New Articles in Press:
Teeth for Life: The First Nations Oral Health Strategy
Lemchuk-Favel, L, October 15, 2010
Synopses of Articles in PubMed:
Oral health interventions among Indigenous populations in Canada.
Discipline of Dental Public Health, Department of Biological and Diagnostic Sciences, Faculty of Dentistry, University of Toronto, Canada.
There has been a great deal of research describing the risk factors and determinants that impact on the health and well being of Aboriginal Canadians that has revealed tremendous oral health inequalities between these groups and their non-Aboriginal counterparts. Building on this research, culturally-based preventive interventions are now needed to address the significantly higher rates of oral disease among Aboriginals across Canada. Included in this article is an overview of oral health interventions targeted at First Nations, Inuit and Métis peoples in Canada, offering a glimpse of some of the innovative research initiatives originating from within Aboriginal communities that are being used to develop new health programmes and policies to improve the health and well being of this population. Particular emphasis is placed upon community-based and national initiatives to prevent dental caries in young Indigenous children that begin by improving the oral and general health of young women and mothers through pre-conception interventions. In addition, recently developed and implemented national First Nations- and Inuit-led oral health surveys are set to provide new evidence to inform future programmes and policy initiatives that will help to reduce dental disease burden and inequalities affecting Indigenous Canadians.
PMID: 20718308 [PubMed - indexed for MEDLINE]
Design and implementation of a dental caries prevention trial in remote Canadian Aboriginal communities.
Harrison R, Veronneau J, Leroux B.
Division of Pediatric Dentistry, Faculty of Dentistry, University of British Columbia, 2199 Wesbrook Mall, Vancouver, V6T 1Z3, Canada.
BACKGROUND: The goal of this cluster randomized trial is to test the effectiveness of a counseling approach, Motivational Interviewing, to control dental caries in young Aboriginal children. Motivational Interviewing, a client-centred, directive counseling style, has not yet been evaluated as an approach for promotion of behaviour change in indigenous communities in remote settings.
METHODS/DESIGN: Aboriginal women were hired from the 9 communities to recruit expectant and new mothers to the trial, administer questionnaires and deliver the counseling to mothers in the test communities. The goal is for mothers to receive the intervention during pregnancy and at their child’s immunization visits. Data on children’s dental health status and family dental health practices will be collected when children are 30-months of age. The communities were randomly allocated to test or control group by a random “draw” over community radio. Sample size and power were determined based on an anticipated 20% reduction in caries prevalence. Randomization checks were conducted between groups.
DISCUSSION: In the 5 test and 4 control communities, 272 of the original target sample size of 309 mothers have been recruited over a two-and-a-half year period. A power calculation using the actual attained sample size showed power to be 79% to detect a treatment effect. If an attrition fraction of 4% per year is maintained, power will remain at 80%. Power will still be > 90% to detect a 25% reduction in caries prevalence. The distribution of most baseline variables was similar for the two randomized groups of mothers. However, despite the random assignment of communities to treatment conditions, group differences exist for stage of pregnancy and prior tooth extractions in the family. Because of the group imbalances on certain variables, control of baseline variables will be done in the analyses of treatment effects. This paper explains the challenges of conducting randomized trials in remote settings, the importance of thorough community collaboration, and also illustrates the likelihood that some baseline variables that may be clinically important will be unevenly split in group-randomized trials when the number of groups is small.
TRIAL REGISTRATION: This trial is registered as ISRCTN41467632.
PMID: 20465831 [PubMed - indexed for MEDLINE]
Prevalence and risk factors for parental-reported oral health of Inuit preschoolers: Nunavut Inuit Child Health Survey, 2007-2008
Rural and Remote Health – Circumpolar Special Issue: Human health at the ends of the earth
Pacey A, Nancarrow T, Egeland GM
Introduction: Studies from the early 20th Century suggest that Inuit had a low prevalence of dental caries. However, Inuit children now experience a high prevalence of tooth decay and dental caries. The main objectives of this study were to provide an estimate of the prevalence and correlates of parental-reported oral health among Inuit preschool-aged children in Nunavut. Methods: Inuit preschool-aged children aged 3 to 5 years from 16 of Nunavut’s 25 communities were randomly selected to participate in the Nunavut Inuit Child Health Survey conducted in 2007 and 2008. The parent/primary caregiver was asked to give written informed consent for their child’s participation. Caregivers were asked to rate their child’s oral and dental health and if their child had any ‘decayed, extracted or filled baby teeth’: an affirmative response designated a child as having reported-caries experience (RCE). Interviewer administered questionnaires included household characteristics, nutritional supplements, past-month qualitative food frequency questionnaire (FFQ), and a 24 hour dietary recall with repeat 24 hour recalls on a 20% sub-sample. Results: The overall participation rate was 72.3% (388 children). Among the participating children, 53% percent were female and the mean age was 4.4 ± 0.9 years. The weighted prevalence of RCE was 69.1% (95% CI: 63.7–74.4%).
Pediatr Clin North Am. 2009 Dec;56(6):1481-99.
