Oral Health

In order to address oral health among mothers and children on the Navajo Nation, we have invited Dr. Nicole Nelson, Charmayne Gene, and Tracilynn Carl. Dr. Nelson  is a dentist at Zuni Comprehensive Health Center and will discuss the importance of oral health care. Charmayne and Tracilynn, both undergrad students and interns with the Dine College Summer Research Enhancement Program (SREP), will discuss their summer projects addressing oral health and nutrition among Navajo mothers and children. 

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Please email us if you have any questions, comments, or suggestions: navajomchproject@dinecollege.edu

This podcast was sponsored by the Arizona Department of Health Services through federal funding from the Health Resources & Services Administration, with support from the Navajo Native American Research Centers for Health (NARCH) Partnership between Diné College and Northern Arizona University through federal funding from the National Institute of Health’s National Institute of General Medical Sciences, award number S06GM142121. The views expressed are the sole responsibility of the program staff and do not necessarily reflect the views of the Arizona Department of Health Services or the United States Government.

Transcript

Introduction | 0:00-0:22
Ya'at'eeh. Welcome to the MCH podcast, where we discuss maternal and child health topics and provide strategies for improving the health of Navajo families. Amá dóó áłchíní ats’íís baa áháyá baa yadelti (Translation, we will be talking about the health of mothers and children).

Amber-Rose Begay | 0:23-1:00
Thank you for joining us today to learn more about maternal and child health on the Navajo Nation. I am your host ARW Hashk’ąąhadzohi nishli, Táchii’nii bashichiin and Tábąąhá dashichei and Naakai Dine’é dashinali. Nataani Nez denashaa. I’m originally from Shiprock, NM where I live and work at Diné College as a project coordinator of the Diné College MCH Project. I am a Navajo woman and mother of 2.
Today, my co-host, Dr. Jamie Wilson, and I will be talking about the importance of oral health for mothers and young children. And we’ve invited some guests that are working in the oral health field in our communities.

Jamie Wilson |1:00-1:43
 Yes, we certainly have a great lineup for our listeners today. First, let me introduce myself. Kinlichiini nishli, todichini bashichiin, nakai da chei, lizi lani da shi nali. Tonalea deenasha.  Our first guest is Dr. Nicole Nelson, DDS, from Tuba City, Arizona. Dr. Nelson is a board-certified dentist and currently works at the Zuni Comprehensive Health Center in New Mexico. Dr. Nelson will be joining us today to talk about the importance of oral health for women and young children. Welcome, Dr. Nelson; we are excited to have you today. Could you introduce yourself for our audience? 

Nicole Nelson |1:44-1:53
Hello. I’m Dr. Nicole Nelson from Tuba City, Arizona. Tabaahi nishli, bilagona bashichiin, tsinajinnie da chei, bilagona da shi nali.

JW |1:54-2:09
 Thanks again, Nicole. Dr. Nelson and I actually went to high school together. So, it’s really awesome to reconnect on a professional level. Our first question for you, Dr. Nelson, is, why is oral health so important for young children?|

Nicole Nelson |2:10-3:26
 For young children, especially, you know, a lot of people feel that you know they have baby teeth their baby teeth, you know, even if they get rotted and they fall out, they're gonna have their permanent teeth. But the baby teeth actually play a vital role in the development of the permanent teeth, so not only do the baby teeth maintain space for the permanent teeth to come in. And the more baby teeth that they keep in their mouth will help prevent some of the major crowdings that we see when a lot of baby teeth are missing. As well as if there's large areas of decay, causing abscesses or other types of infections that can actually harm the developing permanent tooth that is underneath the baby tooth. And so, keeping the baby teeth very healthy is really important for those permanent teeth and those permanent teeth, I always tell my little kids that come in, but if you know, they don't want to have dentures like grandma and grandpa. Then, they need to keep those teeth because those permanent teeth need to be in their mouth, from the time they're like five-six years old until they're like 100, and they’re like 100, but it's just super important. Just mostly for developing permanent teeth and keeping those spaces open so that those teeth have places to come up. |

