Indian Health Service wages national battle to reduce tooth decay among children

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By Bill Graves / Native Health News Alliance

Jessica Greene’s 17-month-old daughter Emerie has only 10 teeth so far, but they’ve been inspected five times by Head Start workers, varnished with fluoride and checked twice by dentists at the Port Gamble S’Klallam Tribe’s clinic on the tribe’s reservation on Washington State’s Olympic Peninsula. After seeing her older son’s teeth damaged by cavities, Greene made sure her daughter got dental care early.

Jessica Greene’s 17-month-old daughter Emerie has only 10 teeth so far, but they’ve been inspected five times by Head Start workers, varnished with fluoride and checked twice by dentists at the Port Gamble S’Klallam Tribe’s clinic on the tribe’s reservation on Washington State’s Olympic Peninsula. After seeing her older son’s teeth damaged by cavities, Greene made sure her daughter got dental care early.
Credit: Jessica Greene

About seven years ago, Jessica Greene was shocked when a daycare provider revealed her 4-year-old son’s teeth were ravaged by cavities. They had so much decay he needed to be sedated under anesthesia to have them repaired and capped.

“I wasn’t very educated,” says Greene. “I was young.”

But Greene, member of the Makah Tribe, learned fast. She made sure dentists started checking her infant daughter’s teeth, and now at 7, the girl has had only one small cavity. Greene’s 17-month-old daughter, Emerie, has only 10 teeth so far, but they’ve been inspected five times by Head Start, varnished with fluoride and checked two more times by dentists at the Port Gamble S’Klallam Tribe dental clinic, where Greene now works as a receptionist.

Dr. Kristi Lisenmayer, a pediatric dentist who works with Native children, sees Greene’s story over and over. In mid-November, for example, she treated a 4-year-old Native American child in Ketchikan, Alaska, with a mouth full of cavities, then immediately helped the mother develop a plan to ensure her infant son will avoid the same fate.

“If parents miss it for the first child, they know to do better for the second one, and they really do,” Lisenmayer says.

In Seattle, Ketchikan and on the Nooksack Indian Reservation in Washington, Lisenmayer fights on the front lines for the Indian Health Service’s (IHS) battle to reduce tooth decay among Native American children under five. The IHS Early Childhood Caries Collaborative aims to step up prevention.

If more Native American parents follow the collaborative’s guidelines below, Indian Country would see a dramatic drop in tooth decay among young children and more smiles, says Bonnie Bruerd, co-chairperson of the IHS collaborative.

  • Begin brushing a baby’s teeth twice a day with a small dab of fluoride toothpaste as soon as the first tooth emerges.
  • Take babies to a dental clinic as soon as the first tooth appears and no later than the first birthday.
  • Feed babies a healthy diet and limit sweets and sodas.

That message has reached:

  • 322 tribal and urban Indian dental programs across the nation, says Dr. Timothy L. Ricks, a dentist who co-chairs the IHS collaborative with Bruerd.
  • The Native American Youth and Family Center’s Head Start in Gresham, Ore., where children brush their teeth daily and have them varnished several times a year with fluoride.
  • The Oklahoma City Indian Clinic where doctors urge new moms to get their children to a dentist by age 1.
  • The Health and Wellness Center of the Confederated Tribes of Grand Ronde in Oregon, where the dental clinic rewards parents with a Pendleton blanket raffle ticket for bringing children age 2 and under in for a checkup.

The federal collaborative was born in 2009, when a small group of IHS officials gathered to brainstorm on what the agency could do to improve oral health among Native Americans, says Ricks, a member of that group.

“It was very clear to all of us that if we were going to make a long-term impact on oral health, we must focus on children,” he said by email.

Dr. Erin M. Lange, one of four dentists in the Confederated Tribes of Grand Ronde Health and Wellness Center near the Oregon coast, applies fluoride to the teeth of 1-year-old Hudson Hubbell, a tribal member. Michelle Pond, Hudson’s mother, has brought all three of her sons regularly to the clinic from the time their first teeth emerged. Only her 4-year-old has had cavities, and both treated with an interim restoration Credit: Bill Graves

Dr. Erin M. Lange, one of four dentists in the Confederated Tribes of Grand Ronde Health and Wellness Center near the Oregon coast, applies fluoride to the teeth of 1-year-old Hudson Hubbell, a tribal member. Michelle Pond, Hudson’s mother, has brought all three of her sons regularly to the clinic from the time their first teeth emerged. Only her 4-year-old has had cavities, and both treated with an interim restoration
Credit: Bill Graves

Tooth decay among Native children

Study after study showed Native American children with a prevalence of tooth cavities three times higher than the general U.S. population and an untreated decay rate almost four times higher than any other population, Ricks said.