Oral health of indigenous children and the influence of early childhood caries on childhood health and well-being
Schroth RJ, Harrison RL, Moffatt ME.
Department of Pediatrics & Child Health and Department of Oral Biology, University of Manitoba, 507-715 Mc Dermot Avenue, Winnipeg, Manitoba R3E 3P4, Canada. firstname.lastname@example.org
Dental caries in Indigenous children is a child health issue that is multifactorial in origin and strongly influenced by the determinants of health. The evidence suggests that extensive dental caries has an effect on health and well-being of the young child. This article focuses on early childhood caries as an overall proxy for Indigenous childhood oral health because decay during early life sets the foundation for oral health throughout childhood and adolescence. Strategies should begin with community engagement and always include primary care providers and other community health workers.
PMID: 19962032 [PubMed - in process]
Oral health inequalities between young Aboriginal and non-Aboriginal children living in Ontario, Canada
Lawrence HP, Binguis D, Douglas J, McKeown L, Switzer B, Figueiredo R, Reade M.
OBJECTIVES: To investigate (i) oral health inequalities between off-reserve Aboriginal and non-Aboriginal children entering junior kindergarten (JK) in the Thunder Bay District, Northwest Ontario, Canada, (ii) oral health inequalities between kindergarten-aged (4 years old) Aboriginal children living on reserves in the Sioux Lookout Zone (SLZ), Northwest Ontario and those living off-reserve in the Thunder Bay District and (iii) early childhood caries (ECC) trends among SLZ children between 2001 and 2005. METHODS: Cross-sectional oral health data (dmft/s Indices) for 416 (2003/2004), 687 (2004/2005) and 544 (2005/2006) 3- to 5-year olds attending JK in the Thunder Bay District were collected by calibrated dental hygienists with the District’s Health Unit. Secondary analysis of oral health status data from two studies conducted in the SLZ between 2001 and 2005 provided the dmft of random samples of children younger than 6 years of age living in 16-20 First Nations communities. RESULTS: When compared with non-Aboriginal children aged 3-5 years attending the same schools in the Thunder Bay District between 2003 and 2006, off-reserve Aboriginal children had 1.9 to 2.3 times the risk of having ECC (dmft > 0), 2.9 to 3.5 times the risk of a dmft > 3 and 1.8 to 2.5 times the risk of untreated decayed teeth after adjusting the prevalence ratios for child’s age and sex, school’s risk level and clustered-correlated data. The mean dmft of on-reserve Aboriginal 4-year olds in 2005 was 11.2 and 5.9 for their off-reserve Aboriginal counterparts. In 2001, the mean dmft scores (95% confidence interval) of 2-, 3- and 4-year-old Aboriginal children in the SLZ were: 9.1 (8.3-9.9), 12.4 (11.8-13.1), 13.1 (12.1-14.2). In 2005, similarly aged SLZ children had a mean dmft of: 6.2 (5.2-7.1), 8.9 (8.2-9.6), 11.2 (10.5-11.9), representing significant reductions in caries severity (32%, 28% and 14.5%, respectively). CONCLUSIONS: Significant disparities in caries experience exist between off-reserve Aboriginal and non-Aboriginal children living in the same locales and between Aboriginal children living on- and off-reserve in northwestern Ontario. The study showed decreased trends in the severity of ECC for children in the SLZ occurring over the 5-year period. Despite this progress, the oral health of young Aboriginal children in Ontario continues to lag far behind that of non-Aboriginal children, demanding further programs and policies to tackle the social determinants of oral health and resolve these inequalities.
PMID: 19780768 [PubMed - in process]
1. Community Dent Oral Epidemiol. 2008 Dec;36(6):503-16. Epub 2008 Apr 14.
A 2-year community-randomized controlled trial of fluoride varnish to prevent early childhood caries in Aboriginal children.
Lawrence HP, Binguis D, Douglas J, McKeown L, Switzer B, Figueiredo R, Laporte A.
Community Dentistry Discipline, Department of Biological and Diagnostic Sciences, Faculty of Dentistry, University of Toronto, Toronto, ON, Canada. email@example.com
OBJECTIVE: To measure the effectiveness of fluoride varnish (FV) (Duraflor), 5% sodium fluoride, Pharmascience Inc., Montréal, QC, Canada) and caregiver counseling in preventing early childhood caries (ECC) in Aboriginal children in a 2-year community-randomized controlled trial. METHODS: Twenty First Nations communities in the Sioux Lookout Zone (SLZ), Northwest Ontario, Canada were randomized to two study groups. All caregivers received oral health counseling, while children in one group received FV twice per year and the controls received no varnish. A total of 1275, 6 months to 5-year-old children from the SLZ communities were enrolled. In addition, a convenience sample of 150 primarily non-Aboriginal children of the same age were recruited from the neighboring community of Thunder Bay and used as comparisons. Longitudinal examinations for the dmft/s indices were conducted by calibrated hygienists in 2003, 2004 and 2005. RESULTS: Aboriginal children living in the SLZ or in Thunder Bay had significantly higher caries prevalence and severity than non-Aboriginal children in Thunder Bay. FV treatment conferred an 18% reduction in the 2-year mean ‘net’ dmfs increment for Aboriginal children and a 25% reduction for all children, using cluster analysis to adjust for the intra-cluster correlation among children in the same community. Adjusted odds ratio for caries incidence was 1.96 times higher in the controls than in the FV group (95% CI = 1.08-3.56; P = 0.027). For those caries-free at baseline, the number (of children) needed to treat (NNT) equaled 7.4. CONCLUSIONS: Findings support the use of FV at least twice per year, in conjunction with caregiver counseling, to prevent ECC, reduce caries increment and oral health inequalities between young Aboriginal and non-Aboriginal children.
