Update on the IHS ECC Collaborative&

Virtual Learning Community Program (VLCP)&

A Call to Action

April 25, 2012Albuquerque 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 (2nd highest)– 77.7% of 2-5 year-olds had experienced

caries (2nd 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 Site ChangeFY 2009 – Q1, FY 2012

Non-VLCP Site ChangeFY 2009 – Q1, FY 2012

National ChangeFY 2009 – Q1, FY 2012

Access, 0-5 + 8% + 6% + 7%

Sealants, 0-5 + 54% + 23% + 32%

Fluoride Patients, 0-5 + 21% + 16% + 17%

Medical Fl Apps, 0-5 + 140% + 130% + 136%

ITRs, 0-5 + 61% + 80% + 73%

VLCP “Champions”:Highlighted on March VLCP call

• Increased dental access from 47-103% 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

FY 2009 (baseline) FY 2010 FY 2011 FY 2012 (projected)0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

0-2 year-olds3-5 year-olds0-5 year-olds

0-2 year-old access

2009 (baseline) 2010 20110

50

100

150

200

250

300

350

400

450

500AIDCAlb1ACLMescaleroSanta FeZuniSouthern ColoradoJicarillaTaosAlb2YsletaPine Hill

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 2009• 47% increase in 0-2 year-old sealants since 2009

(but very small numbers, from 99 to 159)

FY 2009 (baseline) FY 2010 FY 2011 FY 2012 (projected)0

500

1000

1500

2000

2500

0-2 year-olds3-5 year-olds0-5 year-olds

0-2 year-old sealants

2009 (baseline) 2010 20110

20

40

60

80

100

120AIDCAlb1ACLMescaleroSanta FeZuniSouthern ColoradoJicarillaTaosAlb2YsletaPine Hill

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 1st molars, and 75% of sealants in primary 2nd 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 2009• 13% increase in 0-2 year-old sealants since 2009

FY 2009 (baseline) FY 2010 FY 2011 FY 2012 (projected)0

500

1000

1500

2000

2500

3000

3500

4000

4500

0-2 year-olds3-5 year-olds0-5 year-olds

0-2 year-olds receiving fluoride varnish

2009 (baseline) 2010 20110

50

100

150

200

250

300

350

400

450AIDCAlb1ACLMescaleroSanta FeZuniSouthern ColoradoJicarillaTaosAlb2YsletaPine Hill

Everyone except Southern Colorado decreased from 2010-2011. 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 2009• 318% increase in 0-2 year-old sealants since 2009 (small

numbers, from 11 to 67)

FY 2009 (baseline) FY 2010 FY 2011 FY 2012 (projected)0

50

100

150

200

250

300

350

400

0-2 year-olds3-5 year-olds0-5 year-olds

ITRs, 0-5 year-olds, Albuquerque Area

2009 (baseline) 2010 20110

20

40

60

80

100

120

140

160

180AIDCAlb1ACLMescaleroSanta FeZuniSouthern ColoradoJicarillaTaosAlb2YsletaPine Hill

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 concernsabout 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 3rd 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 amalgamsSee 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!