In a 2010 survey of 8,461 Native American children across the nation, IHS found:

  • 21 percent of 1-year-olds, 44 percent of 2-year-olds and 75 percent of 5-year-olds had a history of tooth decay.
  • One in three needed early or urgent dental care, which can cost up to $10,000.

Tooth decay can undermine a child’s overall physical and psychological health in sinister ways. It can reduce weight, blunt school performance, lower confidence and take away a smile. It can cause infections and pain.

In Ketchikan in November, Lisenmayer saw a 5-year-old whose teeth had decayed to the roots. He told her he was in pain until he chewed on a plastic toy that caused something to burst in his mouth. He had broken a tooth and split an abscess, she says, releasing pus and pressure and relieving pain.

“I’ll be taking him to the operating room and will have to take six teeth out of him,” Lisenmayer says.

Authorities do not fully understand why tooth decay is so high among Native children. A Canadian study found decay among Native 1-to-3-year-olds was associated with bottle feeding and three or more snacks between meals.

Lisenmayer thinks the displacement of tribes from their traditional lands and foods has created high rates of tooth decay. Many tribal people also had negative experiences with dentists and have become wary of them, she says. A sugar-heavy Western diet fuels tooth decay, she says, and distrustful parents resist taking their children to a dentist until the kids are in pain.

IHS collaborative goals

The IHS has focused its Early Childhood Caries Collaborative on specific, measurable goals for children under five. For example, it aims to increase by 25 percent children’s access to dental care and by 25 percent the number of children getting sealants.

To meet these goals, IHS established collaborative efforts across Indian Country, from tribal clinics, to Head Start classrooms to the federal Women, Infant and Children (WIC) program staffs. The collaborative also connected with 54 dental programs across the country to offer providers one-on-one coaching through its online Virtual Learning Community Program.

In the Pacific Northwest, the Northwest Portland Area Indian Health Board, a non-profit tribal advisory organization, has included the collaborative as part of the mission for its Northwest Tribal Dental Support Center, which opened more than a decade ago.

The board provides consultants, one of whom is Bruerd, to help 43 federally-recognized tribes in Oregon, Washington and Idaho:

  • Improve their dental clinic programs
  • Train their staffs
  • Streamline their procedures
  • Collect data
  • Teach their people how to prevent tooth decay.

The emphasis is on prevention and on getting children into the dentist early, Bruerd says.

Confederated Tribes of the Grand Ronde

Among tribes served by the board is the Confederated Tribes of the Grand Ronde, where dental clinic professionals visit their local Head Start four times a year to varnish the preschoolers’ teeth with fluoride.

They’ve also taught the children to brush their teeth more thoroughly, trained the medical staff to apply fluoride varnish on young children they see and urged parents to bring their children in earlier, says Sheila Blacketer, a dental hygienist. These efforts have cut the tooth decay rate among the Head Start children in half, to 12 percent, she says.

Another national survey next year will reveal precisely how much headway IHS is making with its campaign to reduce tooth decay in Native children under five. But Ricks says the agency collects national data two or three times a year that shows that at the end of a three-year period ending in fiscal year 2013, compared to a 2005-09 baseline, children received:

  • An increase of 10.5 percent in access to care
  • A boost of 63 percent in sealant applications
  • A 66 percent rise in fluoride treatments
  • A 93 percent jump in interim therapeutic restorations.

The Portland Area health board’s tribal dental support center has documented for the children in this age group who its serves an increase since 2000 of 28 percent in dental access, 193 percent in fluoride applications and 88 percent in use of sealants.

While clearly more Native children are getting dental care, Ricks and Bruerd agree the IHS collaborative’s biggest challenge continues to be how to reach those under 2.

“Our biggest hurdle is getting babies in,” Bruerd says.

© Native Health News Alliance

The Native Health News Alliance (NHNA), a partnership of the Native American Journalists Association (NAJA), creates and promotes shared health news content for American Indian communities at no cost.

 

Resource

Learn more about dental care

Following are some websites with more information about dental care for Native Americans:

The Indian Health Service Early Childhood Caries Collaborative: http://www.ihs.gov/doh/index.cfm?fuseaction=ecc.display

National Maternal & Child Oral Health Resource Center:

http://www.mchoralhealth.org/

American Academy of Pediatric Dentistry:

http://www.aapd.org/

Prevalence and Severity of Dental Caries among American Indians and Alaska Natives

http://tinyurl.com/q6g2gke

Prevalence and Severity of Dental Caries among American Indians and Alaska Native preschool children

http://tinyurl.com/otcsdk6

Dental Caries in American Indian Toddlers After A Community-Based Beverage Intervention

http://tinyurl.com/odg35gn

Northwest Tribal Dental Support Center

http://tinyurl.com/nsagnn9

Urban American Indian/Alaska Native Maternal, Infant and Child Health Capacity Needs Assessment

http://tinyurl.com/nftfb7w

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