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2. Int J Circumpolar Health. 2006 Apr;65(2):101-16.
Int J Circumpolar Health. 2006 Apr;65(2):98-100.
A political economic history of medical and dental care in Nunavut, Canada.
Community Dental Health Services Research Unit, Faculty of Dentistry, University of Toronto, Ontario, Canada. email@example.com
OBJECTIVES: To describe the historical development of medical and dental care in the territory of Nunavut, Canada. STUDY DESIGN: Ethnographic case study using political economy as a mode of explanation. METHODS: Participant observations, document reviews and stakeholder interviews, conducted over a four-year period. RESULTS: There is a clear and now long-term movement from state and professionally controlled health care delivery to Indigenous control over care. CONCLUSIONS: Indigenous groups increasingly hold control over health care delivery through a complex form of management that straddles both public and private organizational spheres.
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3. Community Dent Oral Epidemiol. 1993 Oct;21(5):253-60.
A retrospective analysis of the costs associated with the treatment of nursing caries in a remote Canadian aboriginal preschool population.
Milnes AR, Rubin CW, Karpa M, Tate R.
Department of Preventive Dental Science, Faculty of Dentistry, University of Manitoba, Winnipeg, Canada.
Nursing caries is a specific form of rampant dental caries affecting the majority of preschool aboriginal children who live in the Province of Manitoba, Canada. Since the majority of these individuals live in remote regions of the province access to dental treatment is difficult, resulting in long delays in the provision of treatment and, most likely, significant morbidity associated with dental pain and oral infection. Travel to distant centres for treatment under general anesthesia by pediatric dentists has become the usual method by which treatment is provided to the majority of affected children. We believed that this was an expensive method of providing these necessary services and our purpose was to document all costs associated with the treatment of nursing caries in this population. We analyzed the records of 884 children who were treated for nursing caries between 1980 and 1988 in Manitoba and collected data for costs in the following categories: travel, lodging, medical, dental, hospital and nursing. Our results show that the remote band groups had significantly higher costs (P < 0.001) than groups which were located closer to treatment centres. The costs which accounted primarily for this significant difference were travel and medical costs associated with hospitalization and the administration of general anesthesia. Our results support the need for the redeployment of resources on the basis of regional need and the development of community-based preventive programs and treatment programs which will significantly reduce the incidence of nursing caries in preschool Canadian aboriginal children.
Order the article through PubMed (PMID: 8222597 [PubMed - indexed for MEDLINE])
4. Pediatr Dent. 2007 Nov-Dec;29(6):480-7.
A review of repeat general anesthesia for pediatric dental surgery in Alberta, Canada.
Schroth RJ, Smith WF.
Faculty of Dentistry, University of Manitoba, Winnipeg, Manitoba, Canada. firstname.lastname@example.org
PURPOSE: The purpose of this study was to review data from the province of Alberta, Canada for First Nations children who required more than 1 general anesthesia (GA) procedure for dental surgery from 1996 to 2005. METHODS: This study was limited to First Nations and Inuit children younger than 18 years old in Alberta who received 2 or more GA procedures to facilitate dental treatment Data spanning 1996 to 2005 were provided from the Alberta Regional Office of First Nations & Inuit Health Branch, Health Canada. RESULTS: The entire database contained claims for 339 children who received repeat GA procedures for rehabilitative dental core. Seventy-six percent received 2 procedures, while the remainder underwent 3 or more surgeries. Twenty-four percent of First Nations children in this cohort were subjected to >2 GA procedures. Retreatment of previously restored teeth was a common observation. The majority of children were treated by general practitioners instead of pediatric dentists. Seventy-four percent who had 2 or more surgeries were treated by general dentists at the time of the first GA procedure. The mean age of children at the time of the first GA procedure was not associated with whether children received 2 or more GA procedures for dental care (P=.07). CONCLUSIONS: These data suggest that there may be on over-reliance on GA to treat dental caries for First Notions children in Alberta.
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5. Int J Circumpolar Health. 1998;57 Suppl 1:163-8.
Awareness of periodontal disease in a group of northern Canadian children.
Schuller PD, Thompson GW, Taerum T.
University of Alberta, Edmonton, Canada.
