Early Intervention for Childhood Caries to Address Alaska Native Disparities in Oral Health - 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.
