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IHS Division of Oral Health ECC Collaborative
  Frequently Asked Questions (FAQs)

After reading all of the materials in the ECC Packet and viewing the PowerPoint presentations, you may still have questions about the ECC Collaborative. Below are some of the questions that have been asked from dental staff and community partners about this Collaborative.

Still have questions after reviewing this FAQ page? Contact Us

FAQ's (click on the question to view the answer)

  1. I am coding glass ionomer restorations as 2391 (one-surface posterior composite). Is that correct? If not, what code should I use?
  2. Are there studies that show the benefits of fluoride varnish? What are they?
  3. Will this program really work? After all, I’ve been applying fluoride varnish for years and our Head Start caries prevalence rate continues to be high.
  4. Why should I, as a general dentist, be involved in this Collaborative? Can’t I just refer patients to a pediatric dentist?
  5. But aren’t the Interim Therapeutic Restorations a substandard procedure since they are just temporary fillings?
  6. Shouldn’t I just refer young children with caries? After all, I have many patients and my time could be better spent on treating those I feel comfortable in managing.
  7. What about glass ionomer sealants? Aren’t they substandard because of poor retention rates?
  8. What is the role of the Area Dental Officers and Dental Support Centers in this Collaborative?
  9. What is my role as a dental hygienist or dental assistant in this Collaborative?
  10. Can a dental hygienist do an ITR?
  11. Isn’t it better to do a definitive restoration rather than an ITR?
  12. How will we know if we’re being successful with this Collaborative?
  13. Should I take the online courses?
  14. Is there any money available with this ECC Collaborative?
  15. What is different about this Collaborative? Haven’t we done things like this in the past?
  16. Can you tell me what the components of this Collaborative are?
  17. How do I get started?

Answers:

  1. I am coding glass ionomer restorations as 2391 (one-surface posterior composite). Is that correct? If not, what code should I use?
  2. Use code 2940 for Interim Therapeutic Restorations (ITRs).

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  3. Are there studies that show the benefits of fluoride varnish? What are they?
    • One study showed a 44% reduction in caries incidence in 3-yr. olds.
      • Holm AK. Effect of fluoride varnish (Duraflor) in preschool children. Community Dentistry & Oral Epidemiology 1979 October; 7(5):241-5.
    • Other studies have also shown that the use of fluoride varnish greatly reduces caries in children.
      • Clark DC. Results of the Sherbrook-Lac Megantic fluoride varnish study after 20 months. Community Dentistry & Oral Epidemiology 1985 April; 13(2): 61-4.
      • Koch G et al. Caries preventive effect of a fluoride-containing varnish after 1 year’s study. Community Dentistry & Oral Epidemiology 1975 November; 3(6):262-6.
      • Helfenstein U. A note concerning the caries preventive effect of Duraphat. Community Dentistry & Oral Epidemiology 1994 February; 22(1):6-7.
    • The application of fluoride varnish has been proven to be an effective method of reducing early childhood caries by protecting teeth, re-mineralizing weakened tooth enamel and slowing or halting the progression of early decay.
      • J.A. Weintraub et al., “Fluoride Varnish Efficacy in Preventing Early Childhood Caries,” Journal of Dental Research volume 85, issue 2 (2006): 172-176.
    • Children who received four or more application of varnish in 18 months had 35% reduced decayed surfaces over children who received none.
      • Holve S, IHS Primary Care Provider, October 2006.


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  4. Will this program really work? After all, I’ve been applying fluoride varnish for years and our Head Start caries prevalence rate continues to be high.
  5. The caries prevalence doesn’t really decrease over time significantly; nor does DMFT. That’s why early intervention is so important. If we don’t get children in at an early age – before age two – often it really is too late. Once caries has started, most of what we are doing with fluoride varnish is trying to prevent new caries (incidence) or arrest and possibly reverse existing caries.

    • If you are looking only at the Head Start population, caries prevalence would not be expected to change much at all, because once a child has experienced caries, that doesn’t change except on those rare occasions that the lesion is reversed and they become caries free.
    • If you are looking only at the Head Start population, DMFT (or dmft in primary teeth) doesn’t really decrease over time because once a tooth is decayed, it either remains decayed, is filled, or is extracted, so the DFMT remains constant or increases, except, once again, on those rare occasions that the lesion is reversed and they become caries free.
    • Caries incidence would be expected to change if you are reaching children before Head Start and applying fluoride varnish and doing other preventive things. Incidence is measured by the number of new lesions.

