Kellogg study reports on oral disease levels at Indian reservation

Forty percent of children and nearly 60 percent of adults on the Pine Ridge Indian Reservation in South Dakota suffer from moderate to urgent dental needs, including infections and other problems that could be life-threatening, according to a study released Nov. 2 at the 68th annual National Congress of American Indians conference hosted in Portland.

The study, the first in 12 years on the state of oral health at this remote reservation, paints a disturbing picture of unchecked decay, gum disease and other serious dental problems that can lead to lower performance in school, infections and even death. The W.K. Kellogg Foundation funded The Checkup Study, which showed that 90 percent of participants showed signs of active decay, a rate three times that typically found in the United States.

“Many of the Pine Ridge residents suffer daily from wrenching dental pain yet they face huge barriers to getting routine care,” said lead author Terry Batliner, DDS of the Colorado School of Public Health and a member of the Cherokee Nation of Oklahoma. “A severe shortage of dentists willing to practice in isolated areas has left many Americans, including American Indians, with ongoing dental problems that threaten their overall health.”

Dr. Batliner told Dentistry IQ.com, "There are not enough dentists willing to work in Pine Ridge. There are not enough dental positions in the Indian Health Service on the Pine Ridge reservation to meet the needs of the people. We need more dental providers and we need a stable cohort of providers.

"I think Dental Therapists should be used as they are in Alaska. If Native people were recruited from their homes, sent to two years of training to learn to do basic dentistry then they could return home and serve their communities. This is working in Alaska and the dental needs in Alaska are similar to the dental needs in Pine Ridge. There are at least 15 studies of dental therapists in the world, two recent studies from Alaska. All the studies show that dental therapists provide competent care equal to dentists within the limited scope of basic dentistry that they provide."

Dr. William Calnon, president of the American Dental Association, responded to the Pine Ridge study, "“Native Americans suffer from inadequate access to dental care and the resulting disease in dramatically greater proportion than the general population. The ADA historically has been the most prominent advocate for increasing resources to help improve oral health in Indian communities, including adequate funding for the Indian Health Service to fulfill its mission. We havelaunched the Native American Oral Health Project in cooperation with the state dental societies in Arizona, New Mexico, North Dakota and South Dakota in order to ramp up efforts to empower the Tribes and their people to take better command of their own oral health.”

Dr. Batliner told DentistryIQ.com, "I am a member of the Cherokee Nation of Oklahoma and have been involved in American Indian issues my entire life. I lived on Pine Ridge in the 1980's and I visit and work there frequently now as an associate professor in the Colorado School of Public Health. I care about the people in Pine Ridge. My son was born there and I have many personal attachments to the Pine Ridge Community."

In an related story, DentistryIQ.com recently interviewed Maxine Brings Him Back-Janis, a Native American dental hygienist, about her research into the oral health care of residents at the Pine Ridge reservation. To view the interview, click here.

The Indian Health Service, a federal agency that provides health and dental care for American Indians and Alaska Natives, conducted a limited survey of dental needs on this reservation back in 1999. To offer a more comprehensive view of the oral health problems in Pine Ridge today, the Checkup team traveled to twenty communities on the reservation and recruited 292 adults and children for the study.

They gave each participant a dental exam, identified any decay or other problems and then offered recommendations for treatment. The Checkup study showed that residents at Pine Ridge had significantly higher numbers of decayed teeth and lower numbers of treated or filled teeth than reported by the 1999 Indian Health Service study.

The team discovered that 84 percent of children in the study and 97 percent of adults had ongoing decay, a problem that can lead to loss of permanent teeth.

Other key findings of the evaluation showed that:

• Ninety two adults or 68 percent of the adult participants had evidence of gum disease and 16 percent showed signs of an advanced problem. Gum disease can lead to a loss of teeth and can put people at risk for other serious health problems like heart disease.
• One child and five adults were found to have signs of a precancerous condition of the mouth. If left untreated, such a condition can progress to full-fledged cancer.
• The high prevalence of decay and gum disease suggests that many participants had chronic pain that could interfere with daily activities.
• About half the adults in the study had missing teeth and two had no teeth at all.

“All Americans, including those living in Pine Ridge, should have access to affordable dental care,” said Sterling K. Speirn, president and CEO of the W.K. Kellogg Foundation. “It is time to expand the reach of dentists by employing a new type of dental practitioner to provide routine care. This approach has worked extremely well in Alaska, where dental therapists are effectively delivering dental care to people living in isolated villages. In fact, since the program got underway in 2005, dental therapists have been able to reach 35,000 people who didn’t have access to care before. ”

Close to 50 million Americans live in dental health shortage areas--places without enough dentists to meet the demand for routine oral health care. However, poverty and extreme conditions make the access problem much worse for residents of the Pine Ridge Indian Reservation, Batliner said.

Just ten dentists working in three locations must provide care for 30,000 people living in an area roughly the size of Connecticut. As a result, many people must wait for months just to get an appointment and some children in the study had never seen a dentist before.

In winter, the weather can make it impossible for residents of remote locations to travel. Even in the summer, they must travel miles along rutted roads just to get to the nearest dental clinic. And even if they manage to get to the clinic, overbooked staff might tell them to come back another day, Batliner points out.

The W.K. Kellogg Foundation, which has a long history of supporting efforts to improve access to oral health care for those who go without, is currently working with five states – Ohio, Kansas, New Mexico, Washington and Vermont -- to consider dental therapists as part of an overall approach to expand care to vulnerable children and families.

More than a dozen other states are considering midlevel dental practitioners as a way to expand access, including California, Connecticut, New Hampshire, Maine and others. Alaska and Minnesota already allow dental therapists to practice.

Other approaches identified by the authors include allowing licensed hygienists to serve as dental therapists in federally designated shortage areas. The authors also said that the tribe could take federal dollars now used to provide dental care on the reservation and use the money to create their own oral health care system.