DENTAL HEALTH

+--------------+------------+-------------+-------------+-------------+
|              | 2002       | 2003        | 2004        | Increase    |
|              |            |             |             |             |
|              | Actual     | President's | Estimate    | or Decrease |
|              |            |             |             |             |
|              |            | Budget      |             |             |
+--------------+------------+-------------+-------------+-------------+
|              |            |             |             |             |
+--------------+------------+-------------+-------------+-------------+
| BA           | \$         | \$          | \$          | +           |
|              | 95,305,000 | 100,085,000 | 105,566,000 | \$5,481,000 |
+--------------+------------+-------------+-------------+-------------+
| FTE          | 775        | 797         | 833         | +36         |
+--------------+------------+-------------+-------------+-------------+
|              |            |             |             |             |
+--------------+------------+-------------+-------------+-------------+
| Patients     | 335,000    | 335,000     | 335,000     | 0           |
| Treated      |            |             |             |             |
+--------------+------------+-------------+-------------+-------------+
| Services     | 2,536,500  | 2,536,500   | 2,536,500   | 0           |
| Provided     |            |             |             |             |
+--------------+------------+-------------+-------------+-------------+

# **PURPOSE AND METHOD OF OPERATION**

# Program Mission and Responsibilities

The Indian Health Service (IHS) Division of Oral Health is committed to
raising the oral health status of the American Indian and Alaska Native
(AI/AN) population to the highest possible level through the provision
of high quality preventive and treatment services in both the community
and clinic levels. Despite a history of documented improvements in oral
health status, the oral health of Indian people still lags well behind
that of the overall population of the United States; this disparity may
be increasing. For the past four years, oral health problems have been
identified by consumers participating in budget formulation activities
among the top priorities for funding enhancement. As a result, oral
health has been identified as one of the IHS Director\'s initiatives.

Between the early 1970s and the early 1990s, a period of overall dental
program expansion, the IHS Division of Oral Health made significant
strides in improving the oral health of the American Indian and Alaska
Native population. Results of the IHS-wide Oral Health Status and
Treatment Needs Survey of over 25,000 dental patients completed in 1991
revealed several important findings. When compared with results from
earlier monitoring surveys, a general decline in tooth decay among
children and adults was detected. This encouraging trend can be
attributed mainly to the extensive commitment that the IHS and local
communities have made to water fluoridation during the past decade and
the expanded use of dental sealants. However, AI/ANs continue to have
substantially higher rates of dental caries and periodontal disease than
the U.S. population at large.

![](media/image1.png){width="2.985433070866142in"
height="2.4464566929133857in"}

A follow-up oral health survey was initiated in FY 1999 to determine the
current oral health status and continued or emerging problems that must
be addressed. Approximately 13,000 patients participated in the survey
in all 12 Areas. A final report was released during the fall of 2001.

The IHS has been traditionally oriented toward preventive and basic
care. More complex, rehabilitative care, although a legitimate need, is
often deferred so the basic services may be provided to more persons.
Within the [Schedule of Services]{.underline}, which is a service
priority hierarchy used by the Division of Oral Health, over 90 percent
of services provided are basic and emergency care. Estimates of demand
for treatment remain high; however, a continuing emphasis on community
health promotion/disease prevention is essential to long‑term
improvement in the oral health of AI/ANs.

In FY 2000, the IHS developed a process to build public health
infrastructure through tribal and IHS partnerships. Four tribal health
boards were funded to implement Dental Clinical and Preventive Support
Centers, the purpose of which are to provide technical support,
training, and assistance in clinical and preventive aspects of dental
programs providing care to American Indians and Alaska Natives. The four
health boards initially funded were: Alaska Native Tribal Health
Consortium, All Indian Pueblo Council, Inter-tribal Council of Arizona,
and Northwest Portland Area Indian Health Board. In FY 2001, three
additional awards were made: Confederated Salish and Kootenai Tribes of
the Flathead Nation in cooperation with the Billings Area IHS, Oklahoma
City Area Inter-Tribal Health Board, and the Aberdeen Area IHS. Each of
the support centers approaches the objectives in a unique manner, but
all strive towards providing the technical support, training and
assistance needed for the improvement of access to care and quality of
care provided to American Indian and Alaska Natives.

Tribal programs continue to exert a growing influence in the management
of oral health programs. The number of tribally managed programs
continues to grow steadily. Staff employed by or providing care in
tribal programs produce over a third of the total direct dental
services. To responsibly manage a health program requires data that
support an assessment of the health needs of the population. Tribal
programs were well represented in the IHS 1991 and 1999 [Oral Health
Survey]{.underline} of Indian patients. Data gathered by these surveys
provide tribes information from which to make rational decisions
regarding their dental programs.

