Early childhood caries and Early childhood caries and Aboriginal children in Aboriginal children in
CanadaCanada
James Irvine, MD Univ. of SaskatchewanRobert J Schroth, DMD Univ. of ManitobaRosamund Harrison, DMD Univ. of British Columbia
Aboriginal Populations in Canada2006
698,025
389,785
50,485
0100,000200,000300,000400,000500,000600,000700,000800,000
First Nations Metis Inuit
USA AI/ AN = 4.9 million
Percentage of Aboriginal People in Canada, 2006
Source: Statistics Canada 2006
USA: 1% [Alaska: 15% New Mexico: 10%]
Median Annual IncomeAge 15 years and Over, 2005
14,146
22,274
0
5,000
10,000
15,000
20,000
25,000
First Nation Canadian
First Nation Canadian
Prevalence of ECC in CanadaManitoba:98% Garden Hill First Nation59% Northern First Nation23% City of Winnipeg
British Columbia:31% Hartley Bay
Ontario:67-78% District of Manitoulin79-92% Sioux Lookout Zone
Northwest Territories:66% Inuvik Region
Quebec:81% Cree Territory
First Nations Regional Longitudinal Health Survey
(2002/03)
• Directed & implemented by First Nations following principles of Ownership, Control, Access & Possession
• 238 communities; self-reports
• Provided information for planning, policy & advocacy
• Parents asked about child’s (n=6,657) experience of Baby Bottle Tooth Decay–– 30%30% of 3-5 year old children affected
1. Oral Health and the Aboriginal Child. A forum for community members, researchers and policymakers.http://www.mich.ca/pdf/Dental_FinalVersion_of_Conference_Proceedings_January25-2008.pdfpage 16-18.
Oral Health and the Aboriginal Child Forum 2007
http://www.mich.ca/pdf/Dental_FinalVersion_of_Conference_Proceedings_January25-2008.pdfhttp://www.cda-adc.ca/jcda/vol-74/issue-5/429.pdf
COHI Aides, dental therapistsCOHI Aides, dental therapistsand hygienistsand hygienists•First visits•Counseling•F-Varnish•ART•Sealants•Xylitol
Dental Therapists in CanadaDental Therapists in Canada’’s s Aboriginal communitiesAboriginal communities
Healthy Smile, Happy ChildHealthy Smile, Happy Child• 3 Guiding Pillars:
1. Community Development & Engagement2. Oral Health Promotion/ECC Prevention3. Evaluation/Research
• 4 Manitoba pilot First Nations communities:• 2 remote, rural• 2 urbanSchroth RJ et al 2005. Prevalence of ECC in 4 Manitoba communities. J Can Dent Assoc.; Schroth RJ et al 2007. Int J
Circumpolar Health
• Expanded throughout Manitoba in 2006 •• Goal:Goal: Sustainable early childhood oral health
promotion and ECC prevention initiatives
Healthy Smile Happy ChildHealthy Smile Happy Child• Goal: to reduce incidence/severity of ECC
•• Community developmentCommunity development principles to promote preschool oral health and prevent ECC
• Project staff built relationships with existing existing programsprograms to enable community action
• Emphasis placed on building capacitybuilding capacity to ensure sustainabilitysustainability
66--year followyear follow--up: comparisons with up: comparisons with baselinebaseline
• Follow-up (n=319); baseline (n=408)• Significant improvements in parental knowledge,
attitudes, and behaviors• Reduced dt score: mn(SD)
• 2.1 (3.4) follow-up vs. 1.6 (2.7) baseline, p=.017• Reduced age adjusted deft rate: mn(SD)
• 4.2 (5.0) follow-up vs. 3.9 (5.0) baseline, p<.001• Age adjusted logistic regression for S-ECC
– reduction in prevalence: 38.6% vs. 45.0%, p=.026
A 2-year community-randomized controlled trial of fluoride varnish to prevent early childhood caries in Aboriginal childrenLawrence HP et al. Community Dent Oral Epidemiol 2008
CIHR Grant MOP #64215
Objective: to measure effectiveness of FV and caregiver counseling in preventing in ECC in Aboriginal children
Study design: cluster randomized trial control: caregiver counselingtest: caregiver counseling plus FVplus FV
Sample size: n=1275 (6 mos.- 5 yrs.) Treatment effect (primary outcomes):
– net reduction in caries increment = 18%• measured at d1 and d3 level
–– NNT = 26NNT = 26 to prevent one child from developing caries
Treatment effect: Secondary outcomes
• GA tx: “the proportion of children who had GA dental care 25% lower in test group1”
• not yet reported:– oral health quality of life– cost– acceptability by parents
1. Oral Health and the Aboriginal Child. A forum for community members, researchers and policymakers.http://www.mich.ca/pdf/Dental_FinalVersion_of_Conference_Proceedings_January25-2008.pdfpage 27
Kimaa Kimaa MiywaapitetMiywaapitet NitawaashiimNitawaashiim:: I wish my child would have beautiful teethI wish my child would have beautiful teeth
A clinical trial of the effectiveness of a dental caries
prevention program for Cree mothers and their infantsCIHR Grant FRN 67817
Kimaa Kimaa MiywaapitetMiywaapitet NitawaashiimNitawaashiim:: I wish my child would have beautiful teethI wish my child would have beautiful teeth
Harrison RL, Veronneau J, Leroux B. Design and implementation of a dental caries prevention trial in remote Canadian Aboriginal communities.