Jamie Wilson |3:27-3:43
 Oh wow, that makes a lot of sense because I definitely was one of those kids that had crowding and had to get braces later, and right now, I have a three-year-old, so I’m wondering what else as parents can we do to maintain our child’s oral health. | 

Nicole Nelson | 3:44-4:56
So, for the kids really the only thing that you can do is the brushing and the flossing, but it really starts before their baby teeth come. So, when they're feeding, you know either if they're breastfeeding, or if they're bottle feeding just getting them used to having something in their mouth, so I always recommend like a clean, damp cloth could be a washcloth, or we have special dental little finger costs that you can use just to wipe down the gums. What that does is it helps keep down the accumulation of bacteria which can form after the feeding. And then it also helps the baby become more comfortable and more used to having things in their mouth so once those teeth do come up then you know they're not in shock when you're trying to shove a toothbrush in their mouth. And so it really starts, you know as they grow so from newborn on and then just getting them used to the toothbrush as soon as those first teeth come in. Which is usually around six months, six months to a year depending on each child and each child is different. But getting them into the dentist will also help kind of get them used to everything as well, getting them used to us looking in their mouth and just it makes the transition of you know, as they get older a little bit easier. | 

Jamie Wilson | 4:57-5:06
With my almost three-year-old, I think what really helps with flossing is there’s like floss picks and it makes it a little bit easier to get in there, so she's used to that, so I'm glad. 

Nicole Nelson | 5:07-5:36
Yeah, and what a lot of parents don't realize is you know they're like yeah, they brush and they're like two years old and yeah they brush, they love brushing all the time and they run around with their toothbrush. First, running around with the toothbrush isn’t safe and the most important thing that parents don't quite grasp is that kids don't have the manual dexterity to brush their own teeth until they're about, you know, five or six, and so you know until they're five or six you really need to help them brush, especially brushing those back teeth. 

Jamie Wilson | 5:37-5:57
The back teeth, oh okay. I think what’s helped us get way back there is using an electric toothbrush. They make so many awesome gadgets for children, so we try to make brushing fun for my daughter. But, moving on to our next question, why is oral health also super important for pregnant women? | 

Nicole Nelson | 5:58-8:40
So, the most important thing with pregnant women is maintaining good oral hygiene, and a lot of times, you hear you know it's not safe to go to the dentist while you're pregnant. A lot of times, that stems from the X-rays and getting the X-rays, you know, aren’t really harmful, and we do put, let aprons over a patient, and if they are pregnant, we typically double apron. But sometimes we do withhold X-rays until the second trimester just because in that first trimester, the baby is developing their major organs. But back to the health of the mom, the healthier the mom’s oral hygiene is, is better for the baby because what happens is that the mom can pass on those bacterias that are in her mouth to the baby. Especially after the baby is born, and so we recommend a lot of times if you feel you have cavities, we recommend not kissing the baby on the mouth because little bacteria can be transferred over to the baby and cause decay. And then just other simple things, like sores in the mouth, those can also be transferred over to the baby. But what happens when you're pregnant is the pH in the mouth becomes more acidic, which can cause more decay and so it's recommended to stay on top of the oral hygiene. So, brushing and flossing, mouth rinse, all of those things to help keep the chances of developing decay down, but also what happens is you have your hormonal changes during pregnancy, and that can cause the gums to kind of swell and become like kind of puffy and red and more susceptible to bleeding, and that's gingivitis which is usually accompanied with pregnancy, so keeping on top of all of that will help keep that down. And then, if you do have any type of infection or toothache during pregnancy, a lot of times, dentists will try to avoid any type of dental treatment during the first trimester simply because that's when baby is developing the most. And so, we'll try to do medications to get you through till the second trimester, but if it's an emergency, you know we can provide emergency treatment. But by keeping up with oral hygiene and keeping everything healthy, you kind of avoid some of those situations, and baby is just healthier. And if you do have poor oral health during pregnancy, it can lead to different complications with the pregnancy like preeclampsia, or there's even research stating that it could cause low birth weight. So just another factor to try to keep your oral health as healthy as possible. 

