Collaborating to Improve Oral Health in Oklahoma

Tooth decay (also known as caries or cavities) is one of the most common chronic health conditions affecting children in the United States.¹ American Indian and Alaska Native children have especially high rates of tooth decay; the rate for American Indian and Alaska Native children ages 3 to 5 is 43%—more than 4 times the rate for white children.²

To address this health disparity, the Indian Health Service (IHS) Division of Oral Health created the Early Childhood Caries (ECC) Collaborative in 2009. Dr. Tim Ricks, Deputy Director of the Division, explains why. “Early childhood caries result in pain, infection, delayed speech development, lower self-esteem, and children being ostracized by their peers,” he says. 

This national initiative relies on local IHS Division of Oral Health service units to increase the following for children ages 1 to 5 in their communities:

• Access to dental care
• Dental sealants in primary teeth
• Fluoride varnish applications
• Interim therapeutic restorations (a technique that prevents progression of decay without the need for anesthetic)

Implementing the Program at the Local Level

Stephanie Lovell is a registered dental hygienist with the IHS Lawton Service Unit, serving the towns of Lawton and Anadarko in Oklahoma. She heard about the ECC Collaborative at an IHS regional meeting in 2011. “We went right out to all of the Head Starts, day cares, and public schools and began doing dental screenings and applying fluoride varnishes and dental sealants,” she says.

Lovell uses techniques like glass ionomer sealants that are easier to apply and don’t require as much equipment as traditional resin sealants, making them a good fit for a mobile operation. She might spend a day at a small day care or a week at a larger public school, working alone or with an assistant. “You don’t need a ton of resources or equipment,” she says. “One or 2 people can go out and make a difference.”

All this hard work in the field is paying off: the Lawton Service Unit currently leads over 400 IHS Division of Oral Health service units in reduction of early childhood caries.

Overcoming Barriers to Care in Schools

Coordinating with schools to get parental consent was a big challenge at first, Lovell says, but they streamlined the process by including consent forms in student enrollment packets. “The biggest thing was establishing relationships with parents and teachers,” she continues. “Now when we come to the sites, they’re happy to see us.”

Fear and anxiety about dental care is another obstacle that can be overcome. “One little girl just screamed and refused to get in the dental chair. Her teacher and I worked with her every day, and by the end of the week she ran up and jumped into the chair. She’s decay-free now!”

Visiting the schools year after year can help normalize dental care and build positive feelings about dental visits. “Now kids see me in Walmart and they wave,” Lovell says. “They’re not scared of the dentist like they used to be.”

Shifting the Paradigm on Early Intervention

Protecting children’s oral health starts early—even before kids enter school or day care. “In years past,” Ricks says, “pediatricians would advise parents to take their children to the dentist at age 2 or 3. But that’s too late to prevent decay.” The initiative adopted the slogans “Two is too late” and “First tooth, first exam” to stress the importance of early care.

Prior to the Collaborative’s efforts, many general dentists referred young children out to pediatric dentists—but a shortage of these specialized providers meant that a child could wait 6 months or longer for an appointment. “By that time,” Ricks says, “the child would have a mouth full of cavities.”

Through education and training, the Collaborative encouraged all dentists and hygienists to treat young children instead of referring them out. “We saw a true paradigm shift,” Ricks says. “Now dentists routinely see 1- and 2-year-old kids for preventive care.”