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UW researcher promotes oral health in at-risk communities

Topical fluoride, dental visits, and a diet with little or no sugar are all effective tools to maintain healthy teeth. But how can you maintain dental health when families can’t – or won’t – make use of those tools?

Dr. Joana Cunha-Cruz
Dr. Joana Cunha-Cruz

In two studies set more than 2,000 miles apart, Dr. Joana Cunha-Cruz, a University of Washington researcher, is hoping to find answers. In Alaska, she’s working to help train dental providers to maximize their skills and improve the delivery of care. In Yakima, Wash., she’s working with dietitians to help families make a simple change: more water, fewer sugary drinks.

“Our thinking should be more in terms of population health,” says Dr. Cunha-Cruz, a member of the Department of Oral Health Sciences faculty at the UW School of Dentistry. With that mind-set, she’s looking for ways to reach out effectively to communities that have historically struggled with high levels of dental disease.

Working in a number of small, relatively isolated southeast Alaskan communities, she’s conducting a two-year project to train dentists and dental health aide therapists (DHATs) to improve the delivery of care. DHATs, who have two years of training and function in a way similar to physician assistants in medicine, can perform routine dental services and develop treatment plans. In Alaska, they’ve been employed since the early part of this century.

The dental providers face stark challenges. In the first two Alaskan communities involved in the project, about 50 percent of the children are in families below the federal poverty level. Along with that, there’s a lack of family resources which support healthful habits. Families also have limited access to healthy foods; fresh fruits and vegetables are expensive and don’t last long.

“The easiest food choices are usually processed foods and sweets,” Dr. Cunha-Cruz says – and that’s rocket fuel for decay-causing bacteria. “Water supplies often aren’t fluoridated, and with lots of poverty, oral hygiene is way down on the list of concerns.”

One issue with delivery of care, she says, is that it’s more effective if it’s culturally appropriate, so that’s a key focus of the project’s training program. She also wants to make treatment less intimidating and give more emphasis to early treatment and prevention.

“In the distant past, some care has been provided by dentists who travel by boat, mostly to perform extractions, so the dental experience has often been painful and traumatic,” she says. That leads dental providers to ask themselves, “How can I be the provider who promotes oral health instead of merely treating dental disease?” Working with the providers, Dr. Cunha-Cruz wants to join their efforts to shift the emphasis to wellness for the whole child and for communities.

In Yakima, Dr. Cunha-Cruz is collaborating with dentists and dietitians at the Yakima Valley Farm Workers clinic to change family habits relating to sugary drinks and juice. In the one-year pilot study, which started last month, they’ll work with 21 families. Cute animal-shaped water bottles containing fluoridated water will be delivered to the families’ homes.

“The big thing is to change the home environment,” Dr. Cunha-Cruz says. “We won’t be telling parents that juice is bad, but rather that they need to make water more available to their children. Then we’ll assess how well the parents are doing. We also want to facilitate self-evaluation, and see what the parents are doing to find solutions.”

The dietitians will use well-established behavioral techniques to help their families: setting up goals, giving positive reinforcement, finding solutions to problems. They’ll also track family members’ height and weight. After a brief initial meeting with the families, the dietitians check in by phone once a week for a month. After two months, the families return to the clinic for another meeting.

Some solutions may lie outside the home, too. In schools, for example, placing water fountains closer to cafeterias has helped cut down consumption of sugary drinks. Children might choose juice as a “healthful” alternative, but Dr. Cunha-Cruz cautions that this isn’t a good option.

“Most of the juice we get at the supermarket is high in added sugar,” she says.