Improving the Oral Health of Alaska Natives

Campbell, Dyan; Pollick, Howard; Lituri, Kathy M.; Horowitz, Alice M.; Brown, John P.; Janssen, Julie Ann; Yoder, Karmen K.; García, Raúl I.; Deinard, Amos S.; Hemphill, Sheranita; Torre, Magda A. de la; Shrestha, Buddhi Kumar; Vargas, Clemencia M.

doi:10.2105/ajph.2005.074666

Cited by 4 publications

(3 citation statements)

References 3 publications

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“…The details of the latter are not important here, but as in the United States, they can be likened to the American Indian and Alaska Native push toward self‐government. Clearly, the invocation of federal and tribal jurisdiction in response to the American professional challenges to the pediatric oral health therapist (14) is one example of the complex relationship now extant between dental therapy and indigenous self‐determination.…”

Section: Dental Therapy and Dental Nursing In Canadamentioning

confidence: 99%

On the Pediatric Oral Health Therapist: Lessons from Canada

Quiñonez

Locker

2008

J Public Health Dent

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Section: Dental Therapy and Dental Nursing In Canadamentioning

confidence: 99%

On the Pediatric Oral Health Therapist: Lessons from Canada

Quiñonez

Locker

2008

J Public Health Dent

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“…Despite the unwillingness, for years, of dentists to work in rural communities, with the majority preferring to work in major cities, the Alaska and Minnesota models have faced opposition by dentists who express concerns about the scope of practice of DTs and their ability to fix dental‐care access problems. The American Dental Association also started unsuccessful legal action against the Alaska initiative.…”

Section: Emerging Workforce Modelsmentioning

confidence: 99%

Role of telemedicine and mid-level dental providers in expanding dental-care access: potential application in rural Australia

Estai

Kruger

Tennant

2016

International Dental Journal

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Despite great progress in oral health over the past three decades, the rates of caries remain high in Australia, particularly among underserved populations. The reasons for poor oral health amongst underserved populations are multiple, but rests with socio-economic determinants of health. The present review considers international workforce models that have been created to enhance the recruitment and retention of dental providers in rural areas. Several strategies have been developed to address care access problems in rural areas, including the use of telemedicine and mid-level dental providers (MLDPs). Despite ongoing opposition from dentistry organisations, the Alaska and Minnesota workforce models have proven that developing and deploying dental therapists from rural communities has the potential to address the unmet needs of underserved populations. It is more efficient and cost-effective for MLDPs to perform triage and treat simple cases and for dentists to treat complicated cases. The use of MLDPs is intended to increase the capacity of the dental workforce in areas that are too isolated to entice dentists. Telemedicine has emerged as one solution to address limited access to health care, particularly in locations where there is a lack of providers. Telemedicine not only provides access to care, but also offers support, consultations and access to continuing education for practicing dental providers in rural areas. This strategy has the potential to free up resources to increase care access and reduce oral health disparities, thereby contributing to closing the rural-urban oral health gap.

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“…[3][4][5][6][7][8] While many diabetic patients have difficulty maintaining this level of glycemic control, those achieving intermediate and/or intermittent control experience far fewer complications such as retinopathy, nephropathy, neuropathy, fatigue, weakness, memory loss, cardiovascular disease, need for amputations, tooth loss, and periodontal infection. [1][2][3][4][5][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] Using a proportional hazards model and stringent controls of potential confounders, it has been shown the risk of diabetic nephropathy and cardiac mortality in Pima Indians is elevated 3.2 fold (95% CI 1.1-9.3) in those with severe periodontal disease. 23 Excellent glycemic control is achieved with strict regimens of diet, exercise, weight loss, avoidance of infections, fastidious self-care, avoidance of tobacco, medication adjustments, frequent medical attention, and self-monitoring of blood glucose levels using home glucometers.…”

Section: Introduction Oral Health and Glycemic Controlmentioning

confidence: 99%

Alterations in HbA1c Following Minimal or Enhanced Non-surgical, Non-antibiotic Treatment of Gingivitis or Mild Periodontitis in Type 2 Diabetic Patients: A Pilot Trial

Madden

Herriges²,

Boyd

et al. 2008

The Journal of Contemporary Dental Practice

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Aim:The purpose of this pilot study was to determine and compare the effects of two protocols aimed at reducing periodontal inflammation, upon the metabolic control of the diabetic condition in subjects with elevated baseline glycosylated hemoglobin (HbA1c). Methods and Materials:Forty-two non-smoking type 2 diabetes subjects with mildly elevated HbA1c (>7 but < 9%) and severely elevated (>9%) were randomized to one of two non-surgical periodontal therapy protocols. Patients in the "minimal therapy" (MT) group received scaling, root planning, and oral hygiene instructions on two occasions six months apart. Participants randomized to the "frequent therapy" (FT) protocol received scaling, root planing, and oral hygiene instructions at two-month intervals and were provided a 0.12% chlorhexidine rinse for home use twice daily. Neither systemic nor local antibiotics were provided to either group. Subjects were asked to report any changes in diabetic medications, nutrition, and physical activity. Data analyses (ANOVA, t-test, Mann-Whitney) grouped subjects according to baseline HbA1c (>7 and < 9%, or > 9%), treatment protocol (minimal or frequent), and +/-medication change. Results:In both MT and FT groups the clinical attachment level (CAL) remained unchanged but the other measures [gingival index (GI) and pocket dept (PD)] of periodontal health improved. Mean reductions in plaque showed improvement but calculus was worse in the FT group, likely due to the use of chlorhexidine. At six months, the largest reduction of HbA1c was 3.7; experienced by a subject receiving FT but no changes in diabetic medication. Among the MT and no medication change subjects, the maximum reduction was 1.6. Abstract © Seer PublishingConclusion: Overall, modest improvements in HbA1c were detected with a trend towards FT being better than MT. Although this pilot trial was under-powered to detect small between-group differences, the magnitude of our findings (0.6 mean improvement in HbA1c) matches closely findings from the only meta-analysis conducted on this topic to date. Larger scale studies must be undertaken on diabetic patients with periodontal problems.Clinical Significance: Preventive periodontal regimens for diabetic patients should be sufficiently intense and sustained to eliminate periodontal inflammation and should be closely coordinated with the patient's overall clinical diabetic management.

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Improving the Oral Health of Alaska Natives

Cited by 4 publications

References 3 publications

On the Pediatric Oral Health Therapist: Lessons from Canada

On the Pediatric Oral Health Therapist: Lessons from Canada

Role of telemedicine and mid-level dental providers in expanding dental-care access: potential application in rural Australia

Alterations in HbA1c Following Minimal or Enhanced Non-surgical, Non-antibiotic Treatment of Gingivitis or Mild Periodontitis in Type 2 Diabetic Patients: A Pilot Trial

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