Periodontal disease destroys the supporting structures of the teeth. The clinical signs start early in childhood as inflammation of the gingival tissues; if uncontrolled, it becomes the major cause of loss of teeth in adult life. The purpose of this survey was to determine the understanding that a group of 10- to 15-year-olds living in the Inuvialuit, Gwich’in, and Sahtu Districts of the Northwest Territories have regarding the recognition and prevention of periodontal-gingival disease. A total of 953 students, with a median age of 12.5 years, completed the survey. The data, which included rural and urban centers as well as rural and remote regions, were analyzed using the chi-square method. Ethnic and gender differences are reported. Results indicate that girls have a better awareness of good oral health. Non-Native children have a somewhat better understanding regarding the recognition and prevention of periodontal disease. Both Native and non-Native groups share uncertainties with respect to the rationale and reasons behind the disease process. Educators of oral health prevention should incorporate into their programs preventive measures that take into consideration Native culture and traditions.
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6. Int J Circumpolar Health. 1998;57 Suppl 1:155-62.
Baby-bottle tooth decay: are we on the right track?
Smith PJ, Moffatt ME.
Department of Community Health Sciences, Winnipeg, Manitoba, Canada.
The baby-bottle tooth decay (BBTD) risk factor literature was critically assessed for strength of evidence, and the prevention literature for the identification of which risk factors are being addressed. “Inappropriate” feeding practices (non-nutritive sucking, prolonged bottle/breast feeding, nap-time feeding) are believed to cause BBTD. The association of these practices with BBTD is inconsistent and the strength of association varies greatly. These practices increase exposure to lactose, a cariogenic carbohydrate, but the current causation model fails to explain why the majority of children with these risk factors do not develop BBTD. The association of BBTD with low socioeconomic status is stronger and more consistent. Prevention has focused almost exclusively on education directed at changing the postnatal feeding practices despite the fact that teeth begin formation in utero. Prenatal deficiencies of calcium and vitamin D can lead to enamel defects, and enamel defects in turn predispose teeth to caries. Baby-bottle tooth decay is especially prevalent in Aboriginal people, for whom studies have consistently reported diets deficient in vitamin D and calcium. BBTD may be a consequence of the poor socioeconomic conditions and malnutrition. Perhaps more attention should be given to primary prevention.
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7. Can J Public Health. 2006 May-Jun;97(3):237-40.
Brighter Smiles: Service learning, inter-professional collaboration and health promotion in a First Nations community.
Harrison RL, MacNab AJ, Duffy DJ, Benton DH.
Department of Oral Health Sciences, University of British Columbia Faculty of Dentistry, Vancouver. firstname.lastname@example.org
OBJECTIVE: The goal of Brighter Smiles was to improve children’s dental health in a remote First Nations community in British Columbia in the context of a service-learning experience for pediatrics residents. SETTING AND PARTICIPANTS: The provincial Ministry of Health had competitive funds available for collaborations between remote communities and medical educators. Hartley Bay (Gitga’at), a tribe of the Tsimshian Nation, responded by declaring children’s dental health to be a primary health concern. This northern community has an on-reserve population fluctuating around 200 people and is accessible only by air or water. INTERVENTION: A convenience sample of children had a baseline dental exam; parents also completed a questionnaire about dental health behaviors. Only 31% (4/13) of pre-kindergarten and 8% (2/26) of kindergarten to Grade 12 children had no dental caries. Planning of the Brighter Smiles intervention involved community leaders, teachers, parents, Elders, health care staff, pediatrics residents, and dental and medical faculty from the University of British Columbia (UBC). Brighter Smiles includes school-based brush-ins, fluoride programs, classroom presentations, and regular visits by UBC pediatrics residents to Hartley Bay to provide well-child care that includes age-appropriate dental counseling to parents at the clinic visits. OUTCOMES: An early success indicator was a significantly increased proportion of dental service provider’s time scheduled for preventive maintenance services rather than dental rehabilitation (restorations and extractions). CONCLUSIONS: The goal of providing a service-learning experience for trainee pediatricians in a remote community has been achieved. In addition, early indicators demonstrate improvements in child oral health.
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8. Int J Circumpolar Health. 2007 Apr;66(2):153-67.
Caregiver knowledge and attitudes of preschool oral health and early childhood caries (ECC).
Schroth RJ, Brothwell DJ, Moffatt ME.
Canadian Child Health Clinician Scientist Program, Faculty of Dentistry, University of Manitoba, Winnipeg, Canada. firstname.lastname@example.org
OBJECTIVES: Prevention strategies are integral to improving the oral health for young Aboriginal children. For such to be effective, it is important to understand the social value that parents and caregivers ascribe to primary teeth. The purpose of this paper is to report caregiver knowledge and attitudes toward preschool oral health and early childhood caries (ECC) from 4 communities in Manitoba. STUDY DESIGN: Cross-sectional study, including a retrospective interview with caregivers. METHODS: Children and their main caregivers served as the sample. Preschoolers underwent a comprehensive dental screening while caregivers completed a questionnaire that explored knowledge and attitudes toward preschool dental health. Caregiver responses were matched with findings from each child’s examination. RESULTS: A majority agreed that primary teeth were important, that dental disease could lead to health problems and that a first dental visit should be made by age 1. Caregivers of children with ECC were more likely to believe that caries could not affect a child’s health while those who believed primary teeth are important had children with significantly less decay. CONCLUSIONS: Most caregivers believed that primary teeth are important and correctly responded to inquiries about knowledge and attitudes toward oral health. Attitudes on the importance of baby teeth and bottle feeding after one year of age, the effect of rotten teeth on childhood health and night-time nursing emerged as variables most associated with the absence/presence of ECC and deft rates. Incorporating such questioning into caries risk assessments may be a useful means to determine a child’s risk for ECC.
