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This report