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ADA Foundation Caries Symposium explores prevention of childhood epidemic

August 30, 2016

By David Burger

ADA Foundation logo

New York
— “We can’t eradicate childhood caries alone,” ADA President Carol Gomez Summerhays said. “Bringing together experts helps us get to our goal. Each is a key participant.”

Dr.  Summerhays made these welcoming remarks Aug. 18 at the beginning of the ADA Foundation Caries Symposium held at the New York University College of Dentistry. She talked about a summer trip to the Rosebud Reservation in South Dakota to hear and see firsthand the health care challenges that the Rosebud Sioux Tribe faces — including the fact that many children there do not own a toothbrush.

The tribe is burdened by high rates of early childhood caries, and the trip bolstered her belief that dentists and experts need to get down to the community level, but that one size does not fit all.
Photo of Dr. J. Timothy Wright and Dr. Reneida E. Reyes
Two better than one: Dr. Reneida E. Reyes, right, ADA Foundation president, speaks during a panel discussion Aug. 18 at the NYU College of Dentistry for the ADA Foundation Caries Symposium while Dr. J. Timothy Wright of the North Carolina School of Dentistry takes notes.
About 100 people showed the depth of their commitment to the elimination of childhood caries by participating in the day-and-a-half symposium that posed the question, “If Childhood Caries is a Preventable Disease, Why is it Still a Problem?”

Sponsored by Colgate and Henry Schein, the program brought together people who are involved in childhood caries studies, outreach programs and public health and policy in order to address the issue of childhood caries, especially in underserved populations in the United States. The attendees came from 29 states and Canada, and heard presentations from nearly 20 experts, including university professors and deans who have spent their lives researching and treating children and their teeth. The speakers also included public health dentists and officers, officers from government agencies, practicing dentists, pediatricians and dental hygienists.

The conversations outside the lecture hall during coffee breaks centered on various approaches participants are utilizing with young patients and their parents to reduce childhood caries, including effective communications and strategies for initiating intervention techniques earlier, and including prenatal discussions and well-child visits.

Attendees voiced concern about the disconnect between the public’s willingness to provide well-child visits for older children and the lack of programs advocating similar attention to infant and toddler oral health. They also identified the need to get others to recognize that a problem with a tooth is not an isolated issue, but rather part of overall systemic health.  
Photo of Dr. James J. Crall in front of a packed lecture hall at the ADA Foundation Caries Symposium.
Fruits of labor: Dr. James J. Crall of the UCLA School of Dentistry presents a research study on continuity of care in front of a packed lecture hall Aug. 18 at the NYU College of Dentistry for the ADA Foundation Caries Symposium.
Attendees believe that initiating such conversations earlier in the process does not just involve patient engagement.There was recognition that caries prevention and caries risk management needs to be built into dental residency programs and dental school curricula, and also in curricula for various allied oral health professionals. The importance of establishing a “dental home” – that is, a plan for continuity of care – must be emphasized in a variety of ways, including in Give Kids A Smile programs.

One of the most repeated messages concerned collaboration between dentists and primary care doctors. The latter can be effective in identifying dental issues when they occur, if encouraged to do so and if properly trained.  There is a recognized need to shift the focus to the earliest pediatric care, and for there to be meaningful continuity of care involving pediatricians, caregivers and dental professionals. Identifying models of reimbursement supportive of preventative efforts was also mentioned as having potential value for reducing childhood caries.

Collaboration among all of these parties was one of the main takeaways. “It takes a village,” said Dr. Margherita Fontana, Ph.D., professor, department of cariology, restorative sciences and endodontics, University of Michigan School of Dentistry. She has a trial underway looking at validating an approach to collect dental risk data in the medical setting.  She talked about overcoming barriers and the value of identifying a local champion who will be able to carry the effort forward.

Photo of Dr. Man Wai Ng
Teaching: Dr. Man Wai Ng of the Boston Children’s Hospital and the Harvard School of Dental Medicine presents her research findings on risk assessment and treatment protocols during the ADA Foundation Caries Symposium Aug. 18 at the NYU College of Dentistry.
In the first session there was general agreement about the value of caries risk assessment, and John D.B. Featherstone, Ph.D., dean of the University of California at San Francisco School of Dentistry, gave a presentation about his ongoing efforts at validating an approach. Dr. Man Wai Ng of the Boston Children’s Hospital and the Harvard School of Dental Medicine advanced the discussion by asking how to best use caries risk assessment data, indicating that its value lay in integrating such data into a chronic disease management protocol.  She emphasized the importance of the focused dialog between clinician and patient.  Engaging patients and their families is key, she said, and she presented several strategies, including helping children and their parents set realistic and attainable self-management goals.  

