SAN DIEGO – American Indian and Alaska Native children are particularly vulnerable to one of Indian Country’s most acute diseases: dental caries, also known as severe tooth decay.
Across the nation, tooth decay is the leading chronic infectious disease for children – five times more common than asthma, says Tamanna Tiwari, a researcher at the Center for Native Oral Health Research at the University of Colorado.
Navajo children are especially vulnerable to the disease, and a new study aimed to figure out why.
In one of the study’s papers, titled “Oral Health Status in Navajo Nation Head Start Children,” published in the Journal of Public Health Dentistry, researchers found more than 69 percent of Navajo children had untreated tooth decay.
They also concluded half of all Native children would need to be treated in the operating room because of the severity of their disease.
“It’s a combination of behavior, living in a remote location, having no access to transportation, and also oral health is not a priority because [Native Americans] have other issues to deal with like unemployment,” says Tiwari, one of the study’s researchers, speaking of some possible factors.
The researchers collaborated with the Navajo Nation and its reservation, which stretches across 25,000 square miles between New Mexico, Utah and Arizona.
Researchers used a community-based approach to reach 981 Navajo preschool children in 52 Head Start classrooms. A community advisory board provided input on the study, and Navajos from the community managed the field offices and served as ‘community oral health specialists’ once the study began.
“We didn’t want to go into a community where we did not have any ties,” Tiwari explains. “One of our principal investigators is American Indian, and most of our field staff is American Indian, so we tried to have that cultural component as much as we can.”
The community oral health specialists were trained over a four-week period to teach children good oral hygiene at school and during home visits. Their job was to make oral health interesting for kids, while showing respect and cultural sensitivity toward the community.
The effect of historical trauma in health outcomes
Tiwari says for many Native people there’s a long history of mistrust of health care workers and medical research, which she thinks impacts attitudes about oral health care. To overcome that uncertainty, the researchers engaged people at powwows and at school basketball games as one part of their community-based approach.
Maxine Brings Him Back-Janis (Oglala Sioux), a public health professor at Heritage University in Washington, believes that mistrust stems from historical trauma. She says it plays a role in the health status of Natives and the implications are intergenerational.
“When we’re looking at historical trauma and our American Indian populations, that whole piece of trust is not there,” Janis explains. “As Native people, we have to understand there is historical trauma that exists. We have to recognize and acknowledge that exists and then move into this place where we are no longer victims and we have power.”
Dr. Maria Yellow Horse Brave Heart, now director of Native American and Disparities Research at the University of New Mexico, first applied the term ‘historical trauma’ to Native Americans in the 1980s. The word describes the emotional and psychological impacts to an individual and across generations of Native Americans due to a history of colonialism and genocide.
Dr. Kathleen Rice-Brown, a counseling and psychology professor at the University of South Dakota, believes historical trauma affects behaviors toward health for American Indians today.
“I know it’s scary to go in [to see a doctor] and previously not been treated well,” says Brown, who works with Native clients on and off the reservation. “But sometimes you need to go in to get those services and take that step, and my hope is that they are met on the other end with someone who is culturally aware, has cultural knowledge, and is sensitive and competent to provide them that care.”
Making in-roads in the delivery of oral health care
Janis believes that few oral health ‘in-roads’ have been made in Indian Country. For the remote Navajo Nation reservation, the dentist-to-patient ratio is one of the lowest in the country, with fewer than 33 dentists per 100,000 residents, according to the Colorado School of Public Health.
In 2005, tribes in Alaska began adopting oral health programs to include mid-level dental providers who could provide routine care in rural communities. Since then, lawmakers in other states, such as Washington this year, have considered legislation that would provide similar dental health aide programs in their tribal communities.
“We need to look at a different model that includes these different health professionals, whether it be a dentist, a dental hygienist, a dental therapist,” Janis says. “What are we doing to grow our own health professionals in our own tribal communities? If we see faces like us in the Native sphere, sometimes that has a more of a significant impact.”
For Navajo, oral health programs also seem to be shifting. Mae-Gilene Begay (Navajo), program director of the Navajo Nation Department of Health’s Community Health Representative and Outreach Program, says they’re very much aware of the oral health issues for Navajo.
“It’s difficult for the parents to take their child or children to a health facility for dental work or oral health,” Begay says. “In most cases at the [Indian Health Services] facilities, we’re told ‘We cannot get you in for dental work for five or six months.’ There’s a lack of dentists in Navajo.”
Recently the department partnered with the American Dental Association to establish a Community Dental Health Coordinator position to focus on oral health. They also want to hire more ‘community health representatives,’ who can conduct oral health screenings and educate tribal members on diseases like tooth decay, in addition to providing other health services.
Still, many of the oral health care disparities for Navajo stem from funding gaps, which remain a consistent issue for many tribal communities.
Researchers at the Colorado School of Public Health are still processing data for a final report expected at the end of 2015.
They also conducted a similar study with another Northern Plains tribe, where they also prepared to ensure their methods would prove culturally acceptable and sensitive to Native traditions and beliefs.
“If we’re successful, these methods and interventions could be presented to the tribes and they could include them in their head start centers or [Women, Infants and Children] programs or other areas,” Tiwari says, “and maybe they could be a sustainable change.”
Editor’s Note: This article, written by Mallory Black, was first published by the Native Health News Alliance. Used with permission. All rights reserved.