Tooth decay is a major health problem for American Indian and Alaska Native (AI/AN) children. When compared to other population groups in the United States, AI/AN preschool children have the highest level of tooth decay; more than 4 times higher than white non-Hispanic children, according to the 2014 IHS Oral Health Survey. The reasons why AI/AN children have more tooth decay are not known but it may be partially due to differences in host, bacterial, behavioral, sociodemographic, and environmental risk factors. If left untreated, tooth decay can have serious consequences.
Tooth decay occurring in children 0-5 years of age is referred to as early childhood caries (ECC). Due to their young age and an inability to cooperate for dental care, preschool children with ECC are often treated in a hospital-based operating room under general anesthesia; the cost of treatment can be enormous. Tooth decay, however, is largely preventable by a combination of community, professional, and individual measures including water fluoridation, dental sealants, use of fluoride toothpastes at home, professionally applied topical fluorides, proper infant feeding practices, a healthy diet low in sugar and refined carbohydrates, and regular dental visits starting at 12 months of age.
In 2016, the Indian Health Service Division of Oral Health entered into a Memorandum of Understanding with the National Institutes of Health National Institute of Dental and Craniofacial Research (NIDCR). The intent of this agreement was to provide a field experience for residents from NIDCR’s Dental Public Health Residency Program. In February 2017, one resident, Dr. Alexander Kailembo, a native of Tanzania, worked with the IHS Division of Oral Health to evaluate the relationship between ECC prevalence and the proportion of AI/AN pregnant and nursing mothers accessing dental services in the IHS system in the past year.
Data was analyzed for 2013, 2014, and 2015 at the national, Area, and service unit levels. Based on this analysis, IHS was able to establish for the first time a definitive inverse relationship between maternal access to dental care (pregnant and nursing mothers) and development of ECC in 0-5 year-old AI/AN children. In other words, AI/AN children of pregnant and nursing mothers who access dental services are less likely to develop ECC than children whose mothers are not able to access dental services. This new link may have a significant impact on how the IHS in the future works to reduce ECC through targeting and prioritizing dental services for pregnant mothers and mothers of newborn children.