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9. Community Dent Oral Epidemiol. 1993 Apr;21(2):102-7.
Caries experience of Native children of British Columbia, Canada, 1980-1988.
Harrison RL, Davis DW.
Department of Clinical Dental Sciences, University of British Columbia, Vancouver, Canada.
Surveys of the dental health of Native children in British Columbia, Canada, were conducted in 1980, 1984 and 1988 by Medical Services Branch, Health and Welfare Canada. Data were gathered on children turning 5, 7, 9, 11, 13, and 15 yr of age in each survey year. This paper analyzes the findings related to dental caries and the treatment of caries. Comparisons were made between the 1980 and 1988 surveys using Student’s t-tests; data from the 1984 survey were included for comparison. Results of these surveys demonstrate a continuous improvement in the dental health of Native children between the years 1980 and 1988, but the improvement was limited to the permanent dentition. The deft for 5-yr-olds remained constant over the time interval. In contrast, the DMFT for each group significantly decreased from 1980 to 1988 (P < 0.05). The percentage of 5-yr-old children who were caries-free in the primary dentition remained constant, and primary tooth mortality (tooth abscessed or with crown destroyed) in 5-yr-olds did not change. However, the percentage of children surveyed with caries-free permanent teeth improved significantly at each survey year and permanent tooth mortality significantly declined (P < 0.05). The proportion of filled, compared with carious, primary and permanent teeth increased from 1980 to 1988. In contrast, the number of extracted primary teeth stayed relatively constant for 5-yr-olds, but the proportion of missing teeth declined significantly for all other age groups (P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
Order the article through PubMed (PMID: 8485968 [PubMed - indexed for MEDLINE]) or by contacting the corresponding author at firstname.lastname@example.org
10. J Dent Res. 1974 Mar-Apr;53(2):385-92.
Comparison of oral health in four Canadian Indian communities.
Myers GS, Lee M.
Order the article through PubMed PMID: 4150102 [PubMed - indexed for MEDLINE]
11. Can J Physiol Pharmacol. 1995 Jun;73(6):754-8.
Current status of nutritional deficiencies in Canadian aboriginal people.
Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada.
Since the Nutrition Canada Survey (1973) there has been clear evidence that Aboriginal people have low intakes of many nutrients such as iron, vitamin D, calcium, folate, vitamin A, and fluoride. Recent surveys suggest that the situation has not changed. Children are most likely to be affected clinically. More than half of Aboriginal children in some subpopulations in Manitoba suffer a period of iron deficiency, which may affect development. Nutritional rickets is still a common problem in Manitoba. We have seen cases of megaloblastic anemia due to folate deficiency. The relationship of the well-described low folate intake in pregnancy and birth defects has received no attention for the Aboriginal population. In a recent survey of Inuit children, dental caries of the primary teeth were present in over 70% of children, with a mean DMF (decayed, missing, and filled) index of 1.8 teeth in children under 2 and 9.5 in children 6 to 8 years. Although clinical vitamin A deficiency is not seen, there is now good evidence that sub clinical deficiency increases susceptibility to infections. Although not all Aboriginal populations suffer all of these deficiencies, the problems are sufficiently widespread to suggest this is an urgent problem. It will not be solved simply by education. There must be a political will and a coordinated effort to make a balanced diet available to all at an affordable cost.
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12. Arctic Med Res. 1988;47 Suppl 1:557-61.
Dental caries experience of Inuit children in the Keewatin region, Northwest Territories, 1983/84.
MacDonald L, MacMillan R.
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13. Int J Circumpolar Health. 1998;57 Suppl 1:169-73.
Dental caries knowledge in a group of Northwest Territories children.
Thompson GW, Schuller PD, Lewis DW.
University of Alberta, Edmonton, Canada.
A total of 953 children in schools in communities in the Northwest Territories were surveyed to determine their attitudes and knowledge about dental decay. A questionnaire was answered by these Native and non-Native children in the Northwest Territories. The median age of the children was 12.5 years. The girls tended to brush their teeth more frequently and consumed less sugared sweets between meals. More of the girls and in particular the Native girls knew about “nursing” caries. The Native students more often than not went for dental treatment when it was necessary. The Native students brushed their teeth less frequently and often learned to brush their teeth on their own. The consumption of sugared sweets between meals was greater in the Native sample. The knowledge level of the factors that affect dental decay rates was lower in the Native group, but was not extremely high in either group. These children should receive more information on oral health practices and be given an opportunity to improve their oral health knowledge.
