Assessment of parental oral health knowledge and behaviors among American Indians of a Northern Plains tribe

Public health efforts involving water fluoridation, nutrition, and dental care access have enhanced the potential for optimal oral health in the United States (U.S.). Yet dental caries persists, with low-income and ethnic/racial minority children experiencing a disproportionate burden of disease. Among groups at risk for oral health disparities, prevalence of dental caries in American Indian and Alaska Native (AI/AN) children is among the highest in the U.S. (1). Compared to other ethnic/racial groups, over 62% of AI/AN preschoolers have early childhood caries (ECC) versus 42% of Mexican-American, 32% African American, and 25% non-Hispanic white children (2). Severity of disease, as measured by decayed, missing, and filled teeth (dmft), is 3-4 times higher in AI/AN preschoolers than the general population of U.S. children (3-5). Moreover, population-based studies reveal untreated dental decay increases with age among AI/AN children, with a 21% prevalence in 1-year-olds and 75% prevalence in 5-year olds (4). Advancing severity of oral disparities in reservation communities has become a major public health and policy issue. General oral health outcome assessments indicate oral health beliefs and behaviors of American Indians (AI) differ compared to other U. S. ethnic/racial minority populations (World Health Organization International Collaborative Study of Oral Health Outcomes, ICS-II). For AI adults, barriers in accessing care and past negative dental experiences were associated with decreased likelihood of dental contact and worse perceived oral health status (6, 8). AI adults also reported lower frequencies of daily toothbrushing (7) and were more likely than other U.S. ethnic/racial minority populations to report total tooth loss (6). Beyond general surveys of AI adults, limited data are available related to determinants of oral health disparities for AI/AN children, including parental knowledge and behavior. Oral health status of Alaska Native (AN) children was evaluated as part of an investigation involving Head Start children. Compared to other children, AN children experienced higher rates of ECC. Probability of developing dental caries was more than 4 times higher among AN than other non-AN children. Investigators attributed this disparity primarily to sociodemographic determinants and dietary patterns related to behavioral factors (9). In an oral health literacy study that included AI participants, caregivers’ oral health knowledge and behaviors and self-reported oral health status of their children were evaluated. Compared to whites and African Americans, AI caregivers were most likely to report poorer oral health status for their children, although parental oral health knowledge was not lower (10). The complex interaction of poverty, health care system limitations, culture and ethnicity/race, and health behaviors affect oral health outcomes (11, 12). Accordingly, interest has grown in addressing oral health using a broader framework incorporating psychosocial and behavioral strategies (11, 13). The current study describes the first, essential step in developing such an approach for AI populations – identification of knowledge and behavior levels and associated factors. This community-based study is the first to examine and report outcomes for oral health knowledge and behavior in AI parents from the Northern Plains region. Study findings are being used to develop oral health messages and behavioral approaches for use within a manualized intervention intended to enhance parental oral health behaviors, with the ultimate goal of reducing dental caries prevalence in AI children.