Barriers to ECC Control in AI/AN Children. A Quick Through a Land of Mythology

Transcription

1 Barriers to ECC Control in AI/AN Children A Quick Through a Land of Mythology

2 Barriers to ECC Control: Myth #1 We know everything we need to know to control this disease. We just need to do a better job with the tools we have.

3 Barriers to ECC Control: Myth #2 Dentists Are the Purveyors of Dental Health

4 Barriers to ECC Control: Myth #2 Dentists Are the Purveyors of Dental Health Indian Community Health Profile Recommended Dental Health Indicator: Proportion of the children with a dental clinic visit within the last year You can t say our ECC-prevention program has failed; 60 percent of 2 year- old AI/AN children have never seen a dentist! Would a community of adults have good cardiac health if they all had a visit to their cardiovascular surgeon in the last year?

5 Barriers to ECC Control: Myth #3 "If there are enough shovels to go around, everybody's going to make it." Thomas K. Jones Deputy Under-Secretary of Defense for Nuclear Forces Ronald Reagan Administration

6 Barriers to ECC Control: Myth #3 If There Are Enough Dentists Soon after I started working for this South Dakota tribal community, I knew what we needed was a pediatric dentist. Fifteen years later I am one of two pediatric dentists here But we will never drill and fill our way out of this disease. - John Zimmer, DDS

7 Current IHS Dentist Vacancies (February 2010) City, State IHS Area Belcourt, ND; Aberdeen Kyle, SD; Aberdeen Ft. Yates, ND; Aberdeen Sisseton, SD; Aberdeen Belcourt, ND; Aberdeen Belcourt, ND; Aberdeen Pine Ridge, SD; Aberdeen Flandreau, SD; Aberdeen Eagle Butte, SD; Aberdeen Newtown, ND; Aberdeen Rapid City, SD; Aberdeen Winnebago, NE; Aberdeen Santee, NE; Aberdeen Belcourt, ND; Aberdeen Ft Yukon, AK; Alaska Bethel, AK; Alaska Bethel, AK; Alaska Bethel, AK; Alaska King Cove, AK; Alaska Juneau, AK; Alaska Barrow, AK; Alaska Anchorage, AK; Alaska Fairbanks, AK; Alaska Fairbanks, AK; Alaska City, State IHS Area Albuquerque, NM; Albuquerque Taos, NM; Albuquerque Red Lake, MN; Bemidji Lac du Flambeau, WI; Bemidji Ogema, MN; Bemidji Hayward, WI; Bemidji Crandon, WI; Bemidji Cass Lake, MN; Bemidji Webster, WI; Bemidji Harlem, MT; Billings Crow Agency, MT; Billings Red Bluff, CA; California Philadelphia, MS; Nashville Rock Hill, SC; Nashville Gallup, NM; Navajo Gallup, NM; Navajo Red Mesa, AZ ; Navajo Pinon, AZ; Navajo Kayenta, AZ; Navajo Gallup, NM; Navajo Tuba City, AZ; Navajo Sage, AZ; Navajo Chinle, AZ; Navajo Crownpoint, NM; Navajo Crownpoint, NM; Navajo Tahlequah, OK; Oklahoma City Anadarko, OK; Oklahoma City Coweta, OK; Oklahoma City Lawton, OK; Oklahoma City

8 Barriers to ECC Control: Myth #3 If There Are Enough Dentists With our recent dental clinic renovation including 10 new operatories and additional staff we have more than doubled our capacity. We now can meet almost 25% of the basic needs of our community for dental services. Robert Palmer, DMD, Dental Director, Tuba City, Arizona, 2005.