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14. Bull Environ Contam Toxicol. 2003 Mar;70(3):409-14.
Dentine-lead levels and dental caries in First Nation children from the western James Bay region of northern Ontario, Canada.
Tsuji LJ, Karagatzides JD, Hanning RM, Katapatuk B, Young J, Nieboer E.
Department of Environment and Resource Studies, 200 University Avenue West, University of Waterloo, Waterloo, Ontario, N2L 3G1, Canada.
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15. Am J Orthod Dentofacial Orthop. 2002 Apr;121(4):396-402.
Orthodontic treatment outcome in a First Nations population in Alberta, Canada: a comparative study.
Cadman KC, Glover KE, Heo G, Warren S, Major PW.
University of Alberta, Edmonton, Alberta, Canada.
The primary objective of this study was to determine whether there was a significant difference in the degree of improvement after orthodontic treatment between a sample of First Nations orthodontic patients and a control sample of non-First Nations orthodontic patients. The secondary objective was to determine whether there was a difference in the severity of malocclusions being treated in a sample of the First Nations patients compared with a control sample of the non-First Nations patients. Several factors that might affect treatment outcome, such as missed appointments, treatment duration, oral hygiene, extractions, dental classification, and geographic location, were also studied. A sample of 60 First Nations patients and a control group of 60 non-First Nations patients between the 11 and 18 years of age who had been treated with full fixed orthodontic appliances were evaluated. The weighted peer assessment rating (PAR) index was applied to pretreatment and post treatment study models to address the study’s main objectives. The results showed that the First Nations group had greater PAR scores pretreatment than did the controls, and their weighted PAR scores improved more with treatment. Post treatment PAR scores were similar between the 2 groups. In addition to First Nations status, only extractions and geographic location affected PAR improvement scores.
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16. Probe. 1991 Summer;25(2):68-72.
Swampy Cree Tribal Council dental survey.
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17. J Can Dent Assoc (Tor). 1973 Oct;39(10):709-14.
The dental health of Indian children in the Sioux Lookout Zone of Northwestern Ontario.
Hargreaves JA, Titley KC.
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18. Todays FDA. 2008 Jul;20(7):21-5, 27.
J Can Dent Assoc. 2008 Feb;74(1):73-9.
Fluoride varnish in the prevention of dental caries in children and adolescents: a systematic review.
Azarpazhooh A, Main PA
Department of Endodontics, Faculty of Dentistry, University of Toronto, Toronto, ON, Canada.
OBJECTIVE: To develop a scientifically current and evidence-based protocol for the use of fluoride varnish for the prevention of dental caries among high-risk children and adolescents. METHODS: Previous systematic reviews on this topic were used as the basis for the current review. Ovid MEDLINE, CINAHL and several other relevant bibliographic databases were searched for English-language articles, with human subjects, published from 2000 to 2007. RESULTS: A total of 105 articles were identified by the literature search; relevance was determined by examining the title, abstract and body of the article. Seven original research studies met the inclusion criteria, These articles were read and scored independently by 2 reviewers, and evidence was extracted for systematic review.
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19. J Public Health Dent. 2006 Spring;66(2):116-22.
Is regular visiting associated with lower costs? Analyzing service utilization patterns in the first nations population in Canada.
Leake JL, Birch S, Main PA, Ho E.
Faculty of Dentistry, University of Toronto, 124 Edward St., Toronto ON, Canada. email@example.com
OBJECTIVES: Using an administrative database of dental service records from the Non-Insured Health Benefits (NIHB) program of Health Canada for 1994-2001, the authors set out to test whether regular visitors had lower program expenditures. METHODS: The age-specific mean expenditures per client were compared among those with regular examinations in 8, 7 and fewer years. The study further examined the effect of regular visiting over the first 6 years on expenditures in the last 2 years. “Continuity of care” was measured by the numbers of consecutive years prior to 2000 in which clients had a regular examination. In a “gap analysis” individuals were classified according to the number of years prior to 2000 since they last had an initial or recall examination. Mean expenditures per client were analyzed by age group and type of service. FINDINGS: Over the 8-year period, clients with regular visits had the highest expenditures. In both the continuity of care and gap analyses, the findings were generally consistent; the more that clients visited over the first 6 years, the higher the expenditures in the final 2 years. Clients with more “regular” (initial and recall) examinations received a relatively standard, age-specific, pattern of service but incurred greater expenditures compared to clients with fewer regular, or longer gaps in, examinations. CONCLUSION: The observations of the authors in this client group do not support the thesis that regular visiting is associated with lower expenditures on dental care.
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20. J Can Dent Assoc. 2004 Jun;70(6):382.
Prevalence of dental caries among 7- and 13-year-old First Nations children, District of Manitoulin, Ontario.
Peressini S, Leake JL, Mayhall JT, Maar M, Trudeau R.