Jamie Wilson | 
I think a lot of people have like a perspective on teeth that it's just a cosmetic thing and it's not really related to your overall health, so can you speak a little bit to that. | 

Nicole Nelson | 
Yeah, and you know, unfortunately, I come across that every day just because, you know, we go to work and we have patients come in, and they have these toothaches, and they just want the tooth out, and a lot of times that kind of just stems from lack of care or poor access to care, unfortunately. And that's just kind of where you know a lot of IHS clinics are, and a lot of IHS clinics just pull teeth out, and patients don't understand, you know. If you have poor oral health, it has a bigger effect with your whole body, and it could cause issues, especially with the bacteria; if you have a lot of decay, you're going to have a lot of bacteria, and that bacteria can cause a whole host of problems with your general health and probably a lot more than we can talk about right now. But one of the biggest things that is one of my biggest concerns is diabetes, just because it's such a big and frequent or common diagnosis of a lot of our patients. What patients don't understand is that poor oral hygiene can make your diabetes more uncontrolled, so the more bacteria that you have, the more decay that you have; it can create your blood sugar to go up and become more uncontrolled, and so you can do everything that you possibly can, but everything that you're doing it's not really working and really it could just be you know, your oral hygiene. And because diabetes is such a big problem among a lot of our patients, it makes it difficult for us to do some types of treatments because then your glucose levels are, you know, out of whack, they're just up and down, up and down or they're just constantly at a really higher level that if we do treatment, it's difficult for us because the patient's not going to heal. And so, when you do have diabetes, a lot of times, you will have periodontal disease, which is a disease of the gums and causes bone loss, and it can cause your gums to be puffy and swollen, it can cause infections, it can cause teeth become mobile. And eventually you, you lose some teeth, but in order to help keep that from happening, you have to have regular cleanings, deeper cleanings to clean in those pockets that are around the teeth, and if you have diabetes, if we're going in there during those deeper cleanings we're disrupting the tissue and you're not able to heal which can cause more issues, because you're not healing properly. And then you know, like, I said, that can cause other issues within your body as well. And so that's just something that a lot of patients don't really, you know, it doesn't go hand in hand, like oh, it's just a toothache, but you know it can cause some bigger issues. 

Jamie Wilson |
I’m glad you explained the connection between glucose control and oral health because type 2 diabetes and gestational diabetes are definitely prevalent in our communities. Could you elaborate a little more on why we should be getting our teeth cleaning every six months? 

Nicole Nelson | 
So that's basically preventative. Usually, it's an exam and cleanings every six months, and that's just to help catch things early. So, if you know you do have decay forming, say today, and then six months from now, you know it's not big enough to really recognize on the radio graph or something like that, then in a year from now, you know it's going to be huge or two years from now, even bigger. If you're not going regularly, so if you're going every six months, things can be caught sooner. The cleanings are important because even though you're brushing every day twice a day and you're flossing, you can still accumulate some calculus build up not much but it's better to have that cleaned off regularly so that you don't have any issues with accumulating bacteria which can then cause some gingivitis and the longer it's on their can start to cause some periodontal issues and bone loss. So like I said, it's really preventative usually if you don't have any gingivitis or any type of cavities; a lot of doctors are recommending at least once a year. But if you do have periodontal issues, then we even want to see you more frequently. It can be every three months, every four months, but we tried to make it a little bit shorter than that every six months, just so that we can help maintain those bacteria levels in those pockets around the teeth. | 

Jamie Wilson | 
Those are great recommendations, Dr. Nelson; we both know that dental clinics on the Navajo Nation and I’m sure in other tribal communities, there’s just no way for people to get their cleanings done more than, let's say, once per year. Can you share your perspective on that? Also, I’m curious, do you have any childhood experiences you would like to share?  

