Educators Giving Kids a Head Start in Dental Health

1. Educators Giving Kids a Head Start in Dental Health LT Amy Dayhoff, RDH, MPH 2009 USPHS Scientific and Training Symposium Atlanta, GA

2. Objectives At the end of the session, participants will be able to: Discuss the options for community based preventive measures to improve the oral health of children. 2. Describe how to educate the Head Start staff on the importance of good oral health and to prevent caries in all their students. 3. Discuss the importance of fulfilling Healthy People 2010 Oral Health Objectives in community programs.

3. Facilitators  Brandee Palmer, BS Health Coordinator, Oglala Lakota College Head Start Program, Kyle, SD LCDR Nicole Glines, RHD, BS Community/Clinical Dental Hygienist, Pine Ridge, SD LT Amy Dayhoff, RDH, BS, MPH Community/Clinical Dental Hygienist, Pine Ridge, SD

4. Community Based Prevention Community-based caries preventive measures include school water fluoridation, school daily fluoride supplement programs, school fluoride mouthrinse programs, and school sealant programs. In addition, fluoride varnish is beginning to be more widely used among preschool-age children in community settings, including rural areas served by the Indian Health Service.

5. Community Based Prevention School-based programs promote long-term behavior change and reach beyond the school to actively involve parents. In the area of evaluation, health program participation rates are appropriate primary outcome measures in most community-oriented prevention programs. Other program evaluation priorities include community analysis and formative evaluation, providing data to fine-tune interventions and define the needs and preferences of the community.

6. Native American Health Components American Indian and Alaska Native (AI/AN) children experience dental decay at a higher rate than the general U.S. population. In the 1999 Indian Health Service survey of 2,663 preschool children ages 2-5, 79% had a history of dental decay and 68% had untreated dental decay. Over 50% had severe Early Childhood Cavities (ECC).

7. Pine Ridge Reservation The Pine Ridge Reservation was established during the 1876 Fort Laramie Treaty. Enrolled members living on reservation: 38,000. The 11,000-square mile (approximately 2,700,000 acres) Pine Ridge Reservation is the second-largest Native American Reservation within the United States. 

8. Pine Ridge Reservation

9. Oglala Sioux Tribe Most known for Battle of Wounded Knee, December 29, 1890 at which Chief Little Bigfoot died. Most recognized tribal flag. William Mervin Mills or "Billy" Mills (born June 30, 1938) victory in the 10,000 meter run at the 1964 Summer Olympic Games in Tokyo. To this day, Mills is the only American to win gold in the 10,000 meter run. Chief Crazy Horse (1840-1887) Chief Black Elk (1863-1950) Chief Red Cloud (1822-1909)

10. Terminology Dental Caries (dental decay or cavities): An infectious disease that results in de-mineralization and ultimately cavitation of the tooth surface if not controlled or remineralized. Early Childhood Caries (ECC): Dental decay of the primary teeth of infants and young children (aged 1 to 5 years) often characterized by rapid destruction. Fluoride: A compound of the element fluorine. Fluorine, the 13th most abundant element in nature, is used in a variety of ways to reduce dental decay.

11. Early Childhood Caries

12. Head Start and Early Head Start Head Start and Early Head Start are comprehensive child development programs which serve children from birth to age 5, pregnant woman and their families. They are child-focused programs, and have the overall goal of increasing the social competence of young children in low-income families.

13. Oglala Lakota Head Start 28 classrooms, 11 districts, 14 centers 9 family helpers and 36 Teachers

14. Validity of Program Shortage of providers to provide restorations Transportation of students to appointments Access to care High caries rate Geographic isolation Lack of economic resources Lack of culturally relevant materials

15. Program Objectives Objective 1: Educate the Head Start staff the importance of good oral health and to prevent caries in all their students. Objective 2: Application of fluoride varnish at least four times during the school year. Objective 3: Empower Head Start staff to discuss oral care with parents. Objective 4: Expand the options for community based preventive measures to improve the oral health of children. Objective 5: Fulfill Healthy People 2010 Oral Health Objectives.

16. Program Standing orders from CAPT Jan Colton, Pine Ridge Pediatric Dentist, was obtained for the teachers to apply fluoride varnish Brandee Palmer secured funds for fluoride varnish 200 packages of 0.25 ml child’s dose fluoride varnish 13 boxes x $126.00 = $1,638.00 13 x 200 = 2,600 doses LCDR Glines and LT Dayhoff provided an fluoride varnish training at required Teacher in-service. Teachers could practice applying to volunteer children during the training. First fluoride application by teachers was supervised by dental hygienists.