Department of Community Dentistry, Faculty of Dentisty, University of Toronto, Toronto, Ontario, Canada. firstname.lastname@example.org
PURPOSE: Dental caries is a disease that, although decreasing in the non-Aboriginal child population, remains high for Canadian Aboriginal and Native American children and adolescents. To address dental health issues in First Nations in the District of Manitoulin, Noojmowin Teg Health Centre initiated a multiphase collaborative research project with the department of community dentistry at the University of Toronto. The purpose of this paper was to identify the prevalence of dental caries in children 7 or 13 years of age and to compare these data with published data for the same age groups from other First Nations communities in Canada. METHODS: All children 7 or 13 years of age who were in elementary schools on a reserve in 7 First Nations communities were eligible for a dental health examination as part of the survey. Children attending school off the reserve in 6 of the communities were also eligible. RESULTS: A total of 66 children (56% 7-year-old children, 62% girls) were examined. The mean caries score (deft+ DMFT) for 7-year-old children was 6.2; the mean decayed, extracted, filled permanent teeth (DMFT) score for 13-year-old children was 4.1. Overall, 96% of children had 1 or more past or active carious lesion. CONCLUSION: Results indicate that dental caries is highly prevalent and increasing in severity in this population.
Order the article through PubMed (PMID: 15175117 [PubMed - indexed for MEDLINE])
21.PROBE 2004 Jul-Aug;38(4):172-190. link
Effects of a Community-based Prenatal Nutrition Program on the Oral health of Aboriginal Preschool Children in Northern Ontario
Lawrence, HP; Romanetz, M; Rutherford, L; Cappel, L; Binguis, D; Rogers, JB
Background: Aboriginal preschool children across Canada are at increased risk for Early Childhood Caries (ECC) when compared with their non-Aboriginal age cohorts. Current research indicates that dental public health programs fail to prevent ECC because intervention often arrives too late. Objectives: To evaluate the effectiveness of the dental hygiene-coordinated prenatal nutrition program, delivered by community-based nutrition educators on First Nations reserves located in the Sioux Lookout Zone (Northwestern Ontario) on: (1) parents/caregivers’ beliefs and behavioural decisions related to dental preventive practices and feeding habits of young children; (2) oral health status and treatment needs of those children; (3) early childhood obesity. Methods: Cross-sectional oral health surveys of Anishnaabe 2–5 year olds conducted in 2001and 2002 in 16 communities; 8 communities classified as “high” intervention and 8 as “low” intervention based on frequency of contact and content of contact between nutrition educators and prenatal women. Trained and calibrated dental hygienists examined children for dental caries and oral hygiene and measured height and weight. A questionnaire was used to assess caregiver knowledge, beliefs, and practices in relation to the oral health of the child. Results: 471 (72% response) and 705 (65% response) caregiver-and-child pairs participated in 2001 and 2002, respectively. Oral health knowledge in this population was high and significantly higher among caregivers in the high-intervention communities. In high-intervention communities, caregivers brushed children’s teeth more frequently and started at an earlier age. Differences in feeding habits were noted with regard to bottle feeding on child’s demand and the sugar-rich content of the bottle. Children in high-intervention communities required dental treatment under general anesthetic (GA) but at a later age, were less likely to have abscessed teeth and had less untreated decay by age 4 than those in the low-intervention communities. The program also had significant positive effects on the child’s oral hygiene and body mass index (BMI). Conclusion: The prenatal nutrition program improved caregivers’ knowledge of ECC. However, factors that place undo strain on the caregiver and lead to poor oral hygiene and dietary habits among children in Aboriginal communities need to be addressed. Some strategies to confront these factors are discussed in the paper.
22. J Can Dent Assoc. 2003 Jan;69(1):16-9. link
Pacifier use and early childhood caries: an evidence-based study of the literature.
The Department of Community Dentistry, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada. email@example.com
This evidence-based study of the literature investigated the relationship between pacifier use (with and without sweetening and prolonged or short-term) and early childhood caries (ECC). The review was based on evidence from 3 main sources: a search of several electronic bibliographic databases, a review of the references from relevant studies for additional potentially relevant articles and a review of several dental textbooks. A total of 74 articles were reviewed. Of these, 8 were deemed relevant and were critically appraised according to a “causation checklist” of 13 items. The 8 studies assessed were methodologically inconsistent in terms of definitions of ECC, diagnostic criteria for identifying carious lesions, dental examination procedures, interviewing methods, and descriptions of pacifier use. None of the studies achieved a score greater than 6 and hence none was considered to present strong evidence. Six studies did not control for confounding variables, and the conclusions they generated were inconsistent. The evidence from the other 2 studies, which did control for confounding factors, presented slightly stronger evidence, but they indicated no statistical difference in pacifier use between children with and those without ECC; furthermore, the reported odds ratios suggested that pacifier use might have had a mildly protective effect. Overall, the evidence does not suggest a strong or consistent association between pacifier use and ECC.
PMID: 12556264 [PubMed - indexed for MEDLINE]
23. Int J Paediatr Dent. 2004 Mar;14(2):101-10.
Prevalence of early childhood caries among First Nations children, District of Manitoulin, Ontario.
