Epidemiologic Notes and Reports Dental Caries in American
Indian and Alaskan Native Children
A study conducted by the Indian Health Service (IHS) of the
U.S.
Public Health Service in 1983-1984 showed that American Indian and
Alaskan Native (AI/AN) children develop more tooth decay than the
general population of U.S. schoolchildren (1). This study involved
patients seen in IHS dental clinics in the 11 geographic areas of
the
IHS, including Alaska. Among AI/AN children, an average of 6.8
decayed, missing due to caries, and/or filled permanent teeth
(DMFT)
was identified for approximately 5,800 children 5-19 years old.
The
National Caries Prevalence Survey (NCPS), conducted by the National
Institute of Dental Research in 1979-1980, reported that 5- to
17-year-olds in the overall U.S. population had an average of 4.8
DMFT
(2).
Results from the IHS study indicate that 19% of 5- to
19-year-old
dental patients were caries-free. By contrast, 37% of 5- to
17-year-olds from the NCPS were reported to be caries-free.
Approximately 33% of AI/AN children treated in dental offices had
seven or more DMFT; 15% of other U.S. children had the same rate.
On
average, 12-year-old AI/AN children had 6.5 DMFT, and by age 17
years,
11.9 DMFT. U.S. schoolchildren surveyed from a national random
sample
had 2.6 DMFT at 12 years and 6.3 DMFT at 17 years of age (Figure
2).
Although the 1990 U.S. Public Health Service objective stating that
40% of 9-year-old children should be caries-free (3) has been
achieved
(51% reported from NCPS), 2.3% of AI/AN children of the same age
group
were reported as caries-free from the IHS study.
Severe, rampant tooth decay caused by prolonged bottle feeding
(milk, formula, juices, or sweetened beverages) of infants and
young
children is called nursing-bottle caries. Based on the
characteristic
dental caries pattern of nursing-bottle caries (affecting the upper
front primary teeth and, frequently, the back teeth), up to 50% of
AI/AN preschool-aged children who seek dental services suffer from
this disease. Eighteen percent of preschool-aged AI/AN children
(under 5 years old) had caries-free primary teeth, while over 40%
had
seven or more decayed and/or filled primary teeth (DFT). Children
with nursing-bottle caries had almost four times the amount of
tooth
decay as those children who had not had nursing-bottle caries.
Reported by Indian Health Svc; Dental Disease Prevention Activity,
Center for Prevention Svcs, CDC.
Editorial Note
Editorial Note: Although major differences in the sampling methods
make direct comparisons of the IHS data with the NCPS data
difficult,
the higher incidence of tooth decay in AI/AN children cannot be
explained by these differences alone. Also, since infrequent users
of
the IHS-care system who were studied had as much dental decay as
more
frequent users, the sampling methodology in itself may not account
for
the major differences in caries prevalence between the AI/AN
population and the general U.S. population. The differences in
data
collection indicate the need for standardization of surveillance
methods and reporting of data.
Because the IHS data were collected from a sample of dental
patients, they do not necessarily represent the actual dental
caries
prevalence among all AI/AN children. The magnitude of dental
caries
in these children remains a serious problem. IHS and Native
American
communities are placing increased emphasis on both the extent and
quality of dental caries prevention activities, which include:
community water fluoridation, supplemental fluorides, and pit and
fissure sealants. The IHS anticipates that future surveys will
reflect the impact of these activities by a decrease in caries
prevalence. The IHS is also increasing its emphasis on the
prevention
of nursing-bottle caries by educating health professionals and
parents.
References
Indian Health Service. Unpublished data, 1985.
National Institutes of Health, National Institute of Dental
Research, National Caries Program. The prevalence of dental
caries in United States children, 1979-1980; the national
caries
prevalence survey. Washington, D.C.: Public Health Service,
U.S.
Department of Health and Human Services, 1981. (NIH publication
no. 82-2245).
U.S. Public Health Service. Promoting health/preventing
disease:
objectives for the nation. Washington, D.C.: U.S. Department
of
Health and Human Services, 1980.
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