The Indian Health ServiceEarly Childhood Caries (ECC)

Initiative

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

ECC and AI/AN ChildrenEarly Childhoood Caries Prevalence in 2-5 Year-Olds

28 23

6876

01020304050607080

Caries Experience Untreated Decay

NHANES, 2004 IHS 1999 Oral Health Survey

Why are Primary Teeth Important?

Eating and nutritionTalkingSaving space for

permanent teethSmiling

Costs of ECCECC can cost thousands of dollars to treat

each child, even exceeding $8,000 when a child is hospitalized and treated under general anesthesia.

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).

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.

ECC Initiative ObjectivesOverall Goal: Reduce the prevalence of ECC

among 0-5 year old AI/AN children by 25% by FY 2015.

1. Increase dental access for 0-5 year old AI/AN children by 10% in FY 2010 and 50% by FY 2015.

2. 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.

ECC Initiative Objectives3. Increase the number of sealants among

children 0-5 years old by 10% in FY 2010 and 25% by FY 2015.

4. 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.

The ECC Team

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)

The ECC Initiative: ProductsECC Initiative Packet

Two Online CoursesHow To Apply Fluoride VarnishCaries Stabilization

ECC Initiative webpage

ECC Initiative Packet

Together we can prevent ECC!!!

Left Side of Packet: Medical & Community Partners

Customized information for medical & community partnersIncludes:

ECC Initiative Fact Sheet for Community PartnersHead Start’s Role in ECC Prevention and Early

InterventionThe WIC Staff’s Role in ECC Prevention & Early

InterventionThe CHR’s Role in ECC Prevention and Early

InterventionThe PHN’s Role in ECC Prevention and Early

InterventionThe Medical Provider’s Role in ECC PreventionThe Tribal Council’s/Governing Body’s Role in ECC

Prevention

Right Side of Packet: Dental Team

ECC Initiative Goals & ObjectivesPromoting Awareness of Early Childhood Caries (fact

sheet)Key Oral Health Messages and Setting GoalsWho are the key contacts in your community?Dental SealantsInterim Therapeutic RestorationsRPMS and Coding Questions on the IHS ECC InitiativeThe Basic Screening SurveyGetting Your Community InvolvedECC Initiative Course & Presentation SummariesECC Program Planning

ECC Initiative Online Courses1. How To Apply Fluoride Varnish

2. Caries Stabilization

http://www.doh.ihs.gov/eccModels to Improve Dental

Access

ECC Packet (download and print)

Links to the online courses

Links to ECC resources and updates on best practices.

Best Practices during PregnancyEducate 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.

Best Practices 0-2 year oldsOral 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.

Best Practices 3-5 year oldsYearly 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.

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

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

National Oral Health SurveillanceWe 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.

Screen Date: __ __ / __ __ / __ __ __ __

Site/Tribe: Screener’s Initials:

ID/Chart Number: Birth Date: __ __ / __ __ / __ __ __ __

Age:

Gender (circle one):1=Male 2=Female

Sealants on Permanent Molars (circle one):0=No Sealants1=Sealants2=Cannot be determined or does not apply

Untreated Cavities (circle one):0=No untreated cavities 1=Untreated cavities

Severe Early Childhood Caries (circle one):0=Five or less primary teeth with caries experience1=Six or more primary teeth with caries experience

Caries Experience (circle one):0=No caries experience 1=Caries experience

Treatment Urgency (circle one):0=No obvious problem 1=Early dental care indicated2=Urgent care (within 24 hours) indicated

Comments:

The BSS Form

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.

ECC InitiativeDental 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.

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.

Together, we CAN make a difference!