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

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

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

ECC Collaborative Objectives 1.Increase dental access for 0-5 year old AI/AN children 25% in five years. 2.Increase the number of children 0-5 years old who received a fluoride varnish treatment by 25% in five years.

ECC Collaborative Objectives 3.Increase the number of sealants among children 0-5 years old by 25% in five years. 4.Increase the number ITRs provided for children ages 0-5 by 50% in five years.

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)

National Data

VLCP “Champions”: Highlighted on March VLCP call Increased dental access from % 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

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.

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

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

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?

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

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?

Glass ionomer Sealants Endorsed by the IHS Division of Oral Health Poulsen Study – 50% of sealants in primary 1 st molars, and 75% of sealants in primary 2 nd 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?

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

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

% 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.

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.

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

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?

“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?

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 3 rd 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?

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

Questions?

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