TRIALS 11. 1-9, 2010
•• Objective:Objective: to test effectiveness of a counseling approach, Motivational Interviewing to control dental caries in young Aboriginal children.
• Study design: single-blind study with cluster randomization by community – 5 test/4 control
Kimaa Kimaa MiywaapitetMiywaapitet NitawaashiimNitawaashiim:: I wish my child would have beautiful teethI wish my child would have beautiful teeth
Study design: test momsStudy design: test moms
Pregnant woman recruited: enrolment; MI#1
MI #2 (2 mos.) – MI #6 (24 mos.)
Follow-up: dental exam of child @ 30 mos.
Kimaa Kimaa MiywaapitetMiywaapitet NitawaashiimNitawaashiim:: I wish my child would have beautiful teethI wish my child would have beautiful teeth
Preliminary results: n = 272/309 (87%)272/309 (87%)
•• Outcomes assessedOutcomes assessed for– 108/131 (82%) test children – 131/141 (93%) of control children
•• Ages similarAges similar for – test (mean 37.1, SD 11.1, mos.)– control children (35.6, SD 8.6, mos).
Kimaa Kimaa MiywaapitetMiywaapitet NitawaashiimNitawaashiim:: I wish my child would have beautiful teethI wish my child would have beautiful teeth
“Preliminary” results
• Compared test and control group children for various “tooth-level” indices
• Risk ratio (RR) significant (p<.05) for all indices, except d1-4eft and d4eft.– intervention was associated with a certain certain
% reduction in risk% reduction in risk
References
1. Schroth R. Influence of maternal prenatal vitamin D status on infant oral health. 1.1-1-7-5. 2010. University of Manitoba.
Ref Type: Thesis/Dissertation2. Schroth RJ, Smith PJ, Whalen JC, Lekic C, Moffatt ME. Prevalence of caries among preschool-aged
children in a northern Manitoba community. J Can Dent Assoc 2005; 71(1):27.3. Schroth RJ, Moore P, Brothwell DJ. Prevalence of early childhood caries in 4 Manitoba communities. J
Can Dent Assoc 2005; 71(8):567.4. Leake J, Jozzy S, Uswak G. Severe dental caries, impacts and determinants among children 2-6 years of
age in Inuvik Region, Northwest Territories, Canada. J Can Dent Assoc 2008; 74(6):519.5. Harrison R, MacNab A, Duffy D, Benton D. Brighter smiles. Service learning, inter-professional
collaboration and health promotion in a First Nations community. Can J Public Health 2006; 97(3):237-240.6. Peressini S, Leake JL, Mayhall JT, Maar M, Trudeau R. Prevalence of early childhood caries among First
Nations children, District of Manitoulin, Ontario. Int J Paediatr Dent 2004; 14(2):101-110.7. Lawrence HP, Romanetz, Rutherford L, Cappel L, Binguis D, Rogers JB. Effects of a community-based
prenatal nutrition program on the oral health of Aboriginal preschool children in northern Ontario. Probe2004; 38(4):172-190.
8. First Nations Centre. First Nations Regional Longitudinal Health Survey (RHS) 2002/03. Results for Adults, Youth and Children Living in First Nations Communities. 1-312. 2005. Ottawa, First Nations Centre.
Ref Type: Report9. Schroth, Harrison R, Lawrence H, Peressini S. Oral health and the Aboriginal child: a forum for
community members, researchers and policy-makers. J Can Dent Assoc 2008; 74(5):429-432.10. Schroth R, Harrison R, Lawrence H, Peressini S. Oral Health and the Aboriginal Child: a forum for
community members, researchers and policy-makers. 1-63. 2007. Winnipeg. Ref Type: Report11. Schroth RJ, Brothwell DJ, Moffatt ME. Caregiver knowledge and attitudes of preschool oral health and
early childhood caries (ECC). Int J Circumpolar Health 2007; 66(2):153-167.12. Lawrence HP, Binguis D, Douglas J, McKeown L, Switzer B, Figueiredo R et al. A 2-year community-
randomized controlled trial of fluoride varnish to prevent early childhood caries in Aboriginal children. Community Dent Oral Epidemiol 2008; 36(6):503-516.
13. Harrison R, Veronneau J, Leroux B. Design and implementation of a dental caries prevention trial in remote Canadian Aboriginal communities. Trials 2010; 11:54.