Health or in a Department or Division of Public Health. The location of the program makes a tremendous difference in terms of communication with the state health officer, McClure said.

The responsibilities and priorities of state oral health programs varies according to resources and the partnerships that are made. McClure noted that Maryland has a rich set of dental resources to help move things forward. State oral health programs often rely on nongovernmental partners, for example, professional associations such as the American Dental Association, the American Dental Hygienists Association (ADHA), universities, dental schools, and private foundations.

McClure discussed the responsibilities of state oral health programs which generally fall into three categories: assessment, assurance, and policy. Oral health literacy is an integral part of each of these functions, particularly assessment, because it is in this area that dental disease is tracked and stakeholders are notified of the problems, the issues, and what to do about them, he said. State oral health programs are strategically positioned to carry out oral health literacy initiatives because states are often responsible for bringing people to the table to discuss problems as they arise.

McClure discussed the relevance of two questions to the work of the state dental health program: Does it work, and what does it cost? He pointed out that we live in a world of evidence-based dentistry and states, in their role relating to accountability, must adhere to the evidence on cost-effectiveness. State oral health programs are accountable to the governor, to the legislature, and to the taxpayers. When advocating for a program, the state dental health director often has to marshal the evidence that the program works.

McClure highlighted the importance of developing partnerships. The State Office of Oral Health is ultimately responsible for decisions, but these decisions cannot be made in an isolated fashion. They must be made in conjunction with partners and all stakeholders. Decision making also relies on technical information, reviews of evidence, and examinations of outcomes.

State offices of oral health face many challenges and limitations, said McClure. In addition to funding and staffing, competing priorities are a major challenge. In addition, the bureaucracy associated with state government can sometimes take time and effort away from the main focus of the office.

Ninety-two percent of states provide oral health education and promotion according to a recent review conducted by the Association of State and Territorial Dental Directors. McClure added that states have been providing health promotion interventions to consumers and other stakeholders for years and they see it as one of their core functions.



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