April 25 , 2012 Albuquerque Area Dental Meeting

1. Update on the IHS ECC Collaborative&Virtual Learning Community Program (VLCP)& A Call to Action April 25, 2012 Albuquerque Area Dental Meeting

2. ECC has different levels of severity, from non-cavitated lesions to multiple surfaces Stages of ECC

3. Overall Goal • Reduce ECC prevalence by 25% in 5 years • 2010 BSS in the Albuquerque Area: • 5.7 average teeth decayed (2nd highest) • 77.7% of 2-5 year-olds had experienced caries (2nd highest)/IHS average was 62.3%

4. ECC Collaborative Objectives • Increase dental access for 0-5 year old AI/AN children 25% in five years. • Increase the number of children 0-5 years old who received a fluoride varnish treatment by 25% in five years.

5. ECC Collaborative Objectives • Increase the number of sealants among children 0-5 years old by 25% in five years. • Increase the number ITRs provided for children ages 0-5 by 50% in five years.

6. VLCP Goal The goal of the Virtual Learning Community is to increase awareness and knowledge about ECC and ECC best practices throughout IHS, Tribal, and Urban (I/T/U) dental programs. Jicarilla/Dulce is the only Albuquerque Area program that applied for the VLCP (39 sites participating nationwide)

7. National Data

8. VLCP “Champions”:Highlighted on March VLCP call • Increased dental access from 47-103% in the first quarter. • Increased fluoride varnish by medical providers by 125 applications. • Increased ITRs by 295% for 0-2 year olds and 1000% percent for 0-5 year olds

9. Best Practices: What Works? • Identifying local champions: examples included dental staff, public health nurses, and tribal policy makers. • A dedicated case manager. • Marketing ITRs to your own dental staff and getting them comfortable with young children. • Working routinely with the well-child or WIC clinics.

10. How is the Albuquerque Area doing? • Data reports run from National Dental Data Mart • Albuquerque Indian Dental Clinic (AIDC) • Albuquerque 1 (Sandia, Zia Pueblo) • ACL • Mescalero • Santa Fe (Santa Fe, Santa Clara, Santo Domingo, Cochiti, San Felipe) • Zuni (separate for Zuni and Pine Hill) • Southern Colorado (Southern Colorado and Towaoc) • Jicarilla (Dulce) • Taos • Albuquerque 2 (Iselta, Jemez, Alamo) • Ysleta

11. 0-5 Access to Care, Albuquerque Area • 9% increase in 0-5 year-old access since 2009

12. 0-2 year-old access Zuni (116% increase) is the only clinic in the Area that has shown continuous improvement in access. What are they doing that we can all learn from?

13. 0-5 Sealants, Albuquerque Area • 13% increase in 0-5 year-old sealants since 2009 • 47% increase in 0-2 year-old sealants since 2009 (but very small numbers, from 99 to 159)

14. 0-2 year-old sealants Only AIDC and Santa Fe have had significant increases in 0-2 year-old sealants (by 21 and 30, respectively). Why?

15. Glass ionomer Sealants • Endorsed by the IHS Division of Oral Health • Poulsen Study – 50% of sealants in primary 1st molars, and 75% of sealants in primary 2nd molars, were retained after 12 months in young children (see attached study) • With a caries rate of 77.7% in the Area, and with almost half of children experiencing caries by age two, shouldn’t we be doing GI sealants on just about every 0-2 year-old we see?

16. 0-5 Fluoride Patients, Albuquerque Area • 9% increase in 0-5 year-old sealants since 2009 • 13% increase in 0-2 year-old sealants since 2009

17. 0-2 year-olds receiving fluoride varnish Everyone except Southern Colorado decreased from 2010-2011. Why?

18. % of 0-2 year-old children accessing dental care in 2011 who did not receive fluoride varnish • AIDC: 5% (21/409) • Alb 1: 50% (14/28) • Mescalero: 94% (30/32) • Santa Fe: 18% (41/232) • Zuni: 7% (29/420) • Southern Colorado: 31% (18/59) • Jicarilla: 17% (19/112) • Taos: 24% (5/21) • Alb 2: 56% (69/124) • Ysleta: 0% (0/1) • Pine Hill: 57% (27/47) • We recommend that all 0-2 year-old children accessing care receive fluoride varnish.

19. Other recommendations on fluoride varnish • Provide fluoride varnish to every 0-5 year-old that you see either in a clinic or community setting. • Enter fluoride varnish codes in RPMS or the EDR as you complete them; if applied in a community setting, enter those applications as well. • Work with your clinic’s site manager to learn how to enter fluoride data from community settings. • Allow open access for 0-5 year-olds to apply fluoride varnish by any dental staff. • Apply fluoride varnish 3-4 times annually to increase effectiveness.

20. 0-5 ITRs, Albuquerque Area • 33% increase in 0-5 year-old sealants since 2009 • 318% increase in 0-2 year-old sealants since 2009 (small numbers, from 11 to 67)

21. ITRs, 0-5 year-olds, Albuquerque Area Mescalero (increase from 0 to 27) and AIDC (increase from 0 to 171) have the biggest improvements. How have they embraced ITRs?

22. “The only thing we have to fear is fear itself” - FDR • What may be your concerns about ITRs? • Management of patient • Coding issues (2940) • No anesthesia? • Substandard care?

23. Look at the numbers… • According to the 2010 BSS of 0-5 year-olds: • 57.1% of 2-5 year-olds in the Albuquerque Area had untreated decay • This was the 3rd highest in the country, and 14% higher than the national average • The average fee of a pediatric dentist is 150% higher. The average cost of OR treatment may be as high as $8,000 per case. • Is it better to do nothing or try something?

24. In addition… • ITRs are endorsed by the American Academy of Pediatric Dentistry (AAPD) Reference: AAPD “Policy on Interim Therapeutic Restorations” • The long-term success of ITRs is comparable to amalgams See attached Mandari article

25. Questions?

26. Together, we can make a difference! Thanks for all you are doing to promote oral health in 0-5 year-olds!