Document Type



The Creeks, Seminoles, and Cherokees are the predominate tribes represented in the Claremore Service Unit service population. A periodontal disease prevention program was offered to patients with diabetes who were being seen at the Claremore Indian Hospital. The group was targeted because the prevalence of diabetes in this American Indian population is about 9% or almost twice that of the national average of 5%. Periodontal disease in American Indians with diabetes is known to be more severe than that of other Indian population groups. To attain their goal the Claremore Indian Hospital outlined the following objectives: 1) test the hypothesis that a questionnaire based on the Health Belief Model can be used to predict the outcome of a prevention program twelve months after dental prophylaxis and periodontal disease prevention education; 2) determine if American Indian patients with diabetes would show a decrease in prevalence of Community Periodontal Index of Treatment Needs (CPITN) score, and 3) measure the extent of conditions of periodontal disease as measured by the CPITN one year after dental prophylaxis and periodontal disease prevention education.The Diabetes Program Staff at the Claremore Indian Hospital developed a referral program directing all dentulous, diabetic patients to the Dental Service for screening and dental measures designed to preserve health (prophylaxis). Patients self-selecting themselves for participation in the periodontal disease prevention program were seen by the dental staff and appointed with the hygienist. Patients who had very low treatment needs were excluded because their potential for improvement was minimal. Those with too great a need for corrective surgical treatment were eliminated because they had progressed beyond the benefits of a prevention program. The total of all CPITN scores for each patient were averaged, and those below 0.5 and above 3.5 were excluded. Two hygienists participated in the study, with one being assigned to the diabetic group and one to the non-diabetic group for the duration of the study. After training and experience in performing CPITN exams using index teeth, informal comparisons of the hygienists' exams on five patients were made in an attempt to standardize the two examiners. Four Dental and Diabetic Health Belief Questionnaires were developed. A periodontal disease prevention education class was developed to give a consistent amount of information to patients in the most cost effective format. Patients were scheduled in groups two times each month. Diabetic factors were measured and recorded including the glucose levels over the preceding two month. A group of 171 patients with diabetes received initial assessment. A group of 138 non-diabetics also received the same initial assessment and treatment except for the tests specifically for the diabetic patient, e.g. glucose levels, etc. The non-diabetic group was composed of patients who had previously signed up on the Claremore Indian Hospital routine dental care waiting list. They had been told that they would receive 1 dental cleaning and fillings when they were called off the waiting list. After their initial assessment and prophylaxis, they were contracted to private dentists for restorative treatment. The diabetic patients had no restorative dentistry provided, but were placed on the routine care waiting list. This program which relies on self-selection recognizes the influence of a complex set of educational and social factors that influence personal behavior. The responsibility of dental public health professionals in this type of program is to broadly disseminate information and cues to the community, and promote increased availability of preventive dental services for those who demand them. Diabetic patients could improve periodontal conditions even when their blood glucose levels remained high. Based on the study, the cost for diabetics receiving dental education and dental prophylaxis and root planning would result in overall health cost reductions. Targeting American Indian patients with diabetes for preventive periodontal services is effective.More studies are recommended for corroborating the data for the non-diabetic American Indian population participating in periodontal disease prevention programs. Providing education and training to as much of a targeted population as possible to cues, and promoting availability of the prevention program may result in increased health seeking behavior by a small percent of that population. A small percent of 30,000 patients between ages of 20-45 can be a large number of patients. Estimates based on the 1984 Indian Health Service Oral Health Survey indicate an unmet need in excess of $20 million for dental services exists for the service population in this study. Although 45% of all dental services provided with the $1.5 million budget are for patients over 20 years old, these services represent primarily lower levels of care for dental emergency treatment.

Publication Date



Indian Health Service, Staff Office of Planning, Evaluation and Research, Rockville, MD 20857 (E-92).