Oral Health

Discussion Summary

Date of Discussion: July 2003
Discussion Moderator: Cliff O'Callahan, MD
Discussion Participants: Paul Avritt, Scott Hamstra, Kent Saylor, Indu Agarwal, Richard Mandsager, Donna Perry, David Grossman, Dee Robertson, Paul Wegehaupt, Steve Holve, and Lori Byron.

Consensus: Dental decay in Native children is a huge problem cited by all participants (80-90% in White River, 80% in Northern Quebec, 90% where Steve is..).

Availability of Dentists: The ability to get a child in to dental visits seems to vary dramatically by site. Some are seen when they get first tooth and then every 6 months, while other sites children aren't seen intil they are 3. Various sites mentioned a distinct paucity of dentists. Some sites (Puyallup) automatically refers all pregnant mothers to a dentist for an evaluation.

Primary Care Providers looking at teeth: It seems all sites have providers who recognize the problem and do look at a child's teeth routinely. We didn't raise the issue of how well we examine teeth and document problems.

Interventions:

1. Education: many sites have providers, WIC staff, dental staff, others educating families about the infectious nature of caries, juice, propping, brushing, bottles until 12 months only. Steve shared sobering impression that all their education interventions had no impact on incidence or severity and so they went to varnish.

2. Toothbrushes: Many sites are giving out toothbrushes.

3. Xylitol: Some sites are using xylitol gum. David is PI on study in Alaska looking at interventions with mothers that involve giving them xylitol gum.

4. Fluoride Varnish: Many sites are applying fluoride varnish universally or sporadically. Note was made that it can be applied by staff. Many sites are working on making this universal at Well Child Visits.

5. Chlorhexidine: This is an antiseptic that may reduce the density of Strep mutans. It is being studied with pregnant women by having them use it in rinse form (Alaska) and varnish form (Yakima & Warm Springs).

6. Fluoride supplements: Lots of frustration about the ability to test well water for Fluoride content, depend on communities to consistently fluoridate the water correctly, or get families to be compliant with supplements. Many States provide water testing services, but clinics can pre-purchase test kits (Fluricheck) that families or a community can buy for as low as $9.50 from companies such as Omnii 800-445-3386.