A review of the oral health of American Indian and Alaska Native elders.

OBJECTIVES: This paper reviews the demographics, access to care barriers, and the oral health of American Indian and Alaska Native (Native American) elders aged 65 years and older using complete tooth loss as a measure to compare with the US population. Strategies for improving oral health and increasing access to care for Native American elders also are discussed. METHODS: We reviewed the results from patient surveys conducted by the Indian Health Service (1983-84 and 1991) and data from other sources, including the second International Collaborative Study of Oral Health Outcomes (ICS-II) conducted in 1990 on the Sioux and Navajo reservations. We compared complete tooth loss data from these studies with findings of the 1985 National Institute of Dental Research Oral Health Survey of US Employed Adults and Seniors and the Third National Health and Nutrition Examination Survey (NHANES III). RESULTS: The 1991 Indian Health Service (IHS) patient survey reported a complete tooth loss prevalence of 42 percent among elders. Although it is based on a patient sample, this finding is comparable to the rate of 40 percent found among a random sample of Navajo and Lakota adults aged 65-74 years reported in the ICS-II study. The 1991 IHS patient survey also found complete tooth loss among diabetics to be much higher than among nondiabetics. CONCLUSIONS: The prevalence of complete tooth loss for Native American elders is higher than in population surveys of US elders based on random samples. The actual prevalence of complete tooth loss is probably even higher in Native American elders because estimates presented in this paper are clinic based.