In terms of integration of oral and overall health, several speakers discussed the role of federally qualified health centers. For example, in California only a third of the FQHCs have medical and dental services in the same facility, despite the desirability of having integration between such programs.  Even when that integration does exist, as Dr. Mona Van Kanegan pointed out in her talk, only 29 percent of existing patients actually enrolled to participate in oral health screenings. She described her work with the Oral Health Forum in Illinois, which piloted a case management program in several Chicago public schools. By engaging with parents, she and her colleagues were able to raise awareness about the importance of screening programs and then work with parents to find the resources needed to provide care for their children.

Dr. Richard Niederman, chair, department of epidemiology and health promotion at the NYU College of Dentistry, built on Dr. Van Kanegan’s point when he explained the approach used by his team to bring care to the kids, resulting in a drop from 67 percent of children with untreated caries in 2003, to 21 percent in 2010.  

CAPT. Bruce Dye of the National Institute of Dental and Craniofacial Research shifted the discussion to the importance of using data to affect health policy. While there will always be a desire to further reduce the prevalence of early childhood caries, he said, there may be a point below which it will not be possible to go. For example, he showed  that providing additional fluoride treatments did not diminish caries rates. He provided a graphic demonstration using disparities data on caries rates which he interpreted as suggesting a 20 percent equilibrium level for early childhood caries.
Photo of Dr. James J. Crall in front of a packed lecture hall at the ADA Foundation Caries Symposium.
Sharing: Dr. Bruce Dye of the National Institute of Dental and Craniofacial Research talks to the audience about his research Aug. 18 at the NYU College of Dentistry for the ADA Foundation Caries Symposium.
As with any other assembly of researchers, this group demonstrated an enthusiasm for data. Dr. Natalia Chalmers, Ph.D., from the DentaQuest Institute, provided insight about sealant retention, revealing that age is an important contributor to the longevity observed.  Dr. Joseph Greenburg, founder of Kids Smiles in Philadelphia, said that not only is there variation in state-mandated dental screening, but the law merely stipulates that the data be collected — not that it be displayed or made available.  Baseline data is critical because people can’t make progress without knowing where they are starting from, he said.

Dr. William Calnon, Foundation board member, 2011-12 ADA President and the symposium planning chair, and ADA Foundation Executive Director Gene Wurth, told the attendees that based on challenging issues raised by the participants there was a likelihood of future symposia. “Our hope is that we can use this program in planning future programs that will better address some of these topics,” Dr. Calnon said. “We want to engage in discussions that will help us move forward.”

Dr. Calnon said the Foundation will soon send a summary of the proceedings from the symposium to the participants. He also indicated that he foresees future annual symposia that will sequentially delve more deeply into issues discussed during the 2016 event. The next symposium will address the many aspects of establishing a continuity of care model, based on feedback from attendees.

For more information on the ADA Foundation, visit adafoundation.org.

The proceedings included four sessions, each with three speakers and a moderator, and wrapping up with a panel discussion and Q-and-A.

Photo of Judith Haber, Ph.D.
Learning: Judith Haber, Ph.D., the Ursula Springer Leadership Professor of Nursing and executive director of the Oral Health Nursing Education Practice Program at NYU, asks a question Aug. 18 during the ADA Foundation Caries Symposium.
The sessions were:
  • Session One, “Risk Assessment and Treatment Protocols at Various Venues,” moderated by Dr. J. Timothy Wright, distinguished professor and director of strategic initiatives at the University of North Carolina School of Dentistry. The presenters were John D.B. Featherstone, Ph.D.., dean of the University of California at San Francisco School of Dentistry; Dr. Margherita Fontana, Ph.D., professor, department of cariology, restorative sciences and endodontics, University of Michigan School of Dentistry; and Dr. Man Wai Ng, dentist-in-chief, department of dentistry at Boston Children’s Hospital, associate professor, department of developmental biology, Harvard School of Dental Medicine.
  • Session Two, “Establishing a Continuity of Care Plan: Challenges and Approaches that Vary by Venue,” moderated by Dr. Reneida E. Reyes, president of the ADA Foundation. The presenters were Dr. James J. Crall, chair, division of public health and community dentistry, UCLA School of Dentistry; Dr. Kimon Divaris, Ph.D., associate professor and research director, department of pediatric dentistry, University of North Carolina School of Dentistry; and Dr. Mona Van Kanegan, director, oral health program development of Heartland Health Outreach, project co-director, Oral Health Forum in Chicago.
  • Session Three, “Data Collection: Who, What and How, at Various Venues,” moderated by Dr. Francisco Ramos-Gomez, executive director, UCLA Center for Children’s Oral Health. The presenters were Dr. Natalia I. Chalmers, Ph.D., director of analytics and publication, DentaQuest Institute; Dr. Joseph R. Greenberg, founder, Kids Smiles in Philadelphia; Dr. Richard Niederman, chair, department of epidemiology and health promotion, NYU College of Dentistry.
  • Session Four, “Outcomes Studies that Use the Data to Change Policies,” moderated by Dr. Dushanka V. Kleinman, professor, epidemiology and biostatistics, associate dean for research, University of Maryland School of Public Health. The presenters were Christie Custodio-Lumsden, Ph.D., associate research scientist, section of population oral health, Columbia University College of Dental Medicine; DrCAPT. Bruce A. Dye, dental epidemiology officer, director, dental public health residency program, office of science policy and analysis, National Institute of Dental and Craniofacial Research; Dr. Lynn D. Mouden, chief dental officer, Centers for Medicare & Medicaid Services.
Also speaking at the symposium included Dr. Charles N. Bertolami, Herman Robert Fox Dean, NYU College of Dentistry; Dr. Martha J. Somerman, Ph.D., director, National Institute of Dental and Craniofacial Research; Gene Wurth, executive director, ADA Foundation; Dr. Calnon; Dr. Thomas C. Hart, Ph.D., senior director at the ADA Foundation Volpe Research Center; Ralph Fuccillo, president of the DentaQuest Foundation; and Steve Kess, vice president of global professional relations, Henry Schein, and president of the Henry Schein Cares Foundation.

