236 Journal of Public Health Dentistry

Preface

Candace Jones, MPH

In 1957, the Indian Health Service (IHS) began collecting oral health status information on dental patients receiving care at IHS dental clinics. This "patient monitoring system" col- lected oral health status data on an annual basis until it was discontinued in 1978. Since that time, IHS has relied on periodic surveys of dental patients to assess the oral health status of the American Indian and Alaska Native (Native American) population. To date, IHS has completed two oral health surveys of dental patients, one in 1983-84 and another in 1991. Al- though data from dental patient sur- veys are not representative of the over- all Native American population, the information obtained through these surveys is valuable for monitoring trends in both access to care and the oral health of the Ms dental patient population. The data also are useful for program planning and evaluation. Information from surveys is shared with Congress and other funding sources to advocate for resources to increase access to care and more com- prehensive services for Indian people.

The following set of papers pro- vides background information on the IHS Dental Program along with re- sults from the 1991 IHS Patient Oral Health Status and Treatment Needs Survey (1991 IHS patient survey). Us- ing data from the patient monitoring system (1957-78) and the 1983-84 IHS patient survey, the authors of each pa- per explore trends in the oral health status of Native Americans and evalu- ate the impact of available dental re- sources on the future oral health of this population.

The Indian Health Service is respon- sible for the provision of medical and dental care to approximately 1.5 mil- lion of the nation's 2 million American Indians and Alaska Natives. More than 550 federally recognized tribes and their members live mainly on res- ervations and in rural communities in 35 states, mostly in the western United

FIGURE 1 IHS Area Offices: Aberdeen Area, Alaska Area, Albuquerque Area, Bemidji

Area, Billings Area, California Area, Nashville Area, Navajo Area, Oklahoma Area, Phoenix Area, Portland Area, Tucson Area

States and Alaska. The IHS is com- posed of 12 regional administrative units called Area offices or programs (Figure 1). These regional offices pro- vide administrative support to the tribes and direct programs within their geographic boundaries.

Because comparisons among Areas are important, the 1991 IHS patient survey was designed to capture data in all 12 Areas. Each Area's sample was balanced by age and sex group- ings to represent some 350,000 Native Americans who receive care at IHS, tribal, and urban Indian dental clinics each year. During a 12-month data col- lection period, participating dental clinics collected oral health status and treatment needs data on patients pre- senting for their first dental visit of the year. Data were collected until each Area had obtained information on ap-

proximately 10 percent of the indi- viduals who receive any type of care annually in each of the following age cohorts: 04,5-9,10-14,15-19,20-34, 3544,45-54,5544, and 65+ years. A total of 24,696 patients were exam- ined-about 7 percent of the dental patients seen annually at IHS, tribal, and urban Indian clinics.

The IHS and tribal dentists were trained to collect oral health status and treatment needs data for the 1991 sur- vey according to written survey guidelines. Although data were ob- tained in a clinic setting, dental radio- graphs were not used to aid in diagno- sis for the survey. The 1991 IHS patient survey obtained data on each of the following variables: surface specific caries status, dental sealants, dental fluorosis, oral trauma, periodontal treatment needs, soft tissue lesions,

Send correspondence to Ms. Jones, Director, Indian Health Service Dental Disease Prevention Program, Parklawn Building, Room 6A-30,5600 Fishers Lane, Rockville, h4D 20857. E-mail: jones&hqe.ihs.gov. Public Health Dent 2OOO;6O(Suppl1):236-7]

Vol. 60, Supplement 1, Special Issue 2000 237

FIGURE 2 Geographic Distribution of Indian Health Service Hospitals and Ambulatory

Care Clinics

diabetes status, use of tobacco, access to fluoridated drinking water, diffi- culty in getting dental appointments, and dental treatment needs.

Availability of dental resources is a concern that must be addressed when evaluating the oral health of the Na- tive American population. Unfortu-

nately, only 550 dentists are employed by IHS and/or tribal programs to pro- vide care to the more than 1.5 million members of federally recognized tribes who are eligible to receive den- tal care at MS and/or tribal dental clinics. This discrepancy translates into a dentist-to-population ratio of 1:2,800; significantly higher than the national average of 1:1,500. About 1,200 dental assistants and 150 dental hygienists work for the Indian Health Service. The federal system operates 37 hospitals, 60 health centers, 46 health stations, and three school health centers (Figure 2). Through self- determination contracts and self-gov- ernance compacts, tribes and Alaska Native corporations administer 13 hospitals, 149 health centers, 3 school health centers, 72 health stations, and 161 Alaska village clinics.

We hope that the information pro- vided in this edition of the Journal of Public Health Dentist y is useful to you.