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Degree Name

DrPH (Doctor of Public Health)


Public Health

Date of Award


Committee Chair or Co-Chairs

Deborah Slawson

Committee Members

MaryAnn Littleton, Liang Wang


Dental caries is the most common chronic disease in children, and prevalence rates are disproportionately higher in American Indian/Alaska Native (AI/AN) populations. The Association of State and Territorial Dental Directors (ASTDD) recommends annual oral health screening for children in Head Start programs using the Basic Screening Survey (BSS). The 2014 study was a follow-up to a 2010 national survey of AI/AN children ages five and under that assessed oral health outcomes such as untreated decay, decay experience, urgent need for treatment, presence of sealants and decayed, missing and filled deciduous teeth (dmft) scores, and investigated the changes in Early Childhood Caries (ECC) prevalence from 2010 to 2014 in the Indian Health Service (IHS) Nashville Area. A gap analysis was completed comparing current recommended practices among dental clinics that participated in the IHS ECC Collaborative ASTDD Framework to Prevent and Control Childhood Tooth Decay (ASTDD Framework). Due to historical mistreatment of AI/AN populations in research, and out of respect for the sovereignty of the Tribal Nations that participated in the study, there limited data was made available for this study. In 2010, 579 children were screened in the Nashville Area; 1231 children participated in 2014. While there was a statistically significant, yet clinically small 9.36% reduction of untreated decay from 2010 (30.33%) to 2014 (27.49%), the ECC Collaborative did not reach their objective of a 25% reduction. There was also a significant increase in urgent need for treatment (3.17% in 2010 to 4.35% in 2014), and in presence of sealants (4.54% in 2010 to 10.01% in 2014). Gaps in best practices identified were related to need for increased risk assessments and enhancing policy development. Based on study findings and the limited access to data on Tribal and Area levels, development of culturally appropriate policies that are unique to individual Tribal needs, and focus on perinatal care, is recommended. Individual Tribal programs also need to be evaluated and surveillance needs to be continued to establish trend data. All program evaluations and research should be conducted in an ethical manner that is community-based and considerate of the needs of the Tribe.

Document Type

Dissertation - restricted


Copyright by the authors.