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U.S. Department of Health and Human Services

IHS Division of Oral Health Initiatives

Multi-Directional Integration of Oral Health, Primary Care, and Mental Health

American Indians and Alaska Natives (AI/AN) suffer disproportionately from myriad health conditions including cardiovascular disease, diabetes mellitus, chronic liver disease and cirrhosis, influenza and pneumonia, kidney disease, chronic lower respiratory diseases, depression, and oral disease. The IHS Division of Oral Health (DOH) has a long history of collaborating with other health disciplines at the national, Area, and local level. In 2023, and again in 2024, DOH embarked on a series of funded initiatives for IHS, tribal, and urban dental and medical programs to address some of these health disparities. These funded projects included: hypertension screenings in the dental office, diabetes screenings in the dental office, depression screenings in the dental office, human papillomavirus vaccination screening and education in the dental office, cognitive screenings in the dental office, childhood (MMR, DTP, HPV, etc.) and adult (pneumococcal, COVID-19, influenza, etc.) immunization screenings in the dental office, sexually transmitted infection education and testing referral by dental providers, oral health screenings and silver diamine fluoride applications in 1-5 year-olds in the medical office, and triaging and treating dental conditions in the emergency department by medical providers. DOH chose these evidence-based projects specifically to address multi-directional integration of oral health, primary care, and mental health.

IHS Alternative Workforce Initiative

This initiative was designed to elevate the issue of improving dental workforce efficiency within the Indian Health Service (IHS), especially at IHS, Tribal, and Urban (ITU) dental programs throughout the country. The IHS Dental Workforce Initiative aimed to educate ITU providers, tribal communities, and outside organizations about alternative workforce models and promote such models to help address oral disease disparities in the American Indian and Alaska Native population. The initiative highlighted the Alaska Dental Health Aide Therapist (DHAT) Program that was created by the Alaska Native Tribal Health Consortium in 2004 as well as the expanded function dental assistant (EFDA) program that the IHS spearheaded in 1961, allowing specially trained dental assistants to restore teeth under the direct supervision of a dentist.

Implementation of a Cognitive Assessment in a Dental Setting Initiative

The purpose of this project was to determine if cognitive assessments could be done in dental settings for patients presenting with symptoms of cognitive decline (apparent memory loss, non-compliance in oral hygiene not explained by other factors, non-compliance or non-understanding of treatment not explained by other factors, difficulty communicating to the dental provider not explained by other factors, etc.). The project period was set to be January – June 2023.

Triaging and Treating Dental Conditions in the Emergency Department Initiative

Each year in the U.S. there are over 2 million Emergency Department visits related to dental conditions. Of these, 110,000 result in hospital admissions. 26.1% of dental-related ED visits are from patients who self-pay (do not have a third-party payer, compared to 11.8% of non-dental related ED visits. 42.2% of dental-related ED visits are from patients with Medicaid, compared to 32.4% of non-dental related ED visits. In the 46 IHS and tribal hospitals in FY 2022, there were 9,501 dental-related ED visits, about 1.4% of all ED visits. This project replicated a project in Wisconsin to teach ED medical providers how to triage and treat dental conditions for patients presenting to the ED.

Sexually Transmitted Infections Dental Education Initiative

The IHS Division of Oral Health, as part of its ongoing promotion of multi-directional integration of oral health and overall health, partnered with the IHS National HIV/AIDS Program to develop a project whereby dental professionals will provide – as requested – patients with education about the oral manifestations of HIV and other sexually transmitted infections (STIs) and distribute a brochure developed by the IHS HIV/AIDS Program. The purpose of this initiative was to determine if it was feasible for dental programs to perform a brief intervention/education to patients about STIs and oral disease, and refer them to available testing resources.

IHS Heroin, Opioids, and Pain Efforts (HOPE) Initiative

The IHS National Committee on Heroin Opioids and Pain Efforts (HOPE Committee) works with tribal stakeholders to promote appropriate and effective pain management, reduce overdose deaths from heroin and prescription opioid misuse, and improve access to culturally appropriate treatment. The IHS Division of Oral Health partners with the HOPE Committee to provide guidelines on acute dental pain management, identify best practices for opioid stewardship, and develop trainings to support these best practices.

IHS Early Childhood Caries Collaborative

The Indian Health Service (IHS) Early Childhood Caries (ECC) Collaborative was a multi-faceted program designed to enhance knowledge about early childhood caries prevention and early intervention among not only dental providers, but also all healthcare providers and the community. Although the initiative ended in 2017, the emphasis on early childhood caries prevention and early intervention remains a top priority for IHS, Tribal, and Urban (I/T/U) dental programs. The IHS Division of Oral Health (DOH) continues to promote ECC best practices. Visit the IHS ECC webpage to learn more about this monumental initiative.

Medical-led Silver Diamine Fluoride Demonstration Project

In 2022, the IHS Division of Oral Health, in an effort to further strengthen the medical-dental partnerships formed through the IHS Early Childhood Caries Collaborative, developed a medical-led silver diamine fluoride demonstration project. The goal of this project was to identify and share best practices related to medical providers applying silver diamine fluoride in a medical setting.

IHS Periodontal Treatment Initiative

The goal of the IHS Periodontal Disease Initiative is to increase focus on the diagnosis and treatment of periodontal diseases in IHS, Tribal, and Urban dental programs. The overlying theme for this initiative is: "Overall Health begins with Periodontal Health"

IHS Oral Health Literacy Initiative

The goal of the IHS Oral Health Literacy Initiative is to increase knowledge and awareness of oral health literacy best practices in IHS, Tribal, and Urban (I/T/U) dental programs. The theme for this initiative is SMILE — Sharing oral health Messages to Improve Literacy for Everyone.

IHS National Give Kids A Smile® (GKAS)

In 2020, the IHS Division of Oral Health teamed up with the American Dental Association (ADA) to hold the first IHS national Give Kids A Smile® (GKAS). The annual event takes place as part of National Children's Dental Health Month in February.

IHS Oral Health Promotion/Disease Prevention Funding Initiative

Since 2000, IHS DOH has funded a limited number of I/T/U dental programs to purse an oral health promotion/disease prevention project (e.g. starting a school-based sealant program) with the goal of improving the oral health of American Indian/Alaska Natives. This initiative - pending available funding - helps IHS DOH to identify promising practices that can be promoted to other I/T/U dental programs.

Compliance with Minimata Convention

The Indian Health Service Division of Oral Health concurs or is already in compliance with 6 of the 9 measures of the Minamata Convention on Mercury Part II: Products subject to Article 4, paragraph 3 regarding dental amalgam.