to express
lower satisfaction with the amount of time
DDS spent with them than Caucasians, and
• AA were more than twice as likely to report
they were treated unfairly due to race,
ethnicity, or education
• Those with private dental insurance were
significantly more likely than those with
Medicaid to report favorably about providers
listening practices.
Use of Tap Water
• Adults with high school education or
less were significantly less likely to:
• Know if their tap water was fluoridated
• Drink tap water
• Give it to their child
• Medicaid recipients were less likely
to drink tap water than non-Medicaid.
Demands of Our
Healthcare System
• Health literacy is dependent on the demands of the healthcare
and public health systems. Individuals need to:
• Know how to locate and navigate a health facility
• Read, understand, and complete many kinds of forms to receive
treatment and payment reimbursement
• Articulate their signs and symptoms
• Know about various types of health professionals and what
services they provide and how to access those services
• Trust us
• Know how and when to ask questions or ask for clarification when
they do not understand
What We Are Working On…..
• Determining user friendliness of dental
clinics in community health settings
• Surveying Head Start & WIC personnel
regarding their KOP’s about caries
prevention
• Conducting focus groups of Head Start and
WIC personnel
Remember
• Efforts to improve quality, reduce costs
and reduce oral health disparities cannot
succeed without simultaneous
improvements:
• In oral health literacy of the public, health
care providers and policy makers; and
• Ensuring the user friendliness of our dental
facilities.
Improving Oral Health Literacy
• Of the public, health providers and policy
makers is one essential pathway to
eliminating disparities among
Marylanders.
Maryland Oral Health Literacy Model: Moving Science into Action
Healthy People 2020
Increased
Health
Health Literacy Call to
Action
Plain Language Act
State Oral Health Plan and State Oral
Health Policies
Oral Health Literacy
Workshop
Increased
Healthcare
Delivery
2011 IOM Reports
Surgeon General Reports
Evidence-based Protocols
Drivers 
Increased
Disease
Prevention
Programs &
Services

Assessment 
Policy Development  Assurance
THANK YOU!