Peressini S, Leake JL, Mayhall JT, Maar M, Trudeau R.
Department of Community Dentistry, Faculty of Dentistry, University of Toronto, 124 Edward Street, Toronto, Ontario, M5G 1G6, Canada. firstname.lastname@example.org
BACKGROUND: Epidemiological studies of Aboriginal communities in Canada and Native American populations in the United States have reported that early childhood caries (ECC) is highly prevalent. The purpose of this study was to determine the prevalence of ECC and dental caries in the First Nations population of 3- and 5-year-old children in the District of Manitoulin, Ontario to assist in developing effective dental health promotion strategies. METHODS: All 3- and 5-year-old children in elementary schools and day-care centres in seven First Nation communities were eligible for the survey examination. Three-year-old children at home and 5-year-old children attending school off-reserve in six of the communities were also eligible for epidemiological survey examination of oral health status including caries, gingival and soft tissue conditions. Cases of ECC were defined as children with caries or restorations on two or more primary maxillary incisors or canines or those having a total decayed, missing, filled primary teeth (dmft) score of 4 or greater. RESULTS: A total of 87 children (59% 5 years old, 54% females) were examined. Seventy-four per cent of children had one or more carious lesions. Forty-five cases of ECC were found, a prevalence of 52%. The mean dmft score for cases was 7.5 (95% CI 6.5-8.4) and 0.8 (95% CI 0.5-1.1) for non-cases (P < 0.001). Boys in both age groups were more likely to be affected by ECC than girls. CONCLUSION: Our results indicate that dental caries and ECC are highly prevalent in this population, with ECC cases having 6.7 more dmft than non-cases.
PMID: 15005698 [PubMed - indexed for MEDLINE]
24. Community Dent Oral Epidemiol. 2009 Sep 22. Epub 2009 Sep 22.
Oral health inequalities between young Aboriginal and non-Aboriginal children living in Ontario, Canada.
Lawrence HP, Binguis D, Douglas J, McKeown L, Switzer B, Figueiredo R, Reade M.
Community Dentistry Discipline, Department of Biological and Diagnostic Sciences, Faculty of Dentistry, University of Toronto, Toronto, ON, Canada.
Lawrence HP, Binguis D, Douglas J, McKeown L, Switzer B, Figueiredo R, Reade M. Oral health inequalities between young Aboriginal and non-Aboriginal children living in Ontario, Canada. Community Dent Oral Epidemiol 2009. (c) 2009 John Wiley & Sons A/SAbstract – Objectives: To investigate (i) oral health inequalities between off-reserve Aboriginal and non-Aboriginal children entering junior kindergarten (JK) in the Thunder Bay District, Northwest Ontario, Canada, (ii) oral health inequalities between kindergarten-aged (4 years old) Aboriginal children living on reserves in the Sioux Lookout Zone (SLZ), Northwest Ontario and those living off-reserve in the Thunder Bay District and (iii) early childhood caries (ECC) trends among SLZ children between 2001 and 2005. Methods: Cross-sectional oral health data (dmft/s Indices) for 416 (2003/2004), 687 (2004/2005) and 544 (2005/2006) 3- to 5-year olds attending JK in the Thunder Bay District were collected by calibrated dental hygienists with the District’s Health Unit. Secondary analysis of oral health status data from two studies conducted in the SLZ between 2001 and 2005 provided the dmft of random samples of children younger than 6 years of age living in 16-20 First Nations communities. Results: When compared with non-Aboriginal children aged 3-5 years attending the same schools in the Thunder Bay District between 2003 and 2006, off-reserve Aboriginal children had 1.9 to 2.3 times the risk of having ECC (dmft > 0), 2.9 to 3.5 times the risk of a dmft > 3 and 1.8 to 2.5 times the risk of untreated decayed teeth after adjusting the prevalence ratios for child’s age and sex, school’s risk level and clustered-correlated data. The mean dmft of on-reserve Aboriginal 4-year olds in 2005 was 11.2 and 5.9 for their off-reserve Aboriginal counterparts. In 2001, the mean dmft scores (95% confidence interval) of 2-, 3- and 4-year-old Aboriginal children in the SLZ were: 9.1 (8.3-9.9), 12.4 (11.8-13.1), 13.1 (12.1-14.2). In 2005, similarly aged SLZ children had a mean dmft of: 6.2 (5.2-7.1), 8.9 (8.2-9.6), 11.2 (10.5-11.9), representing significant reductions in caries severity (32%, 28% and 14.5%, respectively). Conclusions: Significant disparities in caries experience exist between off-reserve Aboriginal and non-Aboriginal children living in the same locales and between Aboriginal children living on- and off-reserve in northwestern Ontario. The study showed decreased trends in the severity of ECC for children in the SLZ occurring over the 5-year period. Despite this progress, the oral health of young Aboriginal children in Ontario continues to lag far behind that of non-Aboriginal children, demanding further programs and policies to tackle the social determinants of oral health and resolve these inequalities.
PMID: 19780768 [PubMed - as supplied by publisher]