Coordinated by: Bonnie Bruerd, Drph and Kathy Phipps, Drph april 2007



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Northwest Tribal Dental Support Center


Oral Health Promotion and

Disease Prevention Manual








Coordinated by: Bonnie Bruerd, DrPH and Kathy Phipps, DrPH April 2007

Northwest Tribal Dental Support Center


The Northwest Tribal Dental Support Center (NTDSC), originally funded in Fall 2000 and currently in its second five-year grant cycle, provides services to all 33 IHS and tribal dental programs in Idaho, Oregon, and Washington. The overall goal of the NTDSC is to improve the oral health of the American Indian people in the Pacific Northwest.
The objectives and activities of the NTDSC focus on encouraging each program to employ public health principles in the administration of their clinical and community dental programs. The activities of the NTDSC are supported through ongoing communication with local dental programs via site visits, email groups, email and telephone consultation, and an annual Prevention Coordinators’ meeting.
Objective 1: Provide technical assistance to Portland Area dental programs through 8-12 clinical site visits and 8-12 preventive site visits yearly.
Objective 2: Improve access to dental care at programs served by the NTDSC, per the GPRA objective to maintain or improve access to care.
Objective 3: Improve access to prevention services for AI/AN people served by the Portland Area in the areas of sealants, topical fluoride, ECC, and access for patients with diabetes.
Objective 4: Assist dental programs in planning and evaluating HP/DP programs towards reaching Healthy People 2010 Objectives.

Objective 5: Identify training needs and provide training opportunities yearly.

Objective 6: Work with IHS Headquarters and other Dental Support Centers towards meeting national HP/DP objectives.


Director: Joe Finkbonner, RPh, MHA

jfinkbonner@npaihb.org
Project Assistant: Ticey Jo Casey, BS

tcasey@npaihb.org
Clinical Consultant: Jeff Hagen, DDS, MPA

jeffhagen@charter.net
Prevention Consultant: Bonnie Bruerd, DrPH

bonnie.bruerd@comcast.net
Epidemiology Consultant: Kathy Phipps, DrPH

krp123@charter.net



I don't have time

for prevention! Can't you see I'm up to my elbows in treatment?

(cartoon adapted from Shel Silverstein's Where the Side walk Ends)

You may think you can't afford to take time for prevention, but the truth is you can't afford NOT to take the time to prevent dental diseases. It is only through prevention that we will ever improve the oral health of Native American people in the future.


Table of Contents

Introduction .........................................................................................................4
I. Clinic-Based Prevention ..................................................................................5

Individualized Prevention Planning.............................................................6 Chemotherapeutics for Preventing Dental Caries.......................................7

Fluorides...................................................................................................10

Sealants....................................................................................................15

Dietary Counseling ...................................................................................17

Oral Hygiene Instruction and Prophylaxis.................................................19

Periodontal Disease Prevention ...............................................................21

Prevention of Oral and Pharyngeal Cancers.............................................24


II. Community-Based Prevention......................................................................25

Medical and Community Health Staff Training .........................................26

Water Fluoridation.....................................................................................27

School-Based Sealant and Fluoride Programs.........................................28

Early Childhood Cavities Prevention Programs........................................29

Community-Based Program Planning……………………………………….32




Additional Resources........................................................................................34
References...... ...................................................................................................35


INTRODUCTION


Native American populations have a higher prevalence of dental caries and periodontal diseases in all age groups compared to the general U.S. population. (1) More than 80 percent of Native American children experience dental caries. About 50 percent of these children experience severe Early Childhood Caries (ECC). While dental caries in the permanent dentition has decreased among Native American children, dental caries in the primary dentition has continued to increase.

In an Indian Health Service (IHS) survey, one third of Native American

schoolchildren reported missing school because of dental pain. Twenty-five

percent of the children reported avoiding laughing or smiling. Almost half

of the adults in the survey avoided laughing, smiling, and conversation with

others because of the way their teeth look. (2)


Dental caries is caused by a transmissible microbial infection that affects tooth mineral. There are many factors involved in the initiation and progression of dental caries,

including bacterial biofilm, the frequency of simple sugars in the diet, the flow and

composition of saliva, the availability of fluoride, the structure of tooth mineral in a given individual, and oral hygiene behaviors. (3-4) The prevention of dental caries should take in all of these factors.


Our goal is to reduce dental caries among children. This involves the effective use of fluorides, other chemotherapeutics like xylitol and chlorhexidine, sealants, and dietary interventions. A large portion of IHS and Tribal resources are often spent on the treatment of Early Childhood Caries while few resources are spent on the prevention of this devastating disease.
Periodontal diseases in Native American adults are 2.5 times more prevalent than in the general U.S. population. (1) High prevalence of diabetes, along with increasing rates of cigarette smoking among Native American people are significant contributing factors to periodontal disease. Our most effective tools for the primary prevention of periodontal diseases are self-assessment techniques and oral hygiene instruction. As secondary prevention, we can increase our efforts to identify high risk groups and implement early interventions which include scaling, root planing, chemotherapeutics, tobacco cessation, oral hygiene instruction, and the management of diabetes.
You will find that "targeting" is a recurring theme throughout this manual. We are long past the "one size fits all" model for dental disease prevention. Those patients at highest risk should receive increased levels of prevention services.


Clinic-Based Prevention





  • Individualized Prevention Planning




  • Chemotherapeutics for Preventing Dental Caries




  • Systemic and Topical Fluorides




  • Sealants







  • Oral Hygiene Instruction and Prophylaxis




  • Periodontal Disease Prevention




  • Prevention of Oral and Pharyngeal Cancers




To further support clinic-based interventions, it is important

that ALL dental staff are trained to deliver consistent,

repeated oral health promotion messages.

INDIVIDUALIZED PREVENTION PLANNING


An integral component of each dental exam should be a prevention assessment. Checklists have been used effectively to prompt health professionals to provide

prevention screening and services at regular intervals. If your examination form does not adequately address prevention needs, a stamp can be incorporated on each patient's exam form. The prevention assessment is meant to serve as both a mechanical reminder to the dental staff to address the preventive aspects of oral health care and as

documentation that the full spectrum of individual preventive measures were discussed with the patient or parent.



Prevention Assessment

Status of:

Water Fluoridated _____ppm

Use of Fluoride Toothpaste ______

Other Fluoride supplements _____

Oral Hygiene _________________

Tobacco Use _________________
Recommendations:

Topical Fluoride _______________

Sealants _____________________

OHI _________________________

Other ________________________

Recall intervals should reflect the findings from the initial exam and prevention assessment. Patients at low risk for dental caries can be recalled yearly. Those patients with white spots or other signs of early dental caries may need to be recalled several times during the year for fluoride applications. Recall intervals for adults are generally based on periodontal disease status, but should also take into account caries risk.



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