Project Description

Parents play key role in child tooth decay prevention

ALL DOWNLOADS AT END OF STORY. Multimedia elements available: Print, audio, infograpic and photos.


Native mom Heather Hereford-Azure understands that busy lives can get in the way of good oral health habits for the family.

By Mallory Black / Native Health News Alliance

WASHINGTON – By mid-afternoon, Heather Hereford-Azure is exhausted. With a set of twins and a son all under the age of 4, running on four hours of sleep isn’t unusual.

But Heather, who is Arapaho and Shoshone, still finds the energy to make sure Daniel, Deric and Madison brush their teeth twice every day.

“I feel like it’s part of taking good care of them, and I want them to have good habits when they take care of their teeth,” Hereford says. “Cavities hurt. It’s kind of painful.”

Diseases like tooth decay affect Native American children on and off the reservation. The most recent survey by the Indian Health Service found that more than 62 percent of Native American children between the ages of 2 and 5 had experienced early childhood caries, or tooth decay caused by cavities.

Oral health consultant Dr. Kathy Phipps says more than 20 percent of 1-year-olds have the disease, and an alarming 75 percent of 5-year-olds suffer from it as well.

“Early childhood caries, or early childhood cavities in American Indian and Alaska Native children is actually at a very high level, substantially higher than any other racial or ethnic group in the United States, and they’re getting it as early as 8 months [of age],” Phipps says.

Hereford-Azure and her husband Floyd Azure, who is Sioux and Blackfoot, live in Silver Spring, Maryland, almost 2,000 miles away from the Wind River Indian Reservation in Wyoming. That’s where Hereford-Azure is from, and being that far away made her realize that she might parent a little differently than others.

“I remember we went home for a visit, we were staying with my cousin and we got back to her place, and we woke up all the babies so we made them take a bath and made them brush their teeth,” Hereford-Azure recalls. “The next day we went back to my auntie’s house and she got after us. She’s like, ‘Gee whiz, those babies were just tired. You should have just let them go to sleep,’ but we just wanted to brush their teeth before they went to bed.”


Hereford-Azure says that as her children grow older it is more difficult to keep them away from juice and soda.

Teaching the kids to take care of their teeth became a big deal to Hereford-Azure after her dad passed away. She says his teeth were in bad shape, and he suffered from Type 2 diabetes and heart disease. According to the World Health Organization, poor oral health can increase the risk of heart disease and diabetes in adults.

Hereford-Azure tries to give the kids less sugary foods and only water to drink. But as they get older, it’s harder to keep juice and sodas away from them. So to make it fun, she gives the kids ice cubes to suck on. But like all kids, they do get their hands on other sweets.

“If they get candy, we try to brush their teeth when we get home because it sits on their teeth,” she says. “I know they don’t like that feeling. I think that’s why Deric asks to brush his teeth.”

Dr. Warren Brill, president of the American Academy of Pediatric Dentistry, says it’s that sticky plaque feeling that can lead to more trouble down the road if parents don’t take care of their kids’ teeth, even the baby ones.

“Every tooth can get decay, and decay is actually an infectious disease, so you don’t want that infection to spread from the tooth to the nerve into the bloodstream, et cetera,” Brill says.

Hereford-Azure thinks parents might not see it as a priority to get their kids to care for their teeth because they’re busy trying to give them the best life they can. And that might make it difficult to say no to candy, soda or energy drinks, which Dr. Brill says can wreak havoc on everyone’s teeth.

“The worst thing we’ve been seeing now are these kids that are drinking the Monster drinks, the Gatorade, these drinks that are very, very high in sugar,” Brill says. “We’re seeing teenagers with decay patterns in their permanent teeth that we’ve never seen before, so that’s a really big problem.”

Phipps says there are signs that more Native parents likeHereford-Azure are being proactive about their kids’ oral health care pointing to certain areas where income and education levels have gone up, and tooth decay is going down.

“We are seeing some hopeful trends, but we need to see more,” Phipps says.

Brill says tooth decay is 100 percent preventable with good brushing, flossing and dietary habits, and that the best drink for everyone comes from straight from the water tap.



© Native Health News Alliance

This is the latest in a series of oral health stories produced by the Native Health News Alliance (NHNA), a partnership of the Native American Journalists Association (NAJA).

NHNA creates shared health coverage for American Indian communities at no cost. Registered users can download additional print, web and audio content at and publish as is or add their own reporting, highlighting important issues within the local Native community. NHNA services are free to all those who think good journalism has a positive impact in the lives of all of our readers, listeners, and viewers. Click here to learn more.