17. Fluoride Varnish Consent Form Administration for Children and Families OLC Head Start/ Early Head Start Program PARENT or GUARDIAN: Please complete and sign the Parental Permission for fluoride varnish (Paint to Prevent) Program treatment below. Parental Permission I give my son or daughter, _____________________________________, permission to have fluoride varnish placed on his or her teeth at least 4 times in a year by a trained staff or provider with prescription or standing orders. I have read the participation flyers and understand the procedure. The staff may refer to the medical history and contact list if any problems arise. I understand the Paint to Prevent program is a preventive program and the product is safe and effective. Preventive Dental Treatment Authorization I hereby authorize trained staff or providers to apply the varnish product to prevent dental caries and arrest incipient decay. I understand that the consent and authorization herein granted do not include major procedures. I also read the flyers and information on the product and consider it safe. This is considered a high risk area for oral diseases and participation in this preventive program will help reduce the rampant caries rate in the area. Please list any physical conditions that the school should be aware of (allergies, recurring illnesses, disabilities, chronic illnesses, etc.): ______________________________________________________________________________________ In the event that an illness or injury would require more extensive evaluation, I understand that every reasonable attempt will be made to contact me. I have read the general information and hereby agree to all policies of the Head Start/ Early Head Start center concerning medical/dental and preventive treatment including the above authorization for the dental preventive program. . I DO ___________ give my consent to have fluoride varnish applied. I DO NOT _____________ give my consent to have fluoride varnish applied. Parent or guardian’s name (please print): ___________________________________________________Parent or guardian’s signature: ___________________________________________ Date: __________ Dentist Name and phone number____________________________________________________________

18. Program Training

19. Fluoride Varnish The purpose of applying fluoride varnish is to retard,arrest, and reverse the process of cavity formation. Indications Infants and children with a moderate or high risk of developing cavities. A child is considered at risk if he/she: Has had cavities in the past or has white spot lesions and stained fissures Continues to use the bottle past 1 year of age or sleeps with a bottle containing liquids other than water Breastfeeds on demand at night Has a developmental disability Chronically uses high sugar oral medications Has family members with a history of caries Engages in prolonged or ad lib use throughout the day of a bottle or sippy cup containing liquids other than water

20. Fluoride Varnish Contraindications Children with a low risk of cavity formation who consume optimally fluoridated water or children who receive routine fluoride treatments through a dental office.

21. Fluoride Varnish Fluoride Varnish Advantages Does not require special dental equipment. Does not require a professional dental cleaning prior to application. Is easy to apply. Dries immediately upon contact with saliva. Is safe and well tolerated by infants, young children, and individuals with special needs. Is inexpensive. Requires minimal training.

22. What you need Disposable gloves Gauze sponges (2 x 2) Fluoride varnish Small disposable fluoride applicator Paper towels or disposable bibs to place under the child’s head (optional) Trash bag

28. Fluoride Varnishes applied October 2008—416 students December 2008—405 students February 2009—398 students April 2009—423 students

29. Lessons Learned Not utilized as a research project, therefore no specific data was gathered to evaluate program other than survey from teachers

30. Teacher Survey 99% of teachers enjoyed the training and thought it was helpful 76% said that they wanted more training in dental related areas. 89% said they feel comfortable applying the fluoride varnish

31. Healthy People 2010 Healthy People 2010 challenges individuals, communities, and professionals, indeed all of us to take specific steps to ensure that good health, as well as long life, are enjoyed by all.  Healthy People objectives also have been used in performance measurement activities. The Leading Health Indicators will be used to measure the health of the Nation over the next 10 years. The Leading Health Indicators are— Physical Activity  Overweight and Obesity  Tobacco Use  Substance Abuse  Responsible Sexual Behavior  Mental Health  Injury and Violence  Environmental Quality  Immunization  Access to Health Care 

32. Healthy People 2010 21-1. Reduce the proportion of children and adolescents who have dental caries experience in their primary or permanent teeth. 21-1b.  Reduce the proportion of children with dental caries experience in their primary and permanent teeth. 21-1c.  Reduce the proportion of adolescents with dental caries experience in their permanent teeth. 21-3. Increase the proportion of adults who have never had a permanent tooth extracted because of dental caries or periodontal disease. 21-12. Increase the proportion of low-income children and adolescents who received any preventive dental service during the past year.

33. References ADA. (n.d.) Early Childhood Caries. Retrieved May 29, 2009, from www.ada.org. HHS. (n.d.) Healthy People 2010. Retrieved May 15, 2009, from http://www.healthypeople.gov/default.htm IHS. (2008).Dental and Head Start. Retrieved May 1, 2009, from http://www.ihs.gov/nonmedicalprograms/headstart/docs/OralHealthBestPracticesFinal0207.doc Head Start. (n.d.). Retrieved May 28, 2009, from www.nhsa.org. Loue, Sana, Quill, Beth. (2001). Handbook of Rural Health. Kluwer Academic Publishers Group. Springer Wikipedia. (n.d.). Pine Ridge Indian Reservation. Retrieved May 28, 2009, from http://en.wikipedia.org/wiki/Pine_Ridge_Indian_Reservation.

34. Questions LT Amy Dayhoff, RDH MPH

35. Future Training

36. Brandee and her family