PROJECT SUMMARY/ABSTRACT
By 6 years of age 73% of Alaska Native (AN) children in the Yukon-Kuskokwim (Y-K) region of
southwestern Alaska have had a full mouth dental reconstruction (FMDR), requiring general anesthesia
for extensive early childhood caries (ECC). ECC, defined as “the presence of one or more decayed, missing
(due to caries) or filled tooth surfaces in any primary tooth in a child between birth and 71 months of age”,
affects sleep, eating habits, and performance in school. Reasons for high ECC rates include lack of community
water fluoridation, high consumption of sugar-sweetened beverages and remoteness from dental care.
Care coordination has been recommended as a method for improving the reach and coordination of
dental services among health care providers, care systems, and parents, to promote healthy, pain-free
childhoods. Through coordination of services and education of parents, ECC could be mitigated by prevention
counseling (e.g. oral hygiene, reduced sugar) and dental interventions initiated before age 24 months.
The Y-K region is the home of 50 remote communities and approximately 5,000 children age <6 years; medical
and dental care is provided by one Tribal Health Organization. Health care in the communities, including well
child visits, is provided by community health aide/practitioners (CHA/Ps). In 7 communities, dental health care
is provided by dental health aide therapists (DHATs) co-located with CHA/Ps in community clinics. DHATs
provide preventive care and education, oral exams and non-surgical extractions.
Data indicate only 12% of Y-K children have an oral exam by age 24 months; in contrast almost 80% obtained
standard vaccinations, which require 5 visits. The difference in accessing pediatric and dental services could
be mitigated through care coordination. Unfortunately, CHA/Ps and DHATs work independently of each other
and use different electronic medical and dental record systems. There is a critical need to coordinate care
in a way that includes parent education on effective oral health practices and alignment of well child
visits with dental visits early in a child's life.
We propose a mixed methods comparative clinical effectiveness trial to study whether the use of care
coordinators to educate caregivers and to assist in coordination between well child visits and dental visits at
ages 0-24 months increases the proportion of children who receive oral health exams and interventions and
reduces the incidence of ECC in AN children. Our specific aims are: (1) to explore facilitators and barriers to
oral health care including the integration of dental and well child visits for children ages 0-24 months, and
identify stakeholder-based outcomes of interest, (2) to design an implementation plan for integrating a care
coordinator (CC) position into the well child visit workflow, to systematically reach children for an oral health
exam prior to age 24 months, (3) to compare stakeholder-reported, implementation process and clinical
outcomes in communities with and without CCs.
The results of this study will provide Tribal Health Organizations, and health care systems where dental and
pediatric care are co-located, with an evidence-based model for delivering integrated clinical care to improve
oral health.
