Dental health among young Alaska children improved significantly since 2009, report says

Information about childhood tooth decay is displayed on Oct. 17, 2023, at a booth at the Alaska Federation of Natives convention in Anchorage. The booth promoted the Alaska Native Tribal Health Consortium's Dental Health Aide Therapist program. Young children's dental health has improved significantly in recent years, indicating that educational efforts and the services provided by dental therapists are having positive effects. (Photo by Yereth Rosen/Alaska Beacon)

Alaska children’s tooth health improved over a decade in nearly all parts of the state, showing that multiple dental initiatives and strategies may be paying off, a new state report said.

Among children 3 and younger, tooth decay prevalence is down, as is consumption of sugary beverages, while visits to dental offices for checkups are up, according to the report cited in a bulletin released by the Alaska Division of Public Health’s epidemiology section last week.

The report compared data from two three-year periods, 2009-2011 and 2016-2019. In that time, “there was a considerable decrease in the percentage of parents reporting that a healthcare provider had told them their child had tooth decay or cavities.” The drop was 16% between those periods.

At the same time, more young children were getting dental care; the data showed that 40% fewer children went without a first dental visit by age 3. And consumption of more than three cups of sugary beverages a day dropped by 41% between the two periods, according to the report.

The data is based on the information provided by parents through the Alaska Childhood Understanding Behaviors Survey , known as CUBS.

The epidemiology report does not pinpoint the reasons for the positive trends, but it notes that the time covered includes the startup of some helpful programs.

One is the Division of Public Health’s Play Every Day campaign. Embedded in that campaign, which promotes exercise and activity, is information about sugary drinks – a subject of struggle for many parents, said Frances Wise, an oral health program manager for the Alaska Division of Public Health and one of the bulletin’s authors.

The 2016 to 2019 period “does happen to overlap with the period of activity for the play everyday campaign and the sugary beverage education outreach. And I think that that type of outreach and education may have had a contributing factor,” Wise said.

That message has been spread through video , including through a partnership with the Alaska Native Tribal Health Consortium . “There are some really cute videos that have been put out by the campaign that highlight kids and kids’ choices. And I think that they’re really sweet,” Wise said.

The report recommends continued work to discourage consumption of sugary beverages.

Another development is the expansion of the Dental Health Aide Therapist program, through which trained health aides who are not dentists are able to provide basic oral care like cleanings, checkups and even simple tooth extractions and restorations. The program got started in Alaska in 2005 and has been especially important in rural areas where few dentists are available. There have been dramatic results in some rural areas, the bulletin said. In the Yukon-Kuskokwim Delta, the percentage of Medicaid-insured children receiving dental care increased over a 10-year period from 7% to 36%, the bulletin said.

Alaska was the first state to adopt the Dental Health Aide Therapist system. Since then, several other states have followed up with their own programs.

Medicaid itself has been a factor in the improved childhood dental statistics, the bulletin said. Medicaid eligibility in Alaska expanded in 2015, and that “might have further increased access to dental care for young children,” the bulletin said. In Alaska, the children’s Medicaid program is Denali KidCare, and it includes dental services.

While the most recent information in the report is from 2019, the Division of Public Health posts more recent CUBS data on oral health and other indicators. The most recent data there is from 2021.

Despite the positive trends almost everywhere documented in the epidemiology bulletin, there were big regional disparities, with outcomes in rural areas continuing to lag behind urban areas. The highest rates of reported tooth decay among young children were in the Yukon-Kuskokwim region, with 67.8%, and Northwest Alaska, at 51.3%. The lowest rates were in the Matanuska-Susitna Borough, at 17.1%, and Anchorage, at 18.1%.

Lower-income Alaskans also tend to have more childhood dental problems, the bulletin noted.

It recommended more work by medical providers to reduce the disparities in children’s dental care. That would involve a “comprehensive approach” that continues the reduction in use of sugary beverages and an increase in access to dental hygiene and dental care. “By addressing these interconnected factors, communities can move closer to achieving equitable oral health outcomes for all children, regardless of their socioeconomic background or geographic location,” the bulletin said.

Specifically, it recommended that non-dental health care providers pitch in to promote better dental care among their pediatric patients. Providers should consider taking advantage of educational opportunities so that they know more about dental health, the bulletin said.

A notable exception to the positive trend was Juneau, where fluoridation of the municipal water system ended in 2007. There, the percentage of reported tooth decay among young children doubled, from 14.4% in the early three-year period to 30.3% in the later period. That increase was despite the relatively high socioeconomic status of Juneau residents, a factor associated with better dental health.

The bulletin pointed to a 2022 study that found that between 2002 and 2012 — a period that captured the end of local fluoridation — there was a “substantial” increase in procedures and treatment for dental decay among Medicaid-enrolled children in Juneau. That compared to Anchorage statistics, which showed no significant change over the period for Medicaid-enrolled children. The cessation of fluoridation “provides a compelling explanation” for the increase in reported dental decay among Juneau children, the new bulletin said.

One of the recommendations in the report is promotion of “optimally fluoridated public drinking water.”

Alaska ranks near the bottom of states in the percentage of residents served by fluoridated public water systems, according to the U.S. Center for Disease Control and Prevention. As of 2020, only 42.1% of Alaskans were served by systems with fluoridated water, compared to the national rate of 72.7%, according to the CDC.

Correction: The story has been corrected to specify that Francis Wise of the Alaska Division of Public Health, not Laura Grage, commented about the findings.

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