CariesManagementinInfantsatHigh RiskforEarlyChildhoodCaries

GerardoMartinez UCLAVenicePediatricDentistry CommunityHealthandAdvocacyTraining

PrevalenceofECC
Estimatescanvaryfrom5%to72%,dependingon diagnosticcriteria,age,raceandpopulation.5 A2007CDCpublicationnotedthateventhoughcaries prevalencehaddeclinedinschoolagedchildrensincethe 1970scariesrateamong25yearoldshad increased.7 ThisconfirmsECCasthemostcommonchronicchildhood diseaseintheUS.7
25%ofChildrenhave80%ofthedisease.9 DisproportionatelyaffectsMinoritiesanddisadvantaged populations.
5,7Ramosgome z,9Surgeon'sGeneralreport
7

CurrenttreatmentofECC
Focusoninterventionafterdiseasehasbeendetected.8 Followsthesurgicalmodel. TreatmentunderIV/GAinaclinicalsettingorintheOR. Surgicalapproachdoesnotaddresstheunderlyingcondition.
59%ofchildrentreatedunderIV/GAand74%ofchildrentreatedunder sedationrequiredfurthertreatment1.

8ramosgomez,1Gluck

CostofDentalNeglect
ERvisitwithouthospitalization$172 (median)10 ERvisitwithhospitalization$5,044 (median)10 ERvisitsbychildren012yearsoldinCalifornia10
2005 281 2006315 2007 306

Costofrestorativecarerangesfrom$170$2,212,plus anesthesiacostsmayadd$1,000to$6,000if hospitalizationisrequired11

10californiahealthcarefoundation11Udin

SpecialSupplementalNutritionProgramforWomen,Infantand Children (WIC)

Federallyfundedhealthandnutritionprogram13. Provideschecksforbuyinghealthysupplementalfoods13. FY2010thenumberofwomen,infantsandchildren receivingWICbenefitseachmonthreached approximately9.17million15
4.86millionchildren15 2.17millioninfants15 2.14millionwomen15
13WIC

WIC
Over1/3ofinfantsbornintheUSare enrolledinWIC16 >60%ofallchildrenborninCaliforniaare servedbyWIC.14 SantaMonicaWIC:
Average1,500infantsandchildrenper month.
15FNS,16Lee

SantaMonicaWICandSimmsMann HealthandWellnessCenter

ProjectObjectives:
EstablishanInfantOralHealthclinicataWICcenterin SantaMonica. Conductearlyinfantoralcarevisitstoprovidepreventive services:
CariesriskassessmentusingCAMBRA KneetoKneeexamination Prophylaxis Fluoridevarnishbasedonrisk Anticipatoryguidance

Improvecompliancewithdentalvisitbyageone. DetermineprevalenceofECC Determinenumberofpatientsrequiringimmediatereferralfor treatment

Methods:
Patientswereassignedtooneof4groups dependingonageattheirfirstdentalexam
Group#1[618] monthsoldatfirstdentalexam. Group#2(1830] monthsoldatfirstdentalexam. Group#3(3042] monthsoldatfirstdentalexam. Group#4(4260] monthsoldatfirstdentalexam.

ClinicalProtocols RecallVisits
Recallevery1monthifhighcariesrisk. Recallevery3monthsifmoderatecariesrisk. Recallevery6monthsiflowcariesrisk

Results:

DentalHistory

91%

1st Dental Exam Pevious Dental Exam

N: 66

Mean age: 26.3months

HealthCareCoverage

77.3%

MediCal Private NoCoverage

NumberofPatientsperIntervention Group
25 20 15 Number of Patients 10 5 0 [6-18] (18-30] (30-42] (42-60] 21 22

12

11

PercentofPatientsperCariesRisk CategoryatInitialVisit
70
% of Patients

60 50 40 30 20 10 0 Low Moderate
Caries Risk

Low Moderate High

N:66

High

PercentofPatientsperCariesRisk CategoryatFinalVisit
70
% of Patients

60 50 40 30 20 10 0 Low Moderate
Caries Risk

Low Moderate High

N:66

High

DistributionofWSandCavities
100%

1 2

1 1 2

80%

60%

2 20 19 8 5

40%

20%

0% 618 1830 3042 4260 Number ofchildrenwithCavities Only Number ofchildrenwithWhiteSpots Only Number ofchildrenwithWhiteSpots &Cavities Number ofchildrenwithhealthyteeth

