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Experts eye early childhood caries

ECC symposium participants see hope for reducing disease burden in American Indian, Alaska Native children

Rapid City, S.D.—Receiving both a close-up look at the microbiology of early childhood caries and a panoramic view of its effects on affected communities, some 50 researchers, clinicians, tribal health and dental public health representatives gathered in the City of Presidents Oct. 20-22, 2010, for the second Symposium on Early Childhood Caries in American Indian and Alaska Native Children.

Image: Sara Jumping Eagle, M.D., and Dr. Joel Berg
Ideas sharing: Sara Jumping Eagle, M.D., from the AAP’s Committee on Native American Child Health, and Dr. Joel Berg, University of Washington School of Dentistry, compare notes during a workgroup discussion.

Meeting in Rapid City’s historic downtown, where life-sized bronze statues of the United States’ chief executives grace the street corners and local events, shops and galleries feature traditional Sioux and Lakota art, craftwork and culture, stakeholders with a variety of viewpoints came together for the conference with a long-range goal “to eliminate the burden of disease from severe caries among American Indian and Alaska Native children.”

The symposium was co-hosted by the ADA and its Council on Access, Prevention and Interprofessional Relations and the American Academy of Pediatrics. Oral Health America co-sponsored the meeting with support from the DentaQuest Foundation.

The meeting featured two full days of scientific presentations, workgroup activities and goal setting, followed by an optional field trip for participants that wound through the Badlands to meet with a variety of American Indian health and education officials on Pine Ridge Indian Reservation, about 70 miles from Rapid City.

Participants evaluated the latest research in the epidemiology and microbiology of ECC; a variety of traditional and newly developing interventions, cultural and anthropological influences and barriers and more to determine how best to work collaboratively in the future to reduce or eliminate the disease in population groups that have a disproportionately higher risk.

L.D. “Dee” Robertson, M.D., a retired pediatrician who spent 20 years working at an Indian Health Service clinic, served as a conference coordinator. Though little progress has been made in alleviating disease burden in AI/AN children over the past three decades, he said the symposium gave him renewed hope and energy for future success.

“From the information presented by researchers and tribal and public health representatives, we are acknowledging that the situation is obviously far more complex than we’d thought in the past, and more effective products and strategies may be available in the near future,” said Dr. Robertson. “What we need now is exactly what we have lacked for the last 30 years—a sustained commitment to first understand all the factors in development of very severe early childhood caries and second to develop and implement more effective interventions than are currently available.”

According to statistics presented at the symposium, ECC prevalence is about 400 percent higher in AI/AN children than for all U.S. races. In addition, ECC is often much more aggressive and destructive in AI/AN children. In some communities, up to 50 percent of the children have such severe caries that they require full mouth restoration under general anesthesia—a rate about 50-100 times that in all other U.S. races. Severe ECC often leads to a lifetime of oral health problems.

Image: Dr. Rosamund Harrison and Dr. David R. Drake
Workgroup discussion: Dr. Rosamund Harrison, University of British Columbia Division of Pediatric Dentistry, and Dr. David R. Drake, University of Iowa College of Dentistry, discuss microbiology issues at the symposium.
Participant Dr. David R. Drake, a microbiologist and professor at the University of Iowa College of Dentistry and Dows Institute for Dental Research, has dedicated his career to learning more about the transmission of early childhood caries in this population group. He was the first investigator to establish a formal research contract from a National Institutes of Health grant directly with an American Indian tribe (Oglala Sioux). “When I became aware of the magnitude of this horrible disease in such young children, and after all of the things we have done over the years to deal with it with only very limited success, I realized that we needed to see if there were things about this disease that were different than other forms of caries,” said Dr. Drake. “I am committed to working toward understanding the microbiological components of this devastating and unbelievably rapid disease in American Indian children. I am indeed passionate about this.”

Also participating in the symposium was Dr. Robert Schroth of the University of Manitoba Faculty of Dentistry, whose research is investigating whether prenatal and environmental factors predispose Aboriginal Canadian children to early childhood caries.

“It is interesting that the life challenges faced by families on either side of the border are similar and undoubtedly contribute to their children’s poor oral health,” said Dr. Schroth. “Many live in poverty, have limited access to running water in the home, face food security issues and have limited access to early preventive dental care. Researchers and the dental profession, in both the U.S. and Canada, should partner with communities to develop, implement and evaluate culturally appropriate prevention strategies. We can share and learn from our own experiences in our respective countries.”

Sara Jumping Eagle, M.D., a representative of the AAP’s Committee on Native American Child Health, said her organization was excited to co-host an event to address the oral health disparities facing AI/AN children and adolescents.

“The AAP wants to be part of national and community-based efforts to solve the enormous problem of poor oral health among American Indian/Alaska Native children,” said Dr. Jumping Eagle. “Not only has poor oral health been shown to contribute to worsening health in general, it also affects quality of life and self-esteem. High rates of early childhood caries are an additional stressor to the community members and health care providers that are already working hard to address the many health disparities American Indian/Alaska Native people face.”

Dr. Jumping Eagle said she was impressed by the dedication of scientists and health care providers to creating new technology and medicines to address poor oral health and looks forward to the next steps in working to solve the problem of early childhood caries.

“As pediatricians and dentists, we have to reach out to American Indian/Alaska Native communities in new ways that help us to be accessible and trusted members of the communities we serve and work to increase the number of American Indian and Alaska Native dentists and oral health care providers,” Dr. Jumping Eagle said.

Helping AI/AN families, she added, will include addressing not only the physical aspects of oral health, such as brushing and flossing and applying fluoride or other varnishes, but also addressing the community and family’s view of oral health, teaching others to be health educators, working to improve child and family nutrition and empowering community members to develop culturally relevant community-based programs to more fully address these significant oral health disparities.

Dr. Robert J. Weyant, professor and chair for the Department of Dental Public Health and Information Management at the University of Pittsburgh School of Dental Medicine, said the conference was not only interesting but also relevant to him personally as he is currently conducting a five-year study to examine oral health disparities in rural Appalachia.

“Our research right now looks at pregnant women and follows them through their child’s birth and first two years to see how early childhood caries affects them,” Dr. Weyant said. “It seems like it’s similar between the population groups in that it is defined by living in environmental adversity.”

The highlight of the symposium for Dr. Monica Hebl, a Milwaukee general dentist and CAPIR member, was the visit to Pine Ridge Reservation.

“The generosity of the people we met on the Pine Ridge Reservation was inspiring. Knowing how much they appreciated our hard work made our efforts even more worthwhile,” said Dr. Hebl.

She said she also appreciated meeting symposium participants, leaders in their fields who came to help alleviate suffering caused by ECC. “The severity of early childhood caries in these kids created a sense of urgency among the attendees. I am proud to be a part of the ADA efforts to gather the best and brightest minds from so many different groups together with the long-range goal to form a research agenda. The conference fostered enthusiasm and collaboration between the groups and individuals that are interested in trying to help these children. Hopefully we can build on the enthusiasm and collaboration generated at the conference so we can begin to translate the efforts into an improved quality of life for the kids.”

A report detailing the scientific presentations of the symposium and results of the workgroup collaborations will be available on ADA.org later this year.