Taking Care of Children
Bruce, Turtle Mountain Band of Chippewa, DDS, is now
the National Pediatric Dentist Consultant for the
Indian Health Service. When the article below was
first written, he was the Navajo Area Regional
Specialty Consultant at Tuba City Regional Health Care
Dental Unit. Dr. Bruce is still based at the Tuba City
facility and still has the clinical and research tasks
Dr. Craig Bruce works with a relatively large staff at a small, remote hospital at the Western end of Navajo Nation. As a pediatric dentist, Bruce is responsible for a range of dental services for children. Several days a week he cares for children in the clinic. Once a week he does full mouth dental rehabilitation in the operating room for children with serious dental problems.
“American Indian children have very high rates of early childhood decay,” says Bruce. Sixty to 75% of children in Head Start have some type of decay. In my own studies of children in the Tuba City area, I’m finding that 90% of the children have some type of tooth decay; 75% of those have very severe ECC [early childhood caries]. Sometimes I have to remove the upper front teeth."
In an attempt to prevent tooth decay, Bruce is involved in several prevention projects. “At Head Start we are putting fluoride on children’s teeth. It’s in the form of a varnish that we paint on to the teeth after drying the teeth with varnish. This form of fluoride stays on teeth much longer than the rinses or gels we used in the past.” Craig also identifies children with bad decay and arranges for their care.
Bruce is also the local coordinator for a multi site study of chlorhexidine varnish. (Chlorhexidine is an anti-microbial that kills bacteria, including the bacteria that cause tooth decay.) Mothers who have untreated tooth decay can transmit the decay-causing bacteria to their babies and children. In the study Craig and his staff are identifying mothers with babies who are about 4 to 5 months old and don’t yet have teeth. Craig and his staff provide any needed dental care to the mothers and paint their teeth with the chlorhexidine varnish. “After 18 months, we’ll look at the decay rate in the moms as well as the babies. Hopefully we’ll see a significant difference.”
Bruce and his staff provide dental education on both the family and community level. They warn against letting babies and children sip juice and pop throughout the day. If children eat or drink at bedtime, they need to brush their teeth before going to bed. In general Bruce urges people to have good eating habits and good oral hygiene.
While growing up Bruce didn’t know any dentists or doctors. Bruce worked for his father, who owned a small construction company, and entered college as a business major. At the University of South Dakota he discovered he didn’t like business. He was intrigued as he heard some of his friends talk about their plans to be doctors and started taking the prerequisites for medical school, though he wasn’t sure that medicine was the field for him.
Serendipitously, at a ski resort, Bruce met a dentist who helped him see that as a dentist he could work with his hands but also have some involvement with medicine. “Talking to that dentist was a turning point for me,” says Bruce. “I liked the idea of fixing things and making them right. When I got back to school I started shadowing dentists and decided this was the profession for me.”
Knowing that dental school was highly competitive, he proved he could handle graduate level work in science by successfully completing a master’s degree in science at the University of South Dakota.
Bruce was challenged by his dental studies at the University of Nebraska Medical Center College of Dentistry. “The material wasn’t difficult to understand,” he said. “There was just so much to learn.” Some Indian Health Service externships helped Bruce with his hands-on skills. “During the summers, I had a lot of experience under the supervision of an IHS dentist. This helped me immeasurably.”
Following graduation from dental school, Bruce worked on his reservation for two years. “The biggest gain was reconnecting with my family and distant relatives. I learned more about myself and where I came from. It was nice to be where I felt I belonged.”
Bruce particularly enjoyed reconnecting with his grandfather with whom he had spent many summers on the reservation. His grandfather, in turn, was proud to have his grandson back home. “When I was out in the community with Grandpa, he introduced me to people, saying, ‘This is my grandson, Dr. Bruce, the dentist.’ Sometimes he took out the dentures that I made for him and showed people that I had put his name on them.”
During the two years on the reservation, Bruce became more aware of his strengths and deficiencies as a dentist. This helped him clarify what he needed in the general practice residency at Phoenix Indian Medical Center.
Diana Cudeii, Navajo, her husband, Craig Bruce, and patient
At the dental clinic at the Phoenix Indian Medical Center, Bruce met and soon married Diana Cudeii, Navajo, who had been a dental hygienist for several years. The couple then moved to the Turtle Mountain Band of Chippewa Reservation where both of them provided dental care for a few years.
Next Bruce did a residency in pediatric dentistry at Denver Children’s Hospital. He felt that his commitment to serving American Indian children helped him get into this competitive program. “This residency helped me learn more about myself,” says Bruce, “I thought I was kind of a tough macho guy because I raced cars and snow mobiles and rode and broke horses. Working with young kids who had a short life expectancy brought out sensitivities that I didn’t know that I had.” He also developed close bonds with colleagues with whom he shared experiences, such as the death of a patient.
Bruce and his wife returned to the reservation for another year and a half and then moved south. After 8 months on the Hopi Reservation, Bruce transferred to his current job.
A Gratifying Profession
“Dentistry is probably one of the most challenging and fulfilling professions. Many people are afraid of dentists so you have to deal with their emotional needs as well as their physical needs. After Hurricane Katrina, I worked in a mobile clinic in Mississippi where I was able to treat a woman who was in a agonizing pain and was terrified about having an injection.” Bruce calmed the woman and was able to relieve her pain almost immediately. After Bruce extracted her tooth, the woman thanked him effusively. “I feel fortunate that I’m needed and can help. I can’t think of another profession that is more gratifying. I feel very lucky to have found this profession and way of life.
This article was originally published in the Spring 2007 issue of Winds of Change. (The cover artist, Buffalo Gouge, Creek and Cherokee, works with bright colors. Portraits are his main interest. For more information visit Art Exchange Galleries.)
Dr. Bruce says, “All is well. We still live in Flagstaff, AZ, and I am still working in Tuba City, AZ in the Indian Health Service. The only update I have is that I have been chosen to be the new National Pediatric Dentist Consultant for the Indian Health Service. I am still a clinical pediatric dentist but now I have the added task of consulting with our IHS Dental Director and the other approximately 26 pediatric dentists in the Indian Health Service. We are currently working on implementing new strategies to prevent early childhood caries in our children.”
The study for the FDA approval of chlorhexidine varnish in which Dr. Bruce was participating at the time of the above article, is completed. He and his staff are awaiting the results and expect the FDA to approve the use of the varnish as an anticavity agent.