Quantitative evaluation of variance in secondary dentition eruption among ethnic groups in Hawai'i.

Though little scientific evidence existed to support the belief among dentists who treat Pacific Islander populations that many children of the region erupt secondary teeth earlier and at an eruption rate which exceeds Caucasian children. Based upon a data set created in Hawai'i during the 1998-1999 school year, of 26,097 public school children, the opportunity presented itself to examine for variance in eruption timing and sequence. Hawai'i is an ethnic diverse community, with a majority population comprised of Asians and Pacific Islanders. Children, 5 through 9 years of age, were examined for gender and ethnic variance. In the aggregate, at all ages, girls erupted teeth earlier than boys, however, while generally true among individual tooth types, that variance was not always statistically significant. By ethnic group, African Americans exhibited earlier eruption by contrast with Caucasians, however, Caucasian children caught up by nine years of age. Native Hawaiian, Samoan and Tongan children exhibited earlier and high rates of secondary dentition eruption than Caucasian or African American children. Children of various Asian cohorts did not exhibit significant variance by contrast with Caucasians. Based upon these findings, the authors recommend that dietary fluoride supplementation of Native Hawaiian, Samoan and Tongan children begin at birth rather than six months of age and that these children be targeted for pit & fissure sealants as early as five years of age.

Oral health disparities and periodontal disease in Asian and Pacific Island populations.

INTRODUCTION: While oral health disparities exist in many ethnic groups in Hawaii, the challenge of developing research and intervention programs is hampered by the lack of a dental school and adequate state resources. OBJECTIVE: To use a collaboration model to establish a mentoring relationship with a research-intensive school of dentistry to reduce oral health disparities in Hawaii. METHODS: Collaborative interactions with the University of Hawaii School of Medicine (UH) and the University of North Carolina School of Dentistry at Chapel Hill (UNC) included bimonthly teleconferences, on-site planning and mentoring sessions, yearly conferences in Hawaii open to the community using UNC faculty, and on-site skills training sessions. The community was asked to participate in determining priorities for research through focus-group interactions. Two pilot investigations were also conducted. RESULTS: Both universities have been awarded grants to fund activities to support the combined intellectual and physical resources of multiple private, public, and community organizations to achieve the goal of improving the oral health status of the people of Hawaii. As a result of initial planning, two related grants have been submitted (one approved, one disapproved) to fund pilot studies on the oral health status of mothers and their babies in a rural community. These studies include both UH and UNC investigators. CONCLUSIONS: Health disparities occur among diverse ethnic groups in Hawaii, and links between general health and oral health continue to emerge. In spite of obstacles to designing effective research and intervention programs in Hawaii, UH fostered a collaborative relationship with a premiere dental research institution to develop competence in clinical research, conduct pilot studies, and obtain extramural funding for comprehensive studies. Direct involvement of community representatives in the research process is integral to the success of such studies and will continue to serve as the foundation of our community-based participatory research. The network partners have accomplished their primary goal of developing culturally appropriate methods for assessing determinants of oral health, oral health-related quality of life, and health outcomes in Asians and Pacific Islanders.

Republic of the Marshall Islands: planning and implementation of a dental caries prevention program for an island nation.

The Republic of Marshall Islands (R.M.I.) is an island state in eastern Micronesia with a landmass of 70 square miles scattered across 750,000 square miles of the western Pacific Ocean with a national population of approximately 51,000. In a 2002 children's oral health survey, 85 percent of six year old children in the R.M.I. capital of Majuro were found to have had at least one carious tooth and 65 percent had 5 or more affected teeth. The mean caries prevalence among primary (or baby) teeth was 5.79 decayed or filled teeth (dft), a caries prevalence rate close to three times the U.S. national mean. While 12.3 percent were caries-free, 65.0 percent had experienced 5 or more affected teeth (rampant caries). Of these, less than 1 percent had received any form of dental treatment. Comparably remarkable early childhood dental disease rates were also observed on other populated islands and atolls. In response to the rampant dental disease shown to be affecting young children, the R.M.I. Ministry of Health has proposed the implementation of a strategy targeting the pre-natal / pen-natal environment, young parents, pre-school and elementary school children.

Comparative analysis of oral health indicators among young children in Hawai'i, the Republic of Palau and Territory of Guam, 1999-2000.

Dental caries prevalence data were collected in Hawai'i, Palau and Guam and analyzed for dft, DMFT, unmet treatment needs, sealant utilization and various caries patterns. Data sets include examinations of 24,752 children ages 5 through 9 years of age in Hawai'i, 558 children in Palau and 1,518 children in Guam. Dental disease in early childhood is truly endemic throughout the Pacific basin. The findings of this report quantify in a standardized manner and contrast, basic oral health / oral disease indicators from each jurisdiction. While children from all three jurisdictions demonstrated dental disease prevalence rates which far exceed those found on the U.S. mainland, overall, children in Guam were found to be the poorest oral health indicators, followed by Palau and Hawai'i. Overall, young children at all sites exhibited excessively high caries prevalence and unmet treatment needs rates. Significant progress has been made at Palau in the past decade, however, at all three sites presented, more work is necessary if early childhood caries is to be brought under control. Findings also include an apparent negative correlation between dental sealants and DMFT rates.

Early childhood caries among Hawaii public school children, 1989 vs. 1999.

Utilizing a standardized oral health assessment tool, public school children ages 5 through 9 were evaluated Statewide in 1989 and 1999. In both samples, it was demonstrated that Asian & Pacific Islander children (as a group), by contrast with Caucasian, African Amercan or Hispanic children, suffered from disproportionately high rates of dental caries, were more likely to have unmet treatment needs and less likely to utilize dental sealants. Significant variance among oral health/ oral disease indicators was found among ethnic and regional groups and all Hawaii cohorts were found to have poorer oral health indicators by contrast with U.S. national findings. Data was not found to follow any particular pattern with regards to urban vs. rural settings. This report shows the value of considering a variety of oral health indicators in evaluating the health of a community. More research needs to be done in evaluating the influence of socioeconomic status and cultural beliefs and practices on the oral health of young children in Hawai'i.

Quantitative evaluation of variance in secondary dentition eruption among ethnic groups in Hawai'i.

Though little scientific evidence existed to support the belief among dentists who treat Pacific Islander populations that many children of the region erupt secondary teeth earlier and at an eruption rate which exceeds Caucasian children. Based upon a data set created in Hawai'i during the 1998-1999 school year, of 26,097 public school children, the opportunity presented itself to examine for variance in eruption timing and sequence. Hawai'i is an ethnic diverse community, with a majority population comprised of Asians and Pacific Islanders. Children, 5 through 9 years of age, were examined for gender and ethnic variance. In the aggregate, at all ages, girls erupted teeth earlier than boys, however, while generally true among individual tooth types, that variance was not always statistically significant. By ethnic group, African Americans exhibited earlier eruption by contrast with Caucasians, however, Caucasian children caught up by nine years of age. Native Hawaiian, Samoan and Tongan children exhibited earlier and high rates of secondary dentition eruption than Caucasian or African American children. Children of various Asian cohorts did not exhibit significant variance by contrast with Caucasians. Based upon these findings, the authors recommend that dietary fluoride supplementation of Native Hawaiian, Samoan and Tongan children begin at birth rather than 6 months of age and that these children be targeted for pit & fissure sealants as early as five years of age.