######### ACCOMPLISHMENTS

The IHS Dental Program has a long and distinguished history of serving
as a benchmark of dental public health excellence. Beginning in the
1960s, the IHS Dental Program was a pioneer in developing dental
resource planning methods, and, in the early 1970's, published some of
the first and most compelling findings regarding the efficiency and
effectiveness of using expanded duty dental assistants in the provision
of dental restorations.

Later in the 1970s, the IHS published what still remains as one of the
most comprehensive and recognized approaches to quality assurance for
dental care. In the 1980s and 1990s, the IHS Dental Program was
recognized by winning three U.S. Public Health Service J.D. Lane
research competitions for community based research/education projects as
well as three American Dental Association awards for health
promotion/disease prevention.

The program's Baby Bottle Tooth Decay Prevention Project, which won two
of these awards, has been cited internationally as a model of community
empowerment and program effectiveness. As part of these activities the
IHS Dental Program collaborated with the World Health Organization, the
Centers for Disease Control and Prevention, the National Institutes of
Health, the Head Start Bureau, and several universities.

The ultimate benchmark of success for a public health organization is
what it accomplishes in term of positive outcomes for the people it
serves. Comparing findings from the 1999 oral health survey with the
1991 survey, analysis shows:

A 14 percent increase in the number of children 5-19 years with [no
decay.]{.underline}

A 12 percent decrease in the number of children 5-19 years with [high
decay]{.underline} rates (7 or more cavities).

A 21 percent increase in the number of protective dental sealant placed
on first and second molars in adolescent's ages 14 years.

A 9 percent decrease in the number of adults 35-44 years with
periodontal disease (based on Community Periodontal Index of Treatment
Needs (CPITN) scores).

A 21 percent increase in the number of adults 35-44 years who have never
lost a tooth to periodontal (gum) disease or dental caries (cavities).

## [PERFORMANCE MEASURES]{.underline}

The Dental Health budget supports the accomplishment of the following FY
2004 performance measures:

[Indicator 12]{.underline}: During FY 2004, increase the proportion of
AI/AN population receiving optimally fluoridated water by 1% over FY
2003 levels for all IHS Areas.

[Indicator 13]{.underline}: During FY 2004, maintain the proportion of
the AI/AN population that obtain access to dental services at 99% of the
FY 2003 level.

[Indicator 14]{.underline}: During FY 2004, maintain the number of
sealants placed per year in AI/AN children at the FY 2003 level.

[Indicator 15]{.underline}: During FY 2004, increase the proportion of
the AI/AN population diagnosed with diabetes who obtain access to dental
services by 1% over the FY 2003 level.

Following are the funding levels for the last 5 fiscal years:

+---------------+-------------------------------------+---------------+
| # Year        | [Funding]{.underline}               | [FTE          |
|               |                                     | ]{.underline} |
+---------------+-------------------------------------+---------------+
| 1999          | \$71,400,000                        | 763           |
+---------------+-------------------------------------+---------------+
| 2000          | \$80,062,000                        | 745           |
+---------------+-------------------------------------+---------------+
| 2001          | \$95,208,000                        | 749           |
+---------------+-------------------------------------+---------------+
| 2002          | \$95,305,000                        | 775           |
+---------------+-------------------------------------+---------------+
| 2003          | \$100,085,000                       | 797           |
+---------------+-------------------------------------+---------------+

**[RATIONALE FOR BUDGET REQUEST]{.underline}**

**TOTAL REQUEST** \-- The request of \$105,566,000 and 833 FTE is an
increase of \$5,481,000 and 36 FTE over the FY 2003 President's Budget
request of \$100,085,000 and 797 FTE. The increase includes the
following:

[Pay Cost Increases: +\$2,264,000]{.underline}

The request of \$2,264,000 will fund federal and tribal pay costs which
will assist the IHS in maintaining access to services for the IHS
patient population. Provision of these funds is necessary to maintain
the current I/T/U health system which works to eliminate disparities in
health status between the American Indian and Alaska Native population
and the rest of the U.S.

[Phasing-In of Staff for New Facilities: +\$3,217,000 and 36
FTE]{.underline}

The request of \$3,217,000 and 36 FTE provides for the phasing-in of
staff and related costs for new facilities allowing IHS to expand
services in areas where existing capacity is most overextended. The
staffing of new facilities also contributes to the recruitment and
retention of dental staff. The following table displays the requested
increase.

+---------------------------------------+------------------+-----------+
| ### Facilities                        | ######## Dollars | FTE       |
+---------------------------------------+------------------+-----------+
| Ft. Defiance, AZ Hospital             | \$1,328,000      | 15        |
|                                       |                  |           |
| Pawnee, OK Health Center              | 1,269,000        | 14        |
|                                       |                  |           |
| ####### Winnebago, NE Hospital        | [620,            | [7]{.u    |
|                                       | 000]{.underline} | nderline} |
| Total                                 |                  |           |
|                                       | \$3,217,000      | 36        |
+---------------------------------------+------------------+-----------+