Dental Disease Prevention

Baby Bottle Tooth Decay
The YKHC Dental Program has 11 dentists and 14 auxiliaries on staff who handle about 40,000 cases a year.

A large percentage of this care is given in the villages to children who suffer from an unusually high incidence of dental disease. Poor diet and nutrition, inadequate oral hygiene practices, and a lack of direct access to care are contributing factors.

Baby Bottle Tooth Decay is of particular concern in the YK Delta. It has been found in 30-50 percent of the Head Start children in some villages. In its severe form, it causes acute pain, regional swelling, and elevated temperatures. Treatment of these cases places a large demand on the YKHC Dental staff and will continue to do so--studies have predicted a huge population increase in the next 20-30 years.

Standard treatment of this condition requires several appointments for the child where the teeth are repaired with silver alloys, composite resins, or stainless steel crowns. Multiple extractions are also necessary. Frequently, Native children are not able to fully cooperate emotionally with the dental team to allow safe or complete treatment using routine methods. These patients often must travel to the Bethel hospital for emergency dental care. This usually consists of restraint board, mouth prop, and exodontia. It is an unpleasant experience for the child, the parents, and the dentist.

The difficulty in managing the special demands of the child with Baby Bottle Tooth Decay at the YKHC Hospital has been a long term challenge for the dental program. Many sedation patients have been referred into the Bethel hospital by the village dentist only to find the sedation waiting list is backlogged for many, many months. Very few families can afford to travel into Anchorage for care by the Area Pedodontist. Therefore, many of these children have had dental treatment needs which have gone unserviced.

In 1992 a program was begun to provide complete rehabilitation for pediatric dental patients in the YKHC hospital operating room under general anesthesia, thus returning their damaged dentition back to a healthy functioning condition in one treatment appointment. Because there are risks that may include life-threatening outcomes, and safety is the primary goal of the program, general anesthesia is reserved for patients who cannot be reasonably treated with other methods.