The Indian Health Service Early Childhood Caries (ECC) Initiative

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The Indian Health ServiceEarly Childhood Caries
(ECC) Initiative
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Early Childhood Caries

• 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.

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ECC and AI/AN Children
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Why are Primary Teeth Important?

• Eating and nutrition
• Talking
• Saving space for permanent teeth
• Smiling

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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.

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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).

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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.

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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.

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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.

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The ECC Team
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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)

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The ECC Initiative Products

• ECC Initiative Packet
• Two Online Courses
• How To Apply Fluoride Varnish
• Caries Stabilization
• ECC Initiative webpage

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ECC Initiative Packet
Together we can prevent ECC!!!
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Left Side of Packet Medical Community Partners

• Customized information for medical community
  partners
• Includes
• ECC Initiative Fact Sheet for Community Partners
• Head Starts Role in ECC Prevention and Early
  Intervention
• The WIC Staffs Role in ECC Prevention Early
  Intervention
• The CHRs Role in ECC Prevention and Early
  Intervention
• The PHNs Role in ECC Prevention and Early
  Intervention
• The Medical Providers Role in ECC Prevention
• The Tribal Councils/Governing Bodys Role in ECC
  Prevention

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Right Side of Packet Dental Team

• 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

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ECC Initiative Online Courses

• How To Apply Fluoride Varnish
• Caries Stabilization

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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.

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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.

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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.

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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.

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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

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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

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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.

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The BSS Form
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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.

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ECC Initiative

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

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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.

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• Together, we CAN make a difference!