Title: Symposium on Early Childhood Caries in American Indian and Alaska Native Children Panel Report
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Volume: Journal of the American Dental Association
Publisher: American Dental Association Location: Chicago
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Early childhood caries (ECC) is a chronic disease that has a relatively low prevalence and minimal morbidity among most populations of U.S. children. By contrast, in many American Indian and Alaskan Native (AI/AN) communities, the prevalence of ECC is extremely high—approximately 400 percent higher than the U.S. all races. More important, ECC among AI/AN children also has a very high morbidity, with a large proportion of children developing rampant caries. Programmatic efforts by the Indian Health Service (IHS) and tribal health programs, using interventions found effective in preventing ECC in other populations, have shown minimal to no long term benefit. There is a pressing need to examine ECC among AI/AN children in light of the current scientific understanding and identify effective new research and programmatic strategies that are science-based. To achieve this goal, on November 4, 2009, the American Dental Association (ADA) Council on Access, Prevention and Interprofessional Relations (CAPIR), in cooperation with the IHS Division of Oral Health, co-hosted the Symposium on Early Childhood Caries in American Indian and Alaska Native Children. A small, select group of individuals was invited to participate, including representatives from three groups: 1) academic researchers with extensive experience in caries research, 2) career IHS dentists and pediatricians, and 3) individuals with expertise leading health research in AI/AN communities. To ensure that all participants were sensitive to the tribal community perspective on this health issue, the Symposium included three Native Americans, one of whom is from a small Southwest tribal community and is the mother of a child who had ECC despite her efforts to provide a healthful diet and good hygiene. The Symposium was divided into two general sessions. In the morning, several presentations described the prevalence and severity of ECC among AI/AN children, which a former IHS pediatrician described as being a “different disease” from ECC among most other U.S. population groups. Among the reported differences are: • ECC in AI/AN children has a very early onset (often by 18 months of age). • ECC follows an aggressive and destructive course in many AI/AN children. • ECC in AI/AN children has been largely refractory to interventions effective in other populations. Newly acquired data from four geographically diverse AI/AN communities indicate that a likely explanation of why ECC is a different disease for these children is the role of cariogenic bacteria, especially Streptococcus mutans (S. Mutans). AI/AN children are colonized by S. mutans very early in life, and these bacteria soon become the dominant oral flora for many of these children—at times becoming almost a mono-culture. This evidence led to the suggestion that, in order to control ECC among AI/AN children, the paradigm about ECC needs to change to consider it an infectious disease of childhood with a dental manifestation, instead of a dental disease. Although there are, at present, no Food and Drugs Administration (FDA) approved products with specific indication of controlling cariogenic bacteria, there are two ongoing studies to evaluate the effectiveness of therapeutically controlling the level of these bacteria in AI/AN mothers and children. The majority of the afternoon session consisted of discussions of specific issues raised in the morning presentations. One of the key points that the group returned to several times was the lack of adequate measures to define the true burden of disease from ECC for AI/AN children. The standard population surveillance measure of “decayed, missing or filled teeth” (dmft) does not adequately address the variations in severity of caries. Possible new measures were proposed, including a standardized way to assess severity of the caries for each tooth surface, plus standardization of the assessment of level of cariogenic bacteria in the child. At the conclusion of the Symposium, many participants agreed that ECC in AI/AN children may represent a different disease from that experienced by other populations of children. To achieve control of ECC among AI/AN children, new multimodal approaches will be required, with an enhanced emphasis on controlling the infectious etiology of the disease. Control will also require the development of new metrics to better characterize the disease and measure the effectiveness of new prevention approaches. The participants commended the ADA for its support of the ECC Symposium and recommended that the ADA build on the momentum and interest generated by the Symposium and explore ways to host a follow-up two to three-day ECC workshop in 2010. This second meeting would allow more time to present and discuss the relevant research issues and develop the framework for a research agenda directed toward reducing the remarkable health disparity from ECC among AI/AN children.

Reference (Biomedical Style):
Robertson D. Symposium on Early Childhood Caries in American Indian and Alaska Native Children Panel Report. Chicago: American Dental Association; 2009.