November 2019 Volume LIV Number 6

 
 
 
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Resident's Corner

September 2019 Volume LIV Number 5

 The Adventures and Challenges of Pediatric Dentistry in Alaska
Dr. Jennifer Wilson
 
Recently, my co-resident at the NYU Langone Alaska site, Dr. Chelsea Johnston, returned from her operatory and casually reported, "I just flossed Muktuk (whale blubber) from a kid’s tooth!" This is just one example of unique dental findings that become routine to dentists practicing in Alaska.
 
As a general dentist straight out of University of Louisville School of Dentistry, my future husband and I moved to Bethel, Alaska, in 2010 to provide dental care to the Alaska Native (AN) population. We learned how difficult it can be for families to access dental care for their kids. In Bethel, where a gallon of gas costs $9, it is not uncom- mon for parents to accompany their children by boat and travel miles down the Kuskokwim river for their dental appointment. In some villages, clean running water in the home is only a recent luxury. Some children’s water source is collected from chipping ice and melting it in the arctic entrance. Instead of an evening bubble bath, these children join their families for a steam bath. The steam from a wood stove,  suds from some good old Dr Bronner’s soap, followed by a chilly rinse of water provides a routine cleaning. Powdered drink mixes, like Tang and Koolaid have made their way into the daily lives of village kids, along with other processed foods that have replaced the native diet.
 
These unhealthy changes in diet, access to care, and other chal- lenges have led to a high caries rate where Native Alaskans once had the healthiest dentition of anyone on the planet. A CDC/Alaska Native Tribal Health Consortium 2008 oral health survey in five rural Alaska villages showed 91% of children aged 4-15 years had cavities. In my two years serving the communities of the Yukon Kuskokwim Delta, I knew I wanted to continue my education in pediatric dentistry to provide quality care to the kids of Alaska.
 
My residency in Anchorage, Alaska, taught me other ways that pediatric dentistry in Alaska is very different than the rest of the coun- try.  For example, I became more comfortable extracting supernumer- ary teeth, a common finding in the AN population.  An adolescent with pristine dentition came to our emergency clinic with a draining abscess.  She had knocked the cusp off a newly erupted premolar with dens evaginatus (talon cusp), also not uncommon.  I like to refer to the faculty at the NYU Langone Alaska site as my Alaskan pediatric dental gurus. They have quite possibly seen it all! I followed in the footsteps of Dr. Brewer and Dr. Rayes who also had their start in ‘bush’ dentistry prior to specializing in pediatric dentistry. The faculty at our NYU Langone Alaska site skillfully guide their residents through difficult cases.
 
Not all children in Alaska have access to orthodontic care. We see a plethora of retrognathic maxilla cases, where serial extractions may be the best chance for a child to have a dentition free of serious crowding. Molar substitution due to severe decay and/or severe hypoplasia of  6 year molars is another common treatment plan. Children with high caries risk and poor access to care may not seek preventive dental care until after the eruption of the 6-year molars and succumb to unrestor- able decay. For these cases we often recommend molar substitution when the calcification in the furcation of the 2nd  molars initiates. This can be a touchy subject for some parents who have traumatic childhood memories of uncomfortable extractions in a village dental setting. To reassure parents, I remind them that pediatric dentistry has advanced through the years and we have many treatment tools that will give their children a more comfortable experience than their own.
 
Another challenge to pediatric dentistry is that Alaska has one of the highest rates of domestic violence and child abuse in the country. As pediatric dentists we are mandatory reporters for abuse and should be advocates for our patients. This is often an uncomfortable position to be in, but our residency training in Alaska prepares us to handle these situations. As many grandparents have graciously stepped into the immediate parenting roll of  young AN children, it’s important to ask how the caregiver is related to the child or simply ask how the adult would like to be addressed. Establishing these simple commu- nication guidelines early, helps comfort everyone involved in the care of the child. With the increasing popularity of Hall crowns, SDF and more DHATs working in rural Alaskan villages, there is hope that we will see a change in the caries rates our AN children. You never know what Alaska has in store, whether it’s a 7.2 magnitude earthquake during a pedo ops appointment or having to keep the operatory doors closed due to smoke from a nearby brush fire. Pediatric dentists work- ing in the rural villages and even in Anchorage know there is nothing better than finishing care with child and hearing "Quyana" – "Thank you" in Yu’pik.
 
About the Author
Dr. Jennifer Wilson grew up in Australia until age nine and then Eastern Kentucky. She went to Warren- Wilson College in Asheville, N.C., and dental school at the University of Louisville in Kentucky. After comple- tion of the NYU Langone Alaska site residency in June 2019, she will join the practice of Just Kids in Anchor- age, Alaska, owned by Dr. Heidi Ostby, a fellow NYU graduate. She will continue to practice at ANMC as an intermittent employee. Wilson spends her free time with her 3-year-old son, 9-month-old daughter, and husband and can’t wait to get back into horseback riding, now that she has completed her residency.

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