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Epidemiologic Notes and Reports Dental Caries in American Indian and Alaskan Native Children

A study conducted by the Indian Health Service (IHS) of the U.S. Public Health Service in 1983-1984 showed that American Indian and Alaskan Native (AI/AN) children develop more tooth decay than the general population of U.S. schoolchildren (1). This study involved patients seen in IHS dental clinics in the 11 geographic areas of the IHS, including Alaska. Among AI/AN children, an average of 6.8 decayed, missing due to caries, and/or filled permanent teeth (DMFT) was identified for approximately 5,800 children 5-19 years old. The National Caries Prevalence Survey (NCPS), conducted by the National Institute of Dental Research in 1979-1980, reported that 5- to 17-year-olds in the overall U.S. population had an average of 4.8 DMFT (2).

Results from the IHS study indicate that 19% of 5- to 19-year-old dental patients were caries-free. By contrast, 37% of 5- to 17-year-olds from the NCPS were reported to be caries-free. Approximately 33% of AI/AN children treated in dental offices had seven or more DMFT; 15% of other U.S. children had the same rate. On average, 12-year-old AI/AN children had 6.5 DMFT, and by age 17 years, 11.9 DMFT. U.S. schoolchildren surveyed from a national random sample had 2.6 DMFT at 12 years and 6.3 DMFT at 17 years of age (Figure 2). Although the 1990 U.S. Public Health Service objective stating that 40% of 9-year-old children should be caries-free (3) has been achieved (51% reported from NCPS), 2.3% of AI/AN children of the same age group were reported as caries-free from the IHS study.

Severe, rampant tooth decay caused by prolonged bottle feeding (milk, formula, juices, or sweetened beverages) of infants and young children is called nursing-bottle caries. Based on the characteristic dental caries pattern of nursing-bottle caries (affecting the upper front primary teeth and, frequently, the back teeth), up to 50% of AI/AN preschool-aged children who seek dental services suffer from this disease. Eighteen percent of preschool-aged AI/AN children (under 5 years old) had caries-free primary teeth, while over 40% had seven or more decayed and/or filled primary teeth (DFT). Children with nursing-bottle caries had almost four times the amount of tooth decay as those children who had not had nursing-bottle caries. Reported by Indian Health Svc; Dental Disease Prevention Activity, Center for Prevention Svcs, CDC.

Editorial Note

Editorial Note: Although major differences in the sampling methods make direct comparisons of the IHS data with the NCPS data difficult, the higher incidence of tooth decay in AI/AN children cannot be explained by these differences alone. Also, since infrequent users of the IHS-care system who were studied had as much dental decay as more frequent users, the sampling methodology in itself may not account for the major differences in caries prevalence between the AI/AN population and the general U.S. population. The differences in data collection indicate the need for standardization of surveillance methods and reporting of data.

Because the IHS data were collected from a sample of dental patients, they do not necessarily represent the actual dental caries prevalence among all AI/AN children. The magnitude of dental caries in these children remains a serious problem. IHS and Native American communities are placing increased emphasis on both the extent and quality of dental caries prevention activities, which include: community water fluoridation, supplemental fluorides, and pit and fissure sealants. The IHS anticipates that future surveys will reflect the impact of these activities by a decrease in caries prevalence. The IHS is also increasing its emphasis on the prevention of nursing-bottle caries by educating health professionals and parents.


  1. Indian Health Service. Unpublished data, 1985.

  2. National Institutes of Health, National Institute of Dental Research, National Caries Program. The prevalence of dental caries in United States children, 1979-1980; the national caries prevalence survey. Washington, D.C.: Public Health Service, U.S. Department of Health and Human Services, 1981. (NIH publication no. 82-2245).

  3. U.S. Public Health Service. Promoting health/preventing disease: objectives for the nation. Washington, D.C.: U.S. Department of Health and Human Services, 1980.

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