State Response— The State agrees and will look into this request.
VOC with ENPR- do they have to see a Doctor in AK?
State Response—The State will update the VOC policy to include comments on the ENPR.
Regarding Blood Lead Level (BLL)- do we need to see a doc with increased BLL and add into anthros or can parents verbally tell us the child has an increased lead level and we assign the RF?
State Response— The State allows clients to report to the Blood Lead Level (BLL) to LAs verbally. We don’t require any formal documentation from the client’s health care professional.
Policy question: who can bring the child in for certification?
State Response—The State has recently updated program policies and this was discussed at the October policy teleconference. The updated policy is that anyone who the guardian or parent identifies as a proxy with knowledge of the child’s health and nutrition history and has the proper documents can bring the child in for recertification and mid-cert assessments. See updated policies for further clarification
Does the immigration office understand that WIC does not count against citizenship?
State Response—If you participated in the oral health continuing education webinar on Sept. 15, please contact Jennifer Johnson if you want a certificate. If this refers to something else, please let us know.
SDF is a new product on the market although it works similar to silver nitrate which had been used in dentistry since the early 1900s. The silver in the compounds kills the bacteria associated with tooth decay and can arrest the decay process. Use of silver nitrate fell out of favor due to cosmetics in the 1950s and it was felt with the advent of community water fluoridation there was a new approach to manage dental decay.
You will be seeing teeth like the picture below in Alaska as many of the Tribal dental programs will be employing use of this product along with fluoride varnish to prevent and manage early childhood caries. Unlike the picture below – earlier decay associated with feeding practices (e.g., putting babies to bed with bottles) often starts on the back side of upper front teeth – in these cases the blackened tooth areas would be less visible. The main issue with the product is the cosmetics – so education of the parent on the process and the staining is part of the informed consent process. It may require several applications and even with that the evidence is about 10% of teeth with decay will still need the process for drilling and filling. Also, use of SDF is for teeth w/o symptoms – if there was already pulp involvement-abscess then the tooth requires definitive treatment.
Use of this process has the potential to reduce the number of children having to go to the hospital for treatment under general anesthesia. Caught early the process for both SDF, fluoride varnish or even moving soft dental decay with a hand instrument is “painless.” So avoids the dynamic of creating children that are fearful of dental visits and behavior problems with later visits. Some Tribal programs are also using iodine products to reduce the bacterial process with tooth decay.
This is movement to a disease management approach than the surgical approach used (drilling and filling – which temporarily addresses the issue on a specific tooth but doesn’t stop the dental decay process which often leads to more teeth getting decay or even decay on the same tooth that had been treated). Further, the main risk factor for decay in permanent teeth is the past situation with decay in the primary teeth. That said, the next big step is getting sealants on the permanent molars as they erupt. Sealants on primary molars is also recommended. The anatomy of molars (primary and permanent) with pits and grooves in these teeth make these teeth more likely to experience tooth decay than the smooth surfaces of front teeth (canines and incisors).