Comments from and about the ADA Foundation Caries Symposium

Photo of Dr. Reneida Reyes, Steve Kess, Dr. Barbara Shearer, Gene Wurth, Dr. Carol Gomez Summerhays, Dr. Gary Roberts, Dr. William Calnon, Dr. Charles N. Bertolami
Teamwork: The leadership of the ADA and ADA Foundation pose with participants in the ADA Foundation Caries Symposium. From left, Dr. Reneida Reyes, ADA Foundation president; Steve Kess, Henry Schein Cares Foundation president; Dr. Barbara Shearer, professional relations director, Colgate Palmolive; Gene Wurth, ADA Foundation executive director; ADA President Carol Gomez Summerhays; ADA President-elect Gary Roberts; Dr. William Calnon, Foundation board member and symposium planning chair; and Dr. Charles N. Bertolami, Herman Robert Fox Dean, NYU College of Dentistry.

“We’re a team,” said Dr. Reneida Reyes, ADA Foundation president.

ADA President-elect Gary Roberts, who spoke at the Aug. 17 welcome reception overlooking the East River, said that the conference would be an eye-opening experience. The symposium, he said, “brings together people who are like-minded and who can give different perspectives on the problem.”

“Childhood caries is not a new issue,” said Dr. William Calnon, Foundation board member, ADA president 2011-12 and the symposium planning chair. “We have so much science about how to prevent it, but it still causes a tremendous amount of unnecessary suffering for kids. The purpose of this symposium is to ask the hard questions about the nature of the data needed to make a compelling case that will improve access to and continuity of care. We want to see if we can put the pieces together in different ways and explore different, more effective solutions.” Dr. Calnon added that at the start of the conference, he felt “a certain sense of frustration” among the attendees that their efforts often seemed in vain. “There’s so much talent in this room who don’t want this to be a one-and-done deal.”

Dr. Daniel Daley, a Philadelphia-based oral surgeon, came to the symposium on the encouragement of his local dental society, who wanted him to give a report on the symposium. “I thought it was very informative,” he said at the close. “It’s a good thing. It makes people think, and raises awareness of the problem.”

Dr. Elena Ciciolla, a second-year resident at New York Methodist Hospital in Brooklyn, attended the symposium because she has seen many children come to the emergency room solely for dental issues. “It’s a very important topic,” she said. “We saw how big a problem it is and how severe it is. I liked hearing about all this research and realizing where we are and have been, and how we can apply it to affect policy change.”

Dr. Paul Benjamin, a professor at the University of Florida College of Dentistry with more than 40 years’ experience in private practice spoke after the program ended. “The truth is, it was more than I expected,” he said. “I think this symposium needs to grow. We’ve been talking about this for my entire career. We need to actually do it, and stop just talking about it.” Dr. Benjamin recalled something a professor at his dental school once told him. “Our job is to put us out of business,” he said. “That’s why we’re here.”

“We don’t want to walk away with business as usual,” said Dr. Martha J. Somerman, director, National Institute of Dental and Craniofacial Research.

Ralph Fuccillo, president of the DentaQuest Foundation and keynote speaker, had a direct message. “The children are counting on us,” he said.