9 Current IHS Dentist Vacancies (February 2010) City, State IHS Area Belcourt, ND; Aberdeen Kyle, SD; Aberdeen Ft. Yates, ND; Aberdeen Sisseton, SD; Aberdeen Belcourt, ND; Aberdeen Belcourt, ND; Aberdeen Pine Ridge, SD; Aberdeen Flandreau, SD; Aberdeen Eagle Butte, SD; Aberdeen Newtown, ND; Aberdeen Rapid City, SD; Aberdeen Winnebago, NE; Aberdeen Santee, NE; Aberdeen Belcourt, ND; Aberdeen Ft Yukon, AK; Alaska Bethel, AK; Alaska Bethel, AK; Alaska Bethel, AK; Alaska King Cove, AK; Alaska Juneau, AK; Alaska Barrow, AK; Alaska Anchorage, AK; Alaska Fairbanks, AK; Alaska Fairbanks, AK; Alaska City, State IHS Area Albuquerque, NM; Albuquerque Taos, NM; Albuquerque Red Lake, MN; Bemidji Lac du Flambeau, WI; Bemidji Ogema, MN; Bemidji Hayward, WI; Bemidji Crandon, WI; Bemidji Cass Lake, MN; Bemidji Webster, WI; Bemidji Harlem, MT; Billings Crow Agency, MT; Billings Red Bluff, CA; California Philadelphia, MS; Nashville Rock Hill, SC; Nashville Gallup, NM; Navajo Gallup, NM; Navajo Red Mesa, AZ ; Navajo Pinon, AZ; Navajo Kayenta, AZ; Navajo Gallup, NM; Navajo Tuba City, AZ; Navajo Sage, AZ; Navajo Chinle, AZ; Navajo Crownpoint, NM; Navajo Crownpoint, NM; Navajo Tahlequah, OK; Oklahoma City Anadarko, OK; Oklahoma City Coweta, OK; Oklahoma City Lawton, OK; Oklahoma City

10 Barriers to ECC Control: Myth #4 We Can t Control ECC Until We Eliminate Poverty

11 Barriers to ECC Control: Myth #4 It s the poverty

12 Barriers to ECC Control: Myth #5 We Can t Do Anything to Control ECC Because of the Parents Won t Change Their Behavior

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14 Hypertension Prevention In Six Simple Lifestyle Changes! 1. Maintaining ideal body weight 2. Moderate to vigorous exercise for 30 minutes at least 4 times a week 3. Following a heart-healthy diet 4. Etc. 5. Etc. 6. Etc.

15 But for those 104,606,250 U.S. adults who cannot manage those six easy lifestyle changes we have

16 Partial List of FDA-approved Medications for Hypertension chlorothiazide chlorthalidone hydrochlorothiazide (hctz) indapamide methyclothiazide metolazone polythiazide loop thiazides non-isa beta-blockers potassium-sparing thiazides aldosterone receptor blockers bumetadine furosemide Torsemide atenolol betaxolol bisoprolol metoprolol nadolol propranolol propranolol long-acting timolol amiloride triamterene Aldactone (spironolactone) Inspra (eplerenone) FE spironolactone Combined alpha-and beta-blockers benazepril captopril enalapril fosinopril lisinopril moexipril quinapril acebutolol pindolol clonidine clonidine patch methyldopa reserpine guanfacine Dihydropyridines Norvasc amlodipine besylate Sular (nisoldipine) cartia diltia diltiazem taztia verapamil doxazosin Prazosin terazosin nicardipine nifedipine

17 List of FDA-approved Products for Prevention of ECC

18 Barriers to ECC Control: Myth #6 If the Usual Stuff Didn t Work, She Was Probably Lying

19 Barriers to ECC Control: Myth #6 She is probably lying Rule #1: If the mother: - stops the baby bottle before age 1 - does not give the bottle at night - does not put sugared beverages in the bottle - cleans her infant s teeth her child won t get ECC. Rule #2: If the mother does all these and her child still gets ECC she is probably lying

20 Barriers to ECC Control: Myth #7 ECC is Self-limiting Disease of the Primary Dentition

21 Barriers to ECC Control: Myth #7 ECC is Self-limiting Disease This is the second molar of a 14 year-old Indian boy. Sealants provide some but not total protection to the teeth

22 Barriers to ECC Control: Myth #8: Indian Parents Don t Care

23 Barriers to ECC Control: Myth #8: Indian Parents Don t Care It was a windy, near zero mid- January day in South Dakota

24 Barriers to ECC Control: Back To Reality Polio, measles, mumps, rubella, whooping cough, Hib meningitis are all infectious diseases that used to be epidemic in AI/AN children. Now all these are essentially eliminated. ECC is an infectious disease of AI/AN children that is still rampant

25 Barriers to ECC Control: Back To Reality How did we eliminate polio, measles, mumps, rubella, whooping cough, Hib meningitis among AI/AN children? By a combination of technology and public health infrastructure We have the infrastructure to control ECC, but we don t have the technology. Why?

26 Barriers to ECC Control: Why We Don t Have the Technology James Joyce referred to the secret cause of human suffering Polio, measles, mumps, rubella, meningitis are equal opportunity diseases very severe ECC is not.

27 A Perfect Storm What is a child is born with substantial areas of enamel hypoplasia And the child has heavy and repeated exposure to S. mutans from birth And the child has modest exposure to fermentable sugars What would you expect to see?

28 In conclusion, we have nothing to fear but our own velleity

29 Thank you