Prevention of periodontal diseases in children. Periodontal (gum) disease. A chronic bacterial infection that affects the gums and bone supporting the teeth Gingivitis: Early stage of disease Red, swollen, and bleeding gums Usually reversible through good oral hygiene and preventive care
Red, swollen, and bleeding gums
Usually reversible through good oral hygiene and preventive care
Not uncommon in young adults and even youth
Chronic inflammatory response leading to irreversible destruction of tissues and bone that support the teeth
Treatment requires more aggressive surgical care
Periodontitis affects 8.5% of U.S. adults and is the most common cause of tooth loss.
Source: American Academy of Periodontology
Figure 1. Natural History of Periodontal Disease Progression
Colonization of Disease-Promoting
Mediating Risk Factors
Poor Oral Hygiene
Lack of Dental
-Inflammation of the gums
-Bleeding on probing
-Periodontal pockets (<4 mm)
-Periodontal pockets (>4 mm)
-Loss of clinical attachment around the tooth (>3 mm)
-Loss of supporting bone structure
recent oral hygiene behavior
-Calculus (calcified plaque): evidence of chronic oral hygiene behaviorNatural History of Periodontal Disease Progression
Type 2 Diabetes
Source: 1999 IHS Oral Health Survey Report
Source: 1999 IHS Oral Health Survey
Source: SEARCH for Diabetes in Youth Study.NHW=Non-Hispanic White; AA=African American; H=Hispanic; API=Asian/Pacific Islander; AI=American Indian
Periodontal disease already prevalent1.
High metabolic risk trajectory increases risk for periodontitis. T2D is 4-8 times more common in some AI/AN groups2. Diabetes is an established risk factor for periodontitis and is increasingly common in AI/AN youth.
AI/AN youth and young adults also have high rates of obesity, stress3 and tobacco use1, particularly smokeless tobacco, other risk factors for periodontal disease.
The opportunity exists to promote and establish independent oral hygiene behaviors and healthy habits to prevent periodontitis in later adulthood, and to intervene while changes are still reversible.
1 IHS Oral Health Survey (1999) 2 Mealey and Ocampoa (2007) 3 Robin et al (1997)
Kristen Nadeau, Judith Albino, Terry Batliner, Lonnie Johnson, Anne Wilson, Angela Barega, William Henderson
Aim 1:Assess periodontal health status of urban AI/AN adolescents
Aim 2: Assess modifiable oral health behavioral risk factors, knowledge, attitudes in urban AI/AN adolescents at high risk for T2D, and determine whether these factors are associated with severity of periodontal disease as assessed by attachment loss (periodontitis) and mean percent bleeding sites (gingivitis).
Aim 3: Based on the findings from SA’s 1-2, and in partnership with the CNOHR and DIHFS Community Advisory Committees, develop a culturally-appropriate behavioral intervention focused on the factors identified as key mechanisms influencing periodontal disease in AI/AN adolescents and develop a protocol to evaluate its effectiveness.
Long term residents: in a city for multiple generations, some the descendants of people who traditionally owned land that became an urban center.
Forced residents: forced to relocate to urban centers by government policy or by the need to access specialized health or other services.
Medium and short term visitors: in a city to visit family or friends, to pursue an education, job.
Some urban AI/AN are members of the 561 federally recognized tribes (qualifying only for health care on reservations)
Other urban AI/AN are from the 109 tribes “terminated” in the 1950’s and qualify for nothing
Only 1% of the Indian Health budget is allocated to urban programs despite 2/3 of AI/AN living in urban settings and even this 1% remains under threat
Barriers to care: time constraints; transportation issues; distrust of government programs; cost of traveling to receive government-provided health care; depression; few AI/AN providers; changing addresses if transient
Services: NP and volunteer MD, substance abuse, mental health, CDE, weight loss, exercise counseling, energy services, limited medication stock, low-cost dental, very simple labs (glucose, HbA1c, lipids)
Missing Services: subspecialists (in particular endocrinology, cardiology, psychiatry), more expensive medications, diabetes supplies, procedures, imaging, comprehensive laboratory
Main barriers: 77% of clients uninsured (many insured are vets), some waive benefits at work expecting IHS clinic to cover needs like on reservation, if insured, co-pays/deductibles high
Was not affiliated with HMO so couldn’t bill medicaid, lacked IHS funds for training and improvements; now Title V funded and now Medical Assistance site so can proccess medicaid
Community Health Advisory Board: tribal IRB head, health care workers, tribal college president, tribal education specialist, DIHFS coordinator, all AI/AN
Staff meetings of DIHFS: Clinic Coordinator, Diabetes educator, Physical Activity Trainer, psychologist, social services, CAN, lab tech
Denver Indian Center
JEFCO: AI/AN urban student coordinator,Pow-Wow
Cultural Immersion Program at UCD
Offering free cleanings to take burden off DIHFS staff