title: Reducing Alaska Native paediatric oral health disparities: a systematic review of oral health interventions and a case study on multilevel strategies to reduce sugar-sweetened beverage intake.
abstract: BACKGROUND
  Tooth decay is the most common paediatric disease and there is a serious paediatric tooth decay epidemic in Alaska Native communities. When untreated, tooth decay can lead to pain, infection, systemic health problems, hospitalisations and in rare cases death, as well as school absenteeism, poor grades and low quality-of-life. The extent to which population-based oral health interventions have been conducted in Alaska Native paediatric populations is unknown.
  
  
  OBJECTIVE
  To conduct a systematic review of oral health interventions aimed at Alaska Native children below age 18 and to present a case study and conceptual model on multilevel intervention strategies aimed at reducing sugar-sweetened beverage (SSB) intake among Alaska Native children.
  
  
  METHODS
  Based on the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) Statement, the terms "Alaska Native", "children" and "oral health" were used to search Medline, Embase, Web of Science, GoogleScholar and health foundation websites (1970-2012) for relevant clinical trials and evaluation studies.
  
  
  RESULTS
  Eighty-five studies were found in Medline, Embase and Web of Science databases and there were 663 hits in GoogleScholar. A total of 9 publications were included in the qualitative review. These publications describe 3 interventions that focused on: reducing paediatric tooth decay by educating families and communities; providing dental chemotherapeutics to pregnant women; and training mid-level dental care providers. While these approaches have the potential to improve the oral health of Alaska Native children, there are unique challenges regarding intervention acceptability, reach and sustainability. A case study and conceptual model are presented on multilevel strategies to reduce SSB intake among Alaska Native children.
  
  
  CONCLUSIONS
  Few oral health interventions have been tested within Alaska Native communities. Community-centred multilevel interventions are promising approaches to improve the oral and systemic health of Alaska Native children. Future investigators should evaluate the feasibility of implementing multilevel interventions and policies within Alaska Native communities as a way to reduce children's health disparities.
authors.affiliation: University of Washington, School of Dentistry, Department of Oral Health Sciences, Seattle, Washington, USA.
authors.forename: Donald L
authors.initials: DL
authors.lastname: Chi
mesh_terms: D000293:Adolescent; D000413:Alaska / Q000453:epidemiology; D001628:Beverages / Q000009:adverse effects; D018890:Chemoprevention / Q000379:methods; D002648:Child; D002675:Child, Preschool; D003159:Community-Institutional Relations / Q000592:standards; D054521:Cultural Competency; D016206:Databases, Bibliographic; D003731:Dental Caries / Q000208:ethnology* / Q000517:prevention & control; D003752:Dental Health Services / Q000600:supply & distribution; D019422:Dietary Sucrose / Q000009:adverse effects*; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data*; D007223:Infant; D004930:Inuit / Q000706:statistics & numerical data*; D008507:Medically Underserved Area; D019982:Organizational Case Studies; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy / Q000208:ethnology / Q000517:prevention & control*; D011322:Primary Prevention / Q000379:methods; D000078329:Workforce
chemical_list: D019422:Dietary Sucrose
keywords: Alaska Native health disparities; children; dental caries prevention; dental workforce; oral health disparities; primary intervention in oral health; sugar-sweetened beverages