Dental Students Last Stand: Back in the Saddle

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Dental Students Last StandBack in the Saddle

• Amanda Campbell
• Kendra Velasquez

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Overview

• Study Visits for Periodontal Study
• CNOHR Research Components 1 2 (RC1/RC2)
• Motivational Interviewing
• Approvals for RC1/RC2
• NIDCR
• COMIRB
• Tribal
• Trip to Pine Ridge

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Periodontal Study

• Overview of the study
• Collaboration with the Barbara Davis Center.
• To determine if there is a correlation between
  Type I Diabetes and Periodontal Disease.
• Observe patients at the dental clinic.
• Exams
• Plaque Samples
• Charting using Axium

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Early Childhood Caries (ECC)

• Disparities exist in American Indian/ Alaskan
  Native (AI/AN) communities, especially among the
  Oglala Lakota tribe.¹
• Results from IHS Oral Health Surveys show ECC in
  AI/AN continues to increase²
• Compared to other children ages 2-5, AI/AN
  children have more than 3 times the amount of
  untreated decay (19 vs. 68).³

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ECC

• The biggest challenge in treating and preventing
  ECC in AI/AN children is access to care
• AI/AN mothers are least likely to receive
  prenatal care
• They are the highest risk group for preterm birth

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Dental Decay in Children
American Indian
68
Hispanic
30
Black
22
White
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Children Ages 2-5 with Untreated Cavities,
National Institutes of Health http//drc.nidcr.nih
.gov/report/dqs_tables/dqs_1_3_1.htm comparable
IHS National Survey. 1999 http//www.dentist.ihs.g
ov/downloads/Oral_Health_1999_IHS_Survey.pdf
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Promoting Behavioral Change for Oral Health in
American Indian Mothers and Children (RC1)
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RC1

• Research component 1 (RC1) is a Phase III,
  randomized controlled trial.
• 600 consenting pregnant women/mothers of newborns
  from the Pine Ridge Reservation will be enrolled
• The mothers will be randomized to one of two
  groups
• The enhanced community services will receive
  dental aids, brochures, and public service
  announcements focusing on the important risk
  factors for ECC.
• Motivational Interviewing (MI) group will
  receive these services plus MI.
• 4 MI home visits
• one shortly after childbirth and the rest at 6,
  12, and 18 months
• Both groups will receive three oral examinations
  by calibrated dental hygienists.
• 1st exam shortly after teeth erupt
• 2nd 3rd exams will be annually after the 1st
  exam.

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RC1

• Specific aims include
• To collaborate with AI community service
  providers to develop culturally appropriate
  educational and health promotional materials to
  emphasize the value of family oral health from
  birth
• To create a manual for an MI intervention on
  oral health, focusing on AI mothers and their
  newborn children
• To demonstrate the effectiveness of this
  intervention in a randomized trial designed to
  assess its impact on the prevention of ECC.
• Hypothesis
• Enhanced community services plus an MI
  intervention will reduce the dmfs measures of the
  children at ages 1, 2, and 3, compared to
  enhanced community services alone. It is also
  hypothesized that MI interventions will improve
  the mothers dental knowledge, attitudes, and
  behaviors about oral health care.

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MI History

• Developed by William Miller (University of New
  Mexico) Stephen Rollnick (University of
  Cardliff, Wales) in the 1990s.
• Originally developed to help motivate individuals
  to change addictive behaviors, such as alcohol
  abuse and drug dependence.
• MI is now being used to address a wide range of
  different behaviors, such as developing proper
  oral health habits.
• The basis for MI is to use communication skills
  to increase an individuals natural desire to
  change.

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What is MI?

• MI is a calm and peaceful means of talking, which
  focuses on drawing out the motivation for change
  within the individual.
• The technique is designed to help individuals
  identify and process their own feelings about
  change.
• Native people have often referred to MI as
  empowering.

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MI Techniques

• MI employs the use of four basic principles to
  support client change
• Express Empathy
• Understand, accept and reflect on the
  clients thoughts and attitudes.
• Develop Discrepancies
• Change must come from a mismatch between
  present behavior and desired personal goals or
  values.
• Roll with Resistance
• Never try to force change on the
  client. Allow the client to develop his/her own
  answers and solutions.
• Support Self-Efficacy
• Believe in the clients ability to
  change and convey that to him/her.