Nicole Nelson |
I probably went with the Tuba City dental clinic like maybe twice my whole childhood. And so it was just really, really hard to get in and I remember one time, specifically because my dad worked nights in the pediatric unit, he was a registered nurse, and I remember him calling around like midnight one o'clock and telling my mom oh you guys need to get in line the emergency chairs are starting to fill up already, and so we had to go like in the middle of the night to get a spot to be seen. And just the lack of dental care, I think, is what really drove me to pursue dentistry. Just because you know it's a small clinic and it has to provide care to the surrounding areas, so the population that it serves is kind of outrageous. Just being able to be a part of giving back to the community and trying to instill more preventive measures, I think, is what really drove my desire to go and assuring. Our problem is staffing. So we are really understaffed, and then the turnover rates I’ve noticed. Since I started working with IHS, the turnover rates of the doctors is pretty high, and so a lot of reason is because a lot of IHS clinics are very rural. And so, my biggest thing is trying to get native people interested in dental and I’m trying to make dental sound amazing just because the more I feel, the more native dentists that we have, the more native dentists will come back and will provide care for our populations in our communities and not only is that a good thing because it provides staffing. But also, you know, they're familiar with the population, or they're even familiar with the communities, and so they relate to the patients a lot better, and the patients relate to them a lot easier.

Jamie Wilson | 
I completely agree with you. And thank you so much for joining us today; we really appreciate you and all the amazing work you do in tribal communities. And for our audience, please stay tuned for our next guest speakers.

**SECOND PART OF PODCAST**

Amber-Rose Waters |
 We are also joined by two Diné College Summer Research Enhancement Program (SREP) students, Charmayne Gene and Tracilynn Carl. They just completed their 10-week-long research program virtually. The SREP program offers college students the opportunity to gain research experience and skills at a site within their home community. I’ve asked them to join us today to talk about their research projects on oral health. 

Tracilynn Carl |
 Right. Thank you for having me; I am excited to be here. My name is Tracilynn Carl, and I am from Gallup, NM. My clans are Todichi’nii Nishli, Tanesszhani bashichiin, Deschnii dashicheii, Tabaahi dashinali. I am currently a junior at Northern Arizona University in Flagstaff, AZ. My major is Public Health, and my minor is Biology.  |

Charmayne Gene |
 I am also excited to be here, and thanks for having us. Ya'at'ééh Shik'éí Shidine'é, Shí ei Tódích'nii Nishłí dóó Bit'ahnii báshíshchíín. Táchii'nii dasicheii dóó Ta'neeszahnii dashinálí. Kót'eego asdzání nishłí. Tselaní déé nashá. Charmayne Gene ei yinishyé. This is how I represent myself as a Navajo Woman. I come from a small community called Tselani Springs, Arizona. I am currently a Senior majoring in Public Health at Diné College. 

Amber-Rose Waters |
 We appreciate you both for joining us. Traci, could you tell us about your project?

Tracilynn Carl  |
 Sure Amber-Rose. As an SREP student, I was placed with the Dine College Maternal Child Health (MCH) project. I conducted my research project on Oral health and nutrition among infants and young children because healthy eating is not only good for overall health, but it is especially important to eat and drink nutritious food for oral health. One tip for families with young children is to offer water because it is better for their teeth. Sugar-sweetened beverages (like soda and juice) are the top culprits of tooth decay among young children. Plus, water is just better for children.
 The reason why I wanted to conduct this survey was because  Oral health is a priority for children and mothers based on the 2020 Navajo Maternal and Child Health Needs Assessment. 54% of American Indian children have had a tooth decay experience 42% of American Indian children have reported brushing their teeth only once a day. What this tells me is that we need to improve oral health care services and encourage good oral hygiene across the Navajo Nation.   

Amber-Rose Waters |
That’s so true, Traci! I know with my 2 children, we try not to give them too much junk food, like sticky candy, because it is hard to clean their teeth. What other tips or advice can you offer parents about oral health and nutrition?


Tracilynn Carl |
I would say avoid sticky, chewy, high-sugar foods is definitely the way to go! Good job, and kudos to you! It has been well-established that tooth decay is caused by bacteria and sugar in the mouth. So here are some other tips for parents: Do not let your child carry around a bottle or sippy cup of milk, juice, or sugary drinks between meals. Do not put your children to bed with a bottle. And brush their teeth twice a day. Also, as soon as their teeth touch, you can start flossing.   

