This document summarizes evidence on interventions to reduce early childhood caries (ECC). ECC is a serious public health problem affecting many children. Studies show training primary care providers in risk assessment, fluoride varnish application, and referral can increase access to preventive dental care and reduce ECC rates and treatment needs, though more research is still needed on integrating medical and dental services.

1. Early Childhood Caries: Do We Have Sufficient Evidence of Effective Interventions to Reverse National Trends? Gary Rozier, DDS, MPH USPHS Symposium Dental Category Day Atlanta, GA June 2, 2009

3. % Trends in Caries Experience by Dentition Type, U.S., 1971 - 2004 Permanent teeth, 6-11 years of age

4. % Trends in Caries Experience by Dentition Type, U.S., 1971 - 2004 Permanent teeth, 6-11 years of age Primary teeth, 2-5 years of age

6. ABC News- March 6, 2009 Brandon had an astounding 16 baby root canals completed at one visit--nearly every tooth in his mouth. "He comes walking out of that door…and he had blood dripping from his mouth. And all I could see was silver shining through.“ [Mother] Hunter, another child who received the same treatment and was just starting pre-kindergarten, was teased by other children as a "metal mouth" and said "it just made me feel, like, bad." "I feel like they took my son's smile away." [Mother]

7. % parents reporting child dental problems or treatment affecting child or family “occasionally, often or very often” among parents of children with obvious caries experience (d 2 mfs>0) Impacts of Dental Disease 4 Smiling, talking 58 Both child and parent impacts 23 Work, finances 36 Upset, guilty 45 Parent overall impacts 16 Sleeping, irritable 17 Pain 26 Eating, drinking, talking, daycare 35 Child overall impacts Percent Impact

9. “ Maine has 2 DDS for every 2,300 people, compared to 1 MD for every 640. Nationally there is 1 DDS for every 1,600 people.” “ In Maine, training MDs in dentistry provides a dental safety net for the rural poor.” March 3, 2009 Short of Dentists, Maine Adds Teeth to Doctors’ Training Ronald Smart who had not been to a dentist in 5 years, came to Fairfield clinic to have an infected tooth pulled; he has had 3 pulled there before, and likely Will have more.

13. Caries Prevention Methods Food Host Bacteria Multifactoral Disease Plague control Fluoride therapy Sealants Fluoride therapy Antimicrobials Anti-caries Vaccine Diet Counseling

14. .... a quick look at preventive methods for primary care setting.....

22. Dental Caries Incidence by Treatment Group p < 0.001; n=280 3-4 % Number of Applications

24. Geographic Disparities in ECC 27% 61% 63% 29%

32. Number of Visits Per Year Average annual increase = 21% Visits

34. Referral Effectiveness IMB Visit N=24,403 Referred (33%) Not Referred (67%) Referred (1%) Not Referred (99%) Visit 35.6% 12.0% 11.9% 2.5% ECC (5%) No ECC (95%)

39. Percent Sleep with bottle Family has dental problems No fluoride in water Fluoride toothpaste not used Drink juice between meals Other oral condition Dental caries Enamel defects White spot lesions Visible plaque Behavioral Clinical Percent of Patients with Risk Factors n-=1,825; Not mutually exclusive categories

40. Referral Guidelines Cavitation or CSHCN White spot lesions Enamel defects Other concerns > 3 risk factors <3 risk factors Pediatric dentist General dentist Physician manages caries risk Yes (6%) No Yes (23%) No (72%)

41. Percent of Children Referred %

45. Stage of Adoption of Medical Model by State Medicaid Programs Sams et al., 2009. = No Initiative in place; no plans for one (n=13) = Existing Program (n=28) = Plans to implement initiative in next 12 months (n=10) 3 states confirmed by telephone (Mississippi, Illinois, West Virginia) 1 state by guidelines (Wisconsin) RI TX FL NC CA OR WA AZ NM UT NV ID MT CO WY HI AK NE SD ND OK KS IA MO WI MN LA AR IL MI GA TN KY IN OH MS AL WV VA ME VT NH NY PA MD NJ DC MA CT SC Delaware

47. It’s been a wild ride!

48. Screening? Referral? Counseling? Fluoride? Diet? Risk Assessment? CME? Tx?