FLAGSTAFF, Ariz. -- Stanley Tewa's 7-year-old toothy smile is a ragged,
discolored affair complete with decayed, vacant gaps.
Indeed, his Anglo counterparts in Phoenix might giggle as they carve
similar disfigurations into the grin of their Halloween pumpkin. For this
Hopi boy, though, missing teeth is not a laughing matter but instead a
problem that he will increasingly become aware of as he ages. More, as a
member of a minority racial group -- and a relatively impoverished one --
Stanley is among the 25 percent of America's children who have not
experienced a decline in dental caries since the early 1970s, the point at
which mainstream rates began improving.
After dental caries -- or tooth decay -- was identified as the single most
common chronic childhood disease, occurring well over five times the rate
of asthma, the powers that be addressed the problem via water fluoridation,
fluoride in toothpastes and rinses, and protective dental sealants that are
painted on schoolchildren's permanent teeth. Often, though, these
interventions don't reach the communities most in need.
Clearly that's been the case in Hopiland, so much so that in 2002 the
American Dental Association was "astounded to learn that 95 percent of
4-year-old Apache and Hopi children have dental caries." Reasons the ADA
listed for the high decay rate were "lack of fluoridation, poor diet,
excessive soft drinks and sugar consumption, and the lack of good
Community fluoridation of water, although still controversial, grew from
1945 to 1980, by which time approximately 60 percent of the U.S. population
had access to fluoridated water. This oral health benefit, however, did not
reach the Hopi mesas, where significant numbers of households in the arid
region haul their water from community wells.
"Fluoridated water has been the least of our worries while Stanley's been
growing up," said his aunt, Helen Tewa, who is helping to raise him while
working as a school secretary on the Navajo reservation. "We have to live
clear over here with the Navajos, and their water has such high uranium
content that the school has a special spigot where we fill up our drinking
water jugs. So we're happy just to not have to get uranium poisoning."
In addition, the Centers for Disease Control and Prevention, the federal
government's research arm in Atlanta, Ga., pointed out that barriers to
effective oral health care in underserved communities can stem from a lack
of education, or what the CDC terms "limited oral literacy." Not only do
people not make adequate connections between eating habits and healthy
teeth and gums when they are poorly educated on the subject of oral health,
they also are often just plain afraid to go to the dentist.
One way to begin resolving this aspect of the problem, conclude CDC
experts, is for more people from minority groups to enter the practice of
dentistry. "Of the 16,926 undergraduate dental students enrolled in U.S.
dental schools in 1996 -- '97, fewer than 1,000 were African-American, and
fewer than 1,000 were Hispanic."
What about tribal members? Less than 1 percent, or under 200 souls, the CDC
said: not nearly enough to make a dent in the need. In sum, there are not
enough dentists from Indian country to lead the revolution that will raise
tribal standards of oral health to levels mainstream Americans presently
Along with its dismal accounting of discouraging trends, the CDC also set a
number of goals into its "Healthy People 2010" report. First, experts
targeted children 2 to 4 years old in whom tooth decay rates have remained
unchanged for 25 years. Especially in populations where "children whose
parents or caregivers have less than a high school education," wrote CDC
researchers, "or whose parents and caregivers are Hispanic, American
Indians, or Alaska Natives, [children] appear to be at markedly increased
risk for developing early childhood caries."
That said, the CDC's 2010 goal is an 11 percent reduction in current rates
of decay in kids and reducing by 9 percent the number of children who have
decay but do not get treatment. The report goes on to review statistics and
establish targets for adolescents and adults -- groups in Indian country
whose oral health profiles mirror those of the younger generation. As
researchers wrote, "unless arrested early, caries is irreversible, [and]
despite the reduction in cases of caries in recent years, more than half of
all children have caries by the second grade and, by the time students
finish high school, about 80 percent have caries."
The bottom line is that help for historically disenfranchised groups
generally comes from within. Blacks saw that in the 1960s, as did women and
American Indians. While the era brought considerable successes to
minorities, it also left many challenges -- among them a clear need for
American Indian and Alaska Native dentists willing to return to their own
communities and lead the way. So expect dental schools to extend the red
carpet for any stalwarts from Indian country willing to go the distance.
Although Stanley Tewa might not realize that just yet, he surely will as he
grows up. Then again, perhaps -- if some teacher or health educator strikes
a chord with him -- he'll find his way into the ranks himself.