The Indian Health Service Early Childhood Caries (ECC) Initiative

1. The Indian Health ServiceEarly Childhood Caries (ECC) Initiative

2. ECC is defined as the presence of one or more decayed, missing (due to caries), or filled tooth surfaces in any primary tooth in a child under 6 years of age. Early Childhood Caries

3. ECC and AI/AN Children

4. Why are Primary Teeth Important? • Eating and nutrition • Talking • Saving space for permanent teeth • Smiling

5. Costs of ECC • ECC can cost thousands of dollars to treat each child, even exceeding $8,000 when a child is hospitalized and treated under general anesthesia.

6. What is the IHS ECC Initiative? • The IHS Early Childhood Caries Initiative is a new program designed to promote prevention and early intervention of dental caries in young children through an multi-disciplinary approach. • It is both comprehensive (includes prevention and early intervention) and collaborative (multi-disciplinary).

7. How is this Initiative any different than ECC initiatives of the past? • It includes the establishment of a national oral health surveillance system to monitor the prevalence of ECC. • It includes a more formal approach at reaching out to multiple community partners. • It involves not just prevention of ECC but also early intervention. • It includes printed materials, online courses, and support at the Area and National levels.

8. ECC Initiative Objectives Overall Goal: Reduce the prevalence of ECC among 0-5 year old AI/AN children by 25% by FY 2015. • Increase dental access for 0-5 year old AI/AN children by 10% in FY 2010 and 50% by FY 2015. • Increase the number of children 0-5 years old who received a fluoride varnish treatment by 10% in FY 2010 and 25% by FY 2015.

9. ECC Initiative Objectives • Increase the number of sealants among children 0-5 years old by 10% in FY 2010 and 25% by FY 2015. • Increase the number ITRs provided for children ages 0-5 by 10% in FY 2010 and 50% by FY 2015. All four objectives will be tracked separately for 0-2 year olds and 3-5 year olds.

10. The ECC Team

11. Key Components of the ECC Initiative • Best Practices to prevent ECC • Dental Access for prenatal and 0-5 year olds • Caries Stabilization using fluoride, sealants, and Interim Therapeutic Restorations. • Data Collection: Tracking RPMS data and implementation of the Basic Screening Survey (BSS)

12. The ECC Initiative: Products • ECC Initiative Packet • Two Online Courses • How To Apply Fluoride Varnish • Caries Stabilization • ECC Initiative webpage

13. ECC Initiative Packet Together we can prevent ECC!!!

14. Left Side of Packet: Medical & Community Partners • Customized information for medical & community partners • Includes: • ECC Initiative Fact Sheet for Community Partners • Head Start’s Role in ECC Prevention and Early Intervention • The WIC Staff’s Role in ECC Prevention & Early Intervention • The CHR’s Role in ECC Prevention and Early Intervention • The PHN’s Role in ECC Prevention and Early Intervention • The Medical Provider’s Role in ECC Prevention • The Tribal Council’s/Governing Body’s Role in ECC Prevention

15. ECC Initiative Goals & Objectives Promoting Awareness of Early Childhood Caries (fact sheet) Key Oral Health Messages and Setting Goals Who are the key contacts in your community? Dental Sealants Interim Therapeutic Restorations RPMS and Coding Questions on the IHS ECC Initiative The Basic Screening Survey Getting Your Community Involved ECC Initiative Course & Presentation Summaries ECC Program Planning Right Side of Packet: Dental Team

16. ECC Initiative Online Courses • How To Apply Fluoride Varnish • Caries Stabilization

17. http://www.doh.ihs.gov/ecc • Models to Improve Dental Access • ECC Packet (download and print) • Links to the online courses • Links to ECC resources and updates on best practices.

18. Best Practices during Pregnancy • Educate mother about ways to prevent ECC. • Support breastfeeding. Discourage tobacco use. • Provide an oral exam, periodontal disease screening, prophylaxis, and recommendations for completing dental treatment, caries control, and appropriate recall. • Assess caries risk and prescribe anti-bacterials like chlorhexidine or xylitol for high-risk mothers after the baby is born.

19. Best Practices 0-2 year olds • Oral health assessment soon after the first tooth erupts. • Fluoride varnish treatments 4 or more times during the period from 9-24 months of age. • Brush twice daily with a small smear of fluoride toothpaste beginning when the first tooth erupts. • Consider sealants and caries stabilization with GI as appropriate.

20. Best Practices 3-5 year olds • Yearly dental exam. • Fluoride varnish treatments 3-4 times a year. • Brush twice daily with a pea-size dab of fluoride toothpaste. • We also recommend caries stabilization with GI sealants and restorations as appropriate.

21. Caries StabilizationGlass Ionomer Sealants • Glass ionomer sealants are recommended in situations where moisture control cannot be achieved. • Endorsed by the Indian Health Service Division of Oral Health

22. Caries StabilizationInterim Therapeutic Restorations (ITR) • Prevent the progression of caries. • Reduce the levels of cariogenic bacteria. • Follow-up care including OHI, fluoride toothpaste, and the use of fluoride varnishes may improve the treatment outcome. ITRs are endorsed by the AAPD and the IHS, DOH

23. National Oral Health Surveillance • We are using the Basic Screening Survey (BSS) to document ECC and track our progress. • The BSS is used by states to assess oral health status. Developed by the American Association of State and Territorial Dental Directors, this survey can be done in the dental clinic, at health fairs, at other screening opportunities, and through a retrospective chart review.

24. The BSS Form

25. More about the BSS… • Advantages: fast, frequent, and can be customized • Disadvantage: not same level of detail as NHANES or OHS • The BSS requires some planning – where are you going to do it, how often are you going to do it, etc. • Area Dental Support Centers will be trained and calibrated. • Beginning in the Fall of 2010, Support Centers will conduct a BSS on a sample size to be determined by an epidemiologist. • The BSS will be conducted annually thereafter and can show us whether the IHS ECC Initiative is meeting its goals.

26. ECC Initiative • Dental alone cannot prevent ECC because nationally our access to care rate is low, and children don’t often come to the dentist at an early age. That’s why our community partners are critical to the success of this initiative.

27. What can dental staff do? • Collaborate with dental, medical and community partners in your community to develop an ECC program plan. • Encourage Caries Stabilization with ITRs and take the online course. • Support medical and community partners as they get certified and begin fluoride varnish programs in your community. • Apply for mini-grants to support the prevention of ECC. • Work with your ADO or DSC to collect BSS survey data.

28. Together, we CAN make a difference!