The National Healthy People Initiative:: History, Significance, and Embracing the 2030 Oral Health Objectives.

Since 1979, the U.S. Department of Health and Human Services has worked with multiple subject matter experts and the public to develop and issue a set of ambitious, measurable objectives known as "Healthy People." These objectives are aimed at improving the health of the nation issued at the start of each decade, and feature specific targets to be achieved at the end of the decade. The fifth iteration, Healthy People 2030, consists 358 measurable public health objectives associated with evidence-based interventions. Oral health is represented by 11 specific objectives aimed at reducing dental caries in children and adolescents, reducing untreated decay and periodontal disease in adults, and promoting evidence-based prevention strategies, including community water fluoridation, dental sealants, oral cancer screenings, and, most importantly, increasing access to dental services. In fact, access to the oral health care system for children, adolescents, and adults is identified as a Healthy People 2030 Leading Health Indicator - a high-priority Healthy People 2030 objective selected to drive action toward improving health and well-being - for the second straight decade. With the continued promotion of multidirectional integration of oral health and overall health across multiple disciplines, many - including policymakers, oral health professionals, other healthcare professionals, dental and public health organizations, and community advocates - have a role in affecting the outcome of the Healthy People 2030 oral health objectives.

The Indian Health Service Early Childhood Caries Collaborative: A Five-year Summary.

PURPOSE: The purpose of this study was to assess a national initiative's effect on prevalence of early childhood caries and untreated decay in zero- to five-year-old Indian/Alaska Native preschool children. METHODS: The Indian Health Service (IHS) conducted a five-year Early Childhood Caries Collaborative from October 1, 2009 to September 30, 2014. The program used educational materials and routine communication with the 322 IHS and United States tribal dental programs, with an emphasis on early access to care, dental sealanth, fluoride varnish, and interim therapeutic restorations (ITRs). Prevalence and untreated decay data were obtained through the nationwide oral health survey (2010 and 2014). Data were also collected on access to care, sealants, fluoride, and ITRs. RESULTS: The number of zero- to five-year-olds with a dental visit increased seven percent: dental sealants placed increased 65 percent; and fluoride varnish applications increased 161.2 percent. Between 2010 and 2014, the percentage of one- to two-year-olds with decay experience and untreated decay declined, but the difference was not statistically significant. CONCLUSIONS: Early childhood caries prevention strategies, such as early access to dental care, sealants, fluoride varnish, and interim therapeutic restorations, demonstrated some initial improvement in the oral health status of zero- to five-year-old Indian/Alaska Native children.

Permanent first molar eruption and caries patterns in American Indian and Alaska Native children: challenging the concept of targeting second grade for school-based sealant programs.

OBJECTIVE: To describe first permanent molar eruption and caries patterns among American Indian and Alaska Native (AI/AN) children in order to identify the appropriate target grade for school-based sealant programs. METHODS: We used data from the 2011-2012 Indian Health Service oral health surveillance survey of AI/AN children in kindergarten through third grade. Children were screened by trained examiners. Cavitated lesions were classified as decayed, and teeth with any portion of the crown exposed were considered erupted. RESULTS: We screened 15,611 AI/AN children in 186 schools. The percentage with four erupted first molars was 27 percent of kindergarten, 76 percent of first, 96 percent of second, and 99 percent of third-grade children. About 7 percent of kindergarteners had decayed, missing, or filled molars compared with 20 percent, 30 percent, and 38 percent of first, second, and third graders, respectively. CONCLUSION: School-based sealant programs for AI/AN children should target kindergarten and first grade with follow-up programs for second-grade children.

Prevalence and severity of dental caries among American Indian and Alaska Native preschool children.

OBJECTIVES: To describe the Indian Health Service (IHS) oral health surveillance system and the oral health status of American Indian and Alaska Native (AI/AN) children aged 1-5 years. METHODS: A stratified probability sample of IHS/tribal sites was selected. Children were screened by trained examiners at community-based locations including medical clinics, Head Start, preschools, kindergarten, and Women, Infants, and Children (WIC). Data collection was limited to the primary dentition and included number of teeth present plus number of teeth with cavitated lesions, restorations, and extracted because of decay. Number of molars with sealants and urgency of need for dental care data were also obtained. Statistical analyses were performed with SAS (SAS Institute Inc., Cary, NC, USA). Sample weights were used to produce population estimates based on selection probabilities. RESULTS: A total of 8,461 AI/AN children 12-71 months of age were screened at 63 IHS/tribal sites, approximately 7 percent of the estimated IHS user population of the same age. Overall, 54 percent of the children had decay experience, 39 percent had untreated decay, 7 percent had primary molar sealants, 36 percent needed early or urgent dental care, and 6 percent needed urgent dental care. The mean of decayed, missing, or filled teeth was 3.5 (95 percent confidence interval, 3.1-3.9). The prevalence of decay experience increased with age; 21 percent of 1-year-olds and 75 percent of 5-year-olds had a history of caries. When stratified by IHS area, there were substantial differences in the oral health of preschool children. CONCLUSIONS: The results confirm that in the United States, AI/AN children served by IHS/tribal programs are one of the racial/ethnic groups at highest risk of caries.