Amber-Rose Water |
Flossing is definitely something I help my youngest with. We use floss picks to make it easier. It’s also gotten easier over time because it’s become a routine. I have one more question for you, Traci. Since your focus was oral health for infants and children, what are two things you learned about oral health care for these two age groups? 

Tracilynn Carl |
 Well, for infants, I found that lots of parents don’t know that they should be wiping baby’s mouth with a clean cloth or infant toothbrush as young as a few weeks old. First, parents should wash their hands, then use a damp cloth to wipe their baby’s mouth, especially after they drink milk. For toddlers and young children, parents should use a toothbrush and toothpaste with fluoride to clean their teeth twice a day. Try to make it fun for the children, sing a song or let the child use their favorite toothbrush. Amber-Rose, you mentioned routines earlier, and you’re right! Establishing good oral health habits and routines at a young age is so important! Because children are more likely to carry those habits into adulthood. 

Jamie Wilson  |
Wow, those are some great tips, ladies. Speaking of routines, I also have a little one, she’s almost 3 now, but she loves brushing and flossing because we’ve always done this as a family since she was a few months old. Well, thanks again, Traci. Charmayne, you were also part of the SREP program. Could you tell us about your research project? 

Charmayne Gene |
 Sure. I was also part of the Diné College-Maternal Child Health Project. I focused on oral health and nutrition for mothers. More specifically, I looked at oral health education and how the mother’s nutrition plays a key role in both her own health and her child’s health. For oral health, it is very important for mothers to brush their teeth twice per day and floss to prevent serious complications of poor oral health, including tooth decay, infections, gum disease, and gingivitis. Pregnant women are more vulnerable to infection, especially if they have gestational diabetes, because they have a surge in hormones during pregnancy. This can dilate blood vessels in the gums, which increases blood flow and makes the gums more sensitive to bacteria. Since pregnancy puts mothers at more risk, things like gum disease could lead to preterm delivery or low-birth weight in babies. There’s definitely a link between mom’s health and baby’s health. 

Jamie Wilson |
Wow! I did not know poor oral health could have such extensive consequences for baby. I know that pregnant women are more susceptible to certain health conditions because our bodies are so focused on developing a healthy baby. I mean, our whole immunity goes to the baby during development, so I can definitely see why oral health care is crucial for pregnant mothers. Charmayne, could you also tell us why you chose this topic for your research?

Charmayne Gene |
 I chose this topic because oral health is an important component of general health and should be maintained during pregnancy and through a woman’s lifespan. Oral health is an essential part of staying healthy. I was also interested in this topic because I am a mother who is currently pregnant. So taking care of my oral health is a top priority, not only for me but for my baby’s health as well.   

Jamie Wilson |
 That’s so true, Charmayne, and congratulations! You mentioned nutrition for mothers earlier. Can you talk about the link between nutrition and oral health for mothers? |

Charmayne Gene |
Thank you. Well, like Traci mentioned earlier about avoiding certain foods and drinks, such as sticky and high-sugar foods for young children. I would also suggest that mothers avoid sugar-sweetened beverages and sticky foods as well. I know it can be hard because of those pregnancy cravings, but just stocking up on good snacks like fruits, nuts, and vegetables could go a long way in satisfying cravings. Also, if moms give in to cravings, that’s okay too. They just need to brush and floss right away. I carry a floss pick in my purse because I’m always worried about my gums after reading about how almost 75% of pregnant women are more likely to have bleeding gums and gingivitis. So yeah, I think taking extra precautions and stocking up on healthy snacks and foods is important for moms and babies.  |

Amber-Rose Waters |
I can definitely relate to that, Charmayne. When I give into my iced coffee craving, I always brush right after because I don’t want to deal with the consequences of all that sugar in my mouth. Also, I hope to have another baby in the future, and I    understand even more why taking care of my oral health is important.
Well, thank you all for joining us today. We really appreciate your time and all the valuable information you both provided. I’m sure our listeners learned something new today.   

Outro: Amber-Rose Waters |
Ahe’hee. Thanks for listening to the MCH Podcast. For more information about the Dine College MCH project, please visit Navajo MCH Project at Diné College.