The rural nature of the Navajo Nation makes access to health care and social services difficult and challenging. It is not uncommon for homes on the Navajo Nation to be without common household utilities such as telephones, electricity, running water, indoor toilets and road access. There are higher rates of infectious disease, violence, suicide, Sudden Infant Death Syndrome, and car accidents on the reservation. Poverty and poor access to health care contribute to the health disparities that Navajo children face. The Fort Defiance Indian Hospital is located in the south central portion of the Navajo Nation crossing over the Arizona/New Mexico State border with most of the Service Unit in Arizona. The Fort Defiance Service Unit spans from the eastern edge of Navajo County, Arizona, across Apache County, Arizona and into the western edge of San Juan and McKinley Counties, in New Mexico.

Our oral health program is initiated in our Well Child Clinic. Our Well Child Clinic provides a dental coupon at nine months of age to be used to schedule a dental clinic visit so that the first fluoride varnish can be applied. The pediatrician in the Well Child Clinic will re-apply fluoride varnish at 12 months and again at 15 months of age. At twenty-four months, the child is evaluated in the General Pediatric Clinic for their health supervision exam, where the fluoride varnish is re-applied. Our clinic does supply informational handouts to be given to the parents on fluoride varnish and its benefits. During any visit, if any child is noted to have dental caries or need for dental services, they are referred to our Dental Clinic for evaluation and treatment.

Collaboration between our pediatric department and the dental clinic is limited. We as pediatricians perform pre-operative histories and physicals to those children needing general anesthesia to undergo more invasive dental procedure. This program would help strengthen oral health prevention and provide a dental home for our Navajo Patients.

Currently, there is no formal oral health risk assessment being used by our department. Any oral health risk assessment used in our clinic is provider specific and provider directed. The most significant potential barrier to using a risk assessment tool in our clinic is time required to apply one. Any assessment tool needs to be specific, easy to apply and understandable in order to be effective.