Dental Cavities in Alaska Native Children- An update on ongoing research and public health practice activities in Alaska

Thomas Hennessy, MD, MPHDirector

Arctic Investigations ProgramAnchorage, Alaska

tbh0@cdc.gov

Disclosure

• Dr Hennessy has no relevant financial relationships with the manufacturer(s) of commercial services discussed in this CME activity

• Dr Hennessy does not intend to discuss any unapproved/investigational uses of commercial products in this presentation

What’s Ahead? • Caries among Alaska Native children• Alaska’s Dental Health Aides• How can we evaluate the oral health of a

population?• Water fluoridation in Alaska

Caries in Alaska Native Children

Caries in AI/AN Children

Full Mouth Dental Rehabilitation (FMDR)

Dental Therapists: A Definition

• Primary oral health care professionals • Basic clinical dental treatment

and preventive services • Multidisciplinary team

members• Advocate for the needs of

clients• Refer for services beyond the

scope of the dental therapist’s practice.*

*SASKATCHEWAN DENTAL THERAPISTS ASSOCIATION

Alaska’s Dental Health Aides

• Certified by Alaska Community Health Aide Program– Began in 2004 by ANTHC

• Work under supervision of a dentist• 4 levels of training

– Primary aide, expanded, hygienist, therapist• Working in > 40 villages

– 90% are Alaska Natives– 80% working in home village

How to Evaluate the Benefit of Alaska’s Dental Health Aides?

• Basic measures– Number of aides, patients, procedures

• Evaluate certification, training, safety

• Impact on health or dental decay?

Available Dental Caries Data

I.H.S. Basic screening survey• Last survey: 2014• Last published: 2011

• Alaska Basic Screening Survey– Kindergarten and third graders

• Last 2010

• Electronic Dental Records (EDR)• Head Start exams

IHS Oral Health Survey

From Phipps, et al, JPHD, 2012

What we really need is surveillance data

What we really need is surveillance data

Surveillance in Public Health

• Ongoing, systematic collection, analysis and interpretation of health data

• For planning, implementation and evaluation of public health practice

Can We Use Electronic Dental Records for Surveillance?

• Data already collected for clinical use– Less expensive than special studies

• More up-to-date than surveys• More complete than surveys

– All clinic users• Provides local or regional data• Can track patients over time

What can be measured through electronic records?

• Basic descriptive information– Age, sex, residence– Clinic usage, procedures, exams

• Health Outcomes– Decay scores for children of a given age

• Decayed, missing, filled teeth (dmft)– Treated vs. untreated decay– Severe outcomes: full mouth dental

reconstruction

Prevalence Of Caries Among Southcentral Foundation Dental Clinic Pediatric Patients, 2006-

2013, Anchorage, Alaska.

Jody Atzmon1, DDS Tom Hennessy2, MD, MPH, Richard Baum2, BS, Dana Bruden2,

MS, Lisa Bulkow2, MS, Alison Walsh1, DDS, James Singleton3, DDS

1Department of Dental Medicine, Lutheran Medical Center, Brooklyn, New York2Arctic Investigations Program, US Center of Disease Control and Prevention, Anchorage, Alaska

3Southcentral Foundation, Anchorage, Alaska

Mean dft Scores by Age Class

Procedures requiring General Anesthesia

25% of children were treated in the operating room before age 6

Risk of Having a FMDR, According to Caries Score at age 3

Yukon Kuskokwim Region

• EDR since 2005• Use EDR to calculate dmft scores for

the population – Collaboration with ANTHC, CDC

• Measure impact of programs• In-home piped water service• Water fluoridation• Dental Health Aide Therapist Program

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Percentage of 5 year olds receiving Comprehensive Exams in Communities with 

DHATs versus No DHATs

P<0.05 for proportion covered and rate of change

Mean dfmt scores for 5 year olds by Community Water Service Status

Year

Piped Un‐piped

p‐value

Total 5 year old Pop

Dental Examn (%) dmft

Total 5 year old Pop

Dental Examn (%) dmft

2011‐2015 1195 409 (34%) 10.3 985 294 (30%) 11.9 <0.001

Limitations of electronic dental records

• Using the data requires analysis capacity

• Data quality and completeness dependent on charting practices

Electronic Dental Records

• A tool for evaluating oral health in a population over time to:– Assess interventions– Direct prevention efforts

Water Fluoridation

Healthy Alaskans 2020 (HA2020) 

Public health initiative to improve health and ensure health equity25 health priorities• Measureable targets to reach by 2020• Provides strategies and specific actions • Identifies key partners across the state to engage in the

work

HA2020 Dashboard

Water Fluoridation in Alaska

• Alaskan population served with optimally fluoridated water

• 2010: 54.8% US: 72.4%• 2020 Target: 58% US: 79.6%

• Communities that stopped fluoridation– Juneau 2006– Fairbanks 2010– Palmer 2013

• Water fluoridation challenged but continued in– Anchorage 2014, 2017– Bethel 2012– Nome 2012

Next Steps

• Continue to work with EDR to support oral health programs

• Evaluate oral health in communities that stopped water fluoridation

Thanks to…

• CDC Arctic Investigations Program– Dana Bruden, Lisa Bulkow, Richard Baum– Michael Bruce, Prabhu Gounder

• ANTHC– Tim Thomas, Gretchen Day

• Joe Klejcka (YKHC), Jim Singleton (SCF), Dane Lenaker (SEARHC)