Establishment of oral health surveillance in Alaska

INTRODUCTION:  For many American Indian and Alaska Native (AI/AN) communities the prevalence of dental cavities among children is the highest in the U.S. A 2008 oral health survey in five rural Alaska communities showed 91% of children aged 4-15 years had cavities. Conducting comprehensive oral surveys is costly and labor intensive.  AI/AN dental care in south-western Alaska is provided through the regional tribal health corporation. We explored use of electronic dental records for surveillance purposes.

METHODS:  The regional dental unit maintains three databases that capture the existing condition (e.g. decayed, missing teeth) and treatment provided on- and off-site (e.g. fillings, crowns).  We merged data for all children age ≤ 6 years seen by dental providers between 2003-2011 and determined the accumulated decayed, missing, filled teeth (dmft) score for each child.  We provide an average dmft score for children aged 6 years in 2009, 2010, and 2011 seen by the dental system within 2 years and compare dmft scores for communities with/without in-home piped water or a dental health aid therapist (DHAT).

RESULTS:  Between 2009 and 2011 the proportion of children seen by the dental system increased from 58% to 83%; however there was no change in dmft score (9.6 in 2009, 10.9 in 2011). The 2011 dmft scores in communities with and without in-home piped water were 10.3 and 12.0 respectively (p < 0.01). In the 20 DHAT communities 99% of the children were seen compared to 73% in the 29 non-DHAT communities. Dmft scores were lower in DHAT (10.3) vs non-DHAT villages (11.2), (p=0.05).

CONCLUSIONS:  Using the electronic dental record we were able to establish dmft scores for a representative portion of the region’s population of 6 years olds and compare by characteristics of community of residence. Continued surveillance will allow monitoring of trends and evaluation of interventions.