Distributionoftoothdecay

AveragenumberofLesionsperInfected Child
12.0 Averagenumber ofWS&CAVper infectedchild 10.0 Averagenumber ofWSonlyper infectedchild Averagenumber ofCAVonlyper infectedchild 8.0

6.0

10.5
4.0

6.0
2.0

2.0
0.0 6 18

3.0

4.0 1.0

4.0 1.5
42 60

18 30

30 42

NumberofWSandCavitationsperInfectedChild

Ages30monthsto42months
12 10 8 6 4 2 0 1 2 3 4 5 6 7 8 9 10 11 12

Ages42monthsto60months
7 6 5 4 3 2 1 0 1 2 3 4 5 6 7 8 9 10 11

Number of Cavities

Number of White Spots

PrevalenceofECC
# of Children % of Total % Sub# group of Teeth % Total % SubGroup

Total

66

965

ECC Teeth
Severe ECC

14 7

21.2% 10.6% 50%

56 43

5.8% 4.5% 76.8%

Observations
EstablishinganinfantclinicataWICsitecan provideaccesstopatientsatayoungage (Avg.Age:26.3m) Byprovidingearlydentalexamsandpreventive servicescariesriskcanbereduced Earlydetectioncanleadtotimelyreferralfor restorativetreatment

Observations
MostpatientsparticipatinginWICareactive MediCalrecipients WICshouldbeconsideredakeypartnerto improveaccesstocareforhighriskpopulations Thispreliminarydatashowssuccessona preventiondiseasemodelthatcanbereplicated inothernonclinicalsettingsonECCprevention

THANKYOU

References
1. 2. 3. Gluck,George.Jong'sCommunityDentalHealth,5thEdition.Mosby,012003.p.157).vbk:032301467 4#outline(7.3) (Pinkham,JimmyR..PediatricDentistry:InfancyThroughAdolescence,4thEdition.Mosby,042005.p. 204).<vbk:0721603122#outline(12.5.6)> AmericanAcademyofPediatricDentistry:DefititionofEarlyChildhoodCaries (ECC),PediatrDent V32No6:pg15(Referencemanual20102011). RJBerkowitz:Etiologyofnursingcaries:amicrobiologicperspective.J PublicHealth.56,1996,51 RamosGomezF.CosteffectiveModelforthePreventionofEarlyChildhoodCaries.JCDA.July1999 MulliganR,SeirawanH,etal.DentalCariesinUnderprivilegedChildrenofLosAngeles.JHealthCarefor thePoorandUnderserved.22,(2011)648662. RamosGomezF.PediatricDentalCare:PreventionandManagementProtocolsBasedonCariesRisk Assessment.JCDA.38,2010,746761 RamosGomezF.,JueB.,BontaY.ImplementinganInfantOralCareProgram.JCDA2002 Surgeonsgeneralreport2007 EmergencydepartmentvisitsforpreventabledentalconditionsinCalifornia.Californiahealthcare foundation.2009 Udin,R.NewerapproachestoPreventingDentalCariesinChildren.JCDA1999

4.

5. 6. 7. 8. 9. 10. 11.

References
7. 8. 9. 10. 11. 12. 13. 14. 15. 16. RamosGomezF.PediatricDentalCare:PreventionandManagementProtocolsBasedonCariesRisk Assessment.JCDA.38,2010,746761 RamosGomezF.,JueB.,BontaY.ImplementinganInfantOralCareProgram.JCDA2002 Surgeonsgeneralreport2007 EmergencydepartmentvisitsforpreventabledentalconditionsinCalifornia.Californiahealthcare foundation.2009 Udin,R.NewerapproachestoPreventingDentalCariesinChildren.JCDA1999 Perry,DMommy,ithurtstochewTheCaliforniasmilesurveyAnoralHealthAssessmentofCalifornias Kindergartenand3rd GradeChildren.DentalHealthFoundation2006 WICHomepagewww.cdph.ca.gov/programs/wicworks/pages/default.aspx CenterforOralHealth.WICPrograms.www.Centerfororalhealth.org/programs/wicprograms FoodandNutritionServices.USDepartmentofAgriculturewww.fns.gov.wic/faqs/faq.htm#3 LeeYJ.RoizerG.etal.EffectsofWICparticipationonChildrensUseofOralHealthServices.American JournalofPublicHealth.May2004.Vol.94,No.5