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MI session

• Each session of the MI will include
• introduction to a specific subject for the
  session
• exploration of the pros and cons of change in
  this specific area
• assessment of the importance of change to the
  participant
• confidence of the participant in her ability to
  make the change
• enhancement of the participants self-efficacy
  through identification of what she thinks she
  will be able to accomplish
• elicitation of commitment language to follow
  through on the decisions reached in the session
• Lastly, development of a follow-up plan with
  specific action steps.

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MI and Oral Health
Harrison, Benton, Everson-Stewart, Weinstein
(2007)

• 240 South Asian children (6-18 mths)
• Randomly assigned to either MI group or control
  group.
• The control group received a pamphlet and video
  on infant oral health and the prevention of tooth
  decay in infants and toddlers.
• MI group received the pamphlet and video as well
  as a 45-minute MI session, followed by 6
  follow-up telephone calls.
• All children received dental exams at 1 and 2
  years post-intervention.
• Results
• The MI group had approx. 46 lower rate of
  decayed, missing filled tooth surfaces (dmfs)
  at age 2 than the control group.

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Preventing Caries in Preschoolers Testing a
Unique Service Delivery Model in American Indian
Head Start Programs (RC2)

• Focuses on training community members, called
  Community Oral Health Specialists (COHS), to
  administer health information and fluoride
  varnish.
• Children ages 3-5 will be randomized into one of
  two groups
• Group 1 Quarterly fluoride varnish and oral
  health promotion will be provided for 2 years by
  COHS.
• Group 2 Fluoride varnish made available at IHS
  clinics, quarterly for 2 years.

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RC2

• Primary Objectives
• To train lay community members
• Implement and evaluate the two groups
• Assess the efficacy by comparing dmfs between the
  two groups.
• Secondary Objectives
• To assess specific caries patterns, cost and
  mediators/moderators.

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Pilots

• Measures Pilot
• Testing the electronic computer system (ACASI)
• Cultural appropriateness, understandability, user
  friendliness
• Used for all follow-up surveys for RC1/RC2
• MI Pilot
• Assessment of trained MI research staff.
• COHS Pilot
• Assessment of trained COHS staff.

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NIDCR Approvals

• Pilots
• Summaries
• Consent Forms
• Revising Pilot Protocols
• Studies
• Revising Protocols
• Revising Consent Forms

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COMIRB OSTRRB

• Tedious practice in completing expedited, exempt
  and full board COMIRB applications.
• Oglala Sioux Tribe Research Review Board
• Support from the Health and Human Services (HHS)
  Committee.
• Information about the project is given to members
  of the HHS Committee for review.
• Field Office Director gives a brief presentation
  the HHS Committee.
• If endorsed, a tribal resolution is drafted .

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OSTRRB cont.

• Support from Tribal Council
• Resolution submitted to the Tribal Council for
  approval.
• The Tribal Council must approve the resolution in
  order for the study to commence on the
  reservation.
• Once study is completed, all data belongs to the
  tribe.
• Before submitting any official reports/presentatio
  ns, tribe must release the data to us.

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Pine Ridge Reservation

• Location of the study-
• Pine Ridge Reservation in South Dakota
• Pine Ridge is the second largest reservation
• and is comprised of Shannon and Jackson
• counties.
• 2.7 million acres¹
• These are two of the poorest counties in the U.S.
  The average income per family is 3,700 per
  year.²
• Many families have no electricity, telephone
  service, running water, or sewers and must use
  wood burning stoves to heat their homes.¹

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Pine Ridge Reservation

• The unemployment on Pine Ridge is around 85,
  with 45 below the Federal poverty level. ¹
• The life expectancy is among the shortest in the
  Western Hemisphere males 48 years and females
  are round 52 years. ²
• Infant mortality on Pine Ridge is five
• times the National Average.²

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Pine Ridge
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Health Fair
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Health Fair
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Pow-Wow
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Thank You!

• We would like to thank all of CAIANH for letting
  us take part in their current research.
• A special thanks to Judith Albino, Terry
  Batliner, Dallas Daniels, Valerie Orlando, Judy
  Sandoval, and Eugene Brooks.

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QUESTIONS???