Most Native American children today are keeping their teeth and enjoying better oral health thanks in part to the Early Childhood Caries Collaborative launched by the Indian Health Service five years ago to step up prevention and reduce tooth decay among kids under five. But dental health gains are not so evident for adults in Indian County since the last national IHS survey in 1999. Help has come too late for many Native American elders such as Edmo and for some adults, dental care remains elusive.

IHS has a new plan for oral health surveys in 2015 and 2020, but at the moment, "there really is no evidence one way or the other to show whether there has been an improvement" in Native adult dental health, says Kathy Phipps, an epidemiologist who specializes in oral health and helped write the 1999 IHS survey report, which was published in 2001.

"We're seeing improvements in certain areas of the country," says Phipps of Morro Bay, Calif. "A lot of those have to do with improvements in the socio-economic status among Native populations."

Many Native Americans living on reservations, however, must rely on IHS or tribal facilities that in some cases are understaffed, Phipps says. "Those living in poverty or in areas where they don't have geographic access to dental care have not seen improvements."

Urban Native Americans without health insurance also face challenges trying to tap tribal dental services. Michael Teeple, 62 and Ojibwe, had good dental care growing up as an orphan with foster families on farms in Michigan. And he got good dental care as a young man in Portland, Ore., working 15 years for Freightliner, a truck manufacturer. But then he lost his job to alcoholism and spent a decade homeless on the streets of Portland, during which he lost many teeth, sometimes without even noticing.

"All my teeth are missing in back, top and bottom," he says. "I still am baffled how that happened."