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  6. Why should I, as a general dentist, be involved in this Collaborative? Can’t I just refer patients to a pediatric dentist?
  7. General dentists in IHS, Tribal, and Urban dental programs are the key to the success of this Collaborative. The IHS simply does not have enough pediatric dentists to treat every child.

    Sometimes, doing nothing does cause harm. This is the case with ECC. General dentists can do things such as: (1) exams in young children, especially targeting those under two years of age; (2) applying glass ionomer sealants on primary teeth of young children to help prevent caries; (3) applying fluoride varnish 3-4 times a year on young children; and (4) learning the ITR technique and using it to minimize the severity of Early Childhood Caries.

    Think about it this way. If you refer the child to a pediatric dentist, how long will it take for the child to be seen? How much will it cost your program? What could you have done at the clinic? If you can treat the child, treat the child! Reserve referrals for those pediatric patients who are really difficult to manage or those that require extensive treatment.

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  8. But aren’t the Interim Therapeutic Restorations a substandard procedure since they are just temporary fillings?
  9. Interim Therapeutic Restorations (ITRs) are endorsed by both the Indian Health Service and the American Academy of Pediatric Dentistry (AAPD).

    ITRs are NOT inferior treatment. Young children cannot often endure long dental procedures, and ITRs are a solution. By providing ITRs, dentists can stop the progression of caries and place a restoration with little trauma to the child. That’s something general dentists can do. In addition, by doing ITRs, you may be helping prevent children from needing to be treated in an operating room setting later on.

    Most of us were not trained in dental school how to do ITRs or even how to comfortably treat children. However, the Caries Stabilization Course available on this website can help, and your Area pediatric dental consultants can give you tips and tools to comfortably treat young children.

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  10. Shouldn’t I just refer young children with caries? After all, I have many patients and my time could be better spent on treating those I feel comfortable in managing.
  11. You are not just a clinical dentist but a public health dentist! As a public health dentist, you should be committed to doing things to promote oral health of the entire community. Targeting the 0-5 year-old age group is important.

    Consider these facts:

    • Caries in young children can cause pain, infection, delayed speech development, poor self-esteem, teasing from other children, delayed social development, missed school (or Head Start) days, and has even been linked to “less success” in later life. National Maternal & Child Health Bureau.

    So, aggressively preventing ECC and providing early intervention may be beneficial to these children not only now but years down the road.

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  12. What about glass ionomer sealants? Aren’t they substandard because of poor retention rates?
  13. Studies have shown that glass ionomer sealants have a poorer retention rate than resin sealants. However, resin sealants are not retentive in a wet environment. Most of the time, moisture control cannot be achieved in young children when doing sealants, especially 0-4 year-olds. That is where glass ionomer sealants may be beneficial. Take the Caries Stabilization Course to learn how to apply glass ionomer sealants to primary teeth of young children.

    The IHS Division of Oral Health endorses the use of glass ionomer sealants in the prevention of Early Childhood Caries when moisture control cannot be obtained. If you can obtain moisture control, do a resin sealant.

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  14. What is the role of the Area Dental Officers and Dental Support Centers in this Collaborative?
  15. The Collaborative was introduced to the Area Dental Officers and the Dental Support Centers early in the Collaborative. Both will be important in helping set Area goals and overseeing the implementation of the Collaborative. Dental Support Centers may be asked to help support the Collaborative by conducting the Basic Screening Survey (BSS) in their Area to measure the effectiveness of this Collaborative.

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  16. What is my role as a dental hygienist or dental assistant in this Collaborative?
  17. In many dental programs, a dental hygienist or dental assistant is in charge of community-based activities (HP/DP). If so, please read the entire ECC Packet so you will know your role in both informing your entire dental team about the Collaborative and how to engage community partners to help. There is even a handout in the packet where you can fill in who is going to do what for the Collaborative.

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  18. Can a dental hygienist do an ITR?


  19. That is a local decision, determined by whether your state dental practice act or local program policies support a dental hygienist performing an Interim Therapeutic Restoration.

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  20. Isn’t it better to do a definitive restoration rather than an ITR?
  21. If you can do a permanent or definitive restoration, then do it. The simple fact is that most young children cannot tolerate lengthy dental procedures, so the ITR is an alternative. Again, ITR is endorsed by both the IHS and the American Academy of Pediatric Dentists (AAPD).

    Many times, you will find out that the ITR becomes a definitive restoration. After all, by the time the ITR does begin to show wear, have leakage, and need replacement the tooth may be close to exfoliation.

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  22. How will we know if we’re being successful with this Collaborative?
  23. One exciting thing about this Collaborative is the creation of a new IHS National Oral Health Surveillance System. We will be using the Basic Screening Survey (BSS) to collect data on 0-5 year-old children to measure the effectiveness of the Collaborative. Please see the handout in the ECC Packet for additional information about the BSS.

    In the early Fall of 2010, Dental Support Centers, Area Dental Officers, or other advocates in each of the 12 IHS Areas will be trained on how to conduct the BSS. They will then contact local programs to show how to collect data. Data collection on the BSS is really easy – it is one short form that can be used at health fairs, in the clinic, or even looking at previous dental exams (or Head Start exams) in patient records.

    Once the data is collected, an epidemiologist will put the information together and send a report to participating clinics. This report will show how your program compares not only to other IHS clinics with ECC prevalence and treatment, but also to your state, since most states use the BSS. This valuable local data can then be used by you in grant and program award applications in the future.

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  24. Should I take the online courses?
  25. Yes! The two online courses are “How to Apply Fluoride Varnish” and “Caries Stabilization.” Both are available for continuing dental education credits. Encourage your staff to take both courses, and encourage your community and medical partners to take the “How to Apply Fluoride Varnish” course.

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  26. Is there any money available with this ECC Collaborative?
  27. Already, the IHS Division of Oral Health has committed to funding this Collaborative on many levels – printed materials, training for the BSS, travel costs for presentations to engage community partners at many levels, and conduction of the BSS. In addition, by having local data from the BSS (if your program participates), you’ll have valuable information that will be helpful in applying for grants and program awards. In the future there may even be more funding available to programs to carry out the Collaborative.

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  28. What is different about this Collaborative? Haven’t we done things like this in the past?
    • It includes the establishment of a national oral health surveillance system to monitor the prevalence of ECC.
    • It includes a more formal approach at reaching out to multiple community partners. See the ECC Packet and website for more information.
    • It involves not just prevention of ECC but also early intervention (ITRs).
    • It includes printed materials, online courses, and support at the Area and National levels.


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  29. Can you tell me what the components of this Collaborative are?
    • ECC Initiative Packet
      • Information for Community & Medical Partners
      • Information for Dental Teams
    • ECC Webpage (www.ihs.gov/DOH/ecc)
      • Best Practices
      • All ECC Packet Information
      • Resources and additional information<
    • Power Point Presentations (on webpage)
      • One scripted presentation for you to give to your dental team
      • One scripted presentation for you to give to community partners


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  30. How do I get started?
  31. Here is our recommendation for how you should proceed in implementing the IHS ECC Collaborative:

    1. Read the ECC Packet to learn all about the Initiative.
    2. Familiarize yourself with the ECC Webpage (www.ihs.gov/DOH/ecc).
    3. Take the two online courses, “How to Apply Fluoride Varnish” and “Caries Stabilization,” the links of which are on the webpage.
    4. Brief your dental team on the Collaborative. Download the PowerPoint from the webpage entitled “IHS ECC Initiative PowerPoint Presentation – DENTAL TEAM.” Answer any questions they may have about the Initiative…you may even want to print these Frequently Asked Questions to share with them.
    5. Engage your medical and community partners. THIS IS ONE OF THE MOST IMPORTANT STEPS!
      • Download the PowerPoint from the webpage entitled “IHS ECC Initiative PowerPoint Presentation – COMMUNITY PARTNERS.” This provides an overview of the Initiative and can be presented to the community and medical partners you want to engage in the Initiative.
      • Follow that up with distributing customized information on how the Medical and Community Partners can help – information for WIC, Head Start, Medical Providers, Public Health Nurses, Tribal Councils, and CHRs is located on the left side of the ECC Packet. If you need additional copies of this information, find it on the ECC webpage.
    6. Begin immediately implementing the IHS ECC Initiative.
      • Apply fluoride varnish 3-4 times per year on 0-5 year-old children.
      • Provide glass ionomer sealants on primary teeth when appropriate.
      • Provide ITRs as indicated.
      • Consider open access for 0-5 year-old children in your facility (allow walk-ins throughout the day).
      • Follow up regularly with medical and community partners.
    7. Support the collection of data through the Basic Screening Survey (Fall 2010).
    8. Share your program’s efforts and successes with everyone. Send information on what you’re doing to IHS Headquarters so it can be included in the model programs or spotlighted programs part of the webpage.
    9. Use the BSS data to apply for grants and program awards, including the annual IHS Oral HP/DP program awards.


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