A research center based at the University of Washington School of Dentistry will try to understand the causes, and some of the answers, for needless suffering among diverse groups in the Northwest and Alaska. This suffering is caused by the great disparity in dental health services.
The Northwest/Alaska Center for Research to Reduce Oral Health Disparities is funded by the National Institute of Dental and Craniofacial Research and the new National Center on Minority Health and Health Disparities of the National Institutes of Health. Five such centers have been funded nationwide to look for the reasons behind disparities in oral health, and how they might be reduced or eliminated.
“This new center was created by faculty who already have a long track record of identifying the reasons for dental health disparities, and what can realistically be done about them. We’re very excited about the prospects of focused research in an area that can prevent so much pain and so many health problems in our children,” says Dr. Peter Milgrom, principal investigator of the center and professor in the Department of Dental Public Health Sciences.
Children ages 1 to 2 who are from poor families have three times the rate of cavities found in other children. The problems of diverse groups in the Northwest mirror, or are greater than, national trends. Researchers say that even though cavities are largely preventable, 57 percent of Native American children in Alaska have cavities by the age of 3; so do 98 percent of their mothers. Nationwide, while the rate of cavities has plummeted, children in Native American populations have stable or increasing rates of dental caries.
Meanwhile, more than half of Hispanics in parts of Washington have cavities — overall, children in Washington are more likely than children in many other states to have tooth decay.
This disparity causes considerable suffering. For one thing, children with dental problems are more likely to do poorly in — or drop out of — school, Milgrom says.
“The knowledge and the technology exist to prevent painful and expensive problems that will dog someone into adulthood and can hurt their health throughout their life,” Milgrom says. “The challenge facing everyone in dentistry is to translate our knowledge into means of care that will work in culturally appropriate and effective ways.”
Among the studies and projects:
- A pilot program at Odessa Brown Children’s Center, in central Seattle, to see if Medicaid-sponsored orthodontic care can prevent more troublesome — and more expensive — problems in adolescence.
- A study to see how the transmission of the bacteria that causes cavities, Streptococcus mutans, between Alaskan Native mothers and their babies might be reduced. The study will be based at the Yukon-Kuskokwim Native Health Corporation in Bethel, Alaska, and in remote villages.
- Researchers will examine why, within some minority populations, individuals are afraid to go to the dentist, and whether parents and caregivers may be passing on cultural beliefs that lead to dental fear. The researchers will use culturally appropriate approaches to talk about dental fear and will create long-distance learning programs to help people overcome their fear.
- A study of xylitol, a natural sugar found in some chewing gum and toothpaste that is thought to prevent tooth decay. Eventually, researchers would like to develop foods with xylitol, suitable for children, that could help prevent tooth decay.
- In other research, scientists will test the theory that there are natural antibodies in epithelial cells lining the mouth that protect against dental caries. They will work with caries-prone children in the Yakima Valley to determine if these children experience a breakdown in such antibody protection.
The UW’s many partners in the effort include Heritage College, a nonprofit four-year institution located on tribal lands of the Yakama Indian Nation in Toppenish, Wash. UW is pairing with the institution in order to share scientific knowledge and train students outside of the Seattle area. Previously, two students from Heritage have spent summers working in UW laboratories; this summer, more are expected. Faculty members from Heritage will work with UW faculty to enhance their skills in research relevant to the needs of the Valley.
“This exchange of people and ideas opens up the future for our students. We expect that many will go on to explore graduate education thanks to this early exposure and mentoring,” says Dr. James Falco, dean of arts and sciences at Heritage College, and co-director of the dental disparities center.
The UW’s other collaborators include the Alaska Native Tribal Health Consortium, the Yukon-Koskokwim Native Health Corporation, the Yakima Valley Farm Workers Clinic, the Northwest Tribal Epidemiology Center, Washington Dental Service Foundation and the State of Washington Medical Assistance Administration.
For more information about NIDCR’s plan for eradicating oral health disparities, you can go to http://www.nidcr.nih.gov/research/health_disp.asp on the Internet. Other centers, formed in partnership with the National Center on Minority Health and Health Disparities, are at Boston University, New York University, the University of California at San Francisco and the University of Michigan.
The need for the centers is underscored by findings reported in the first-ever Surgeon General’s Report on Oral Health, released in May 2000 (http://www.nidcr.nih.gov/sgr/oralhealth.asp). The report identified a “silent epidemic” of dental and oral diseases that disproportionately burdens the nation’s poor, especially children and the elderly, as well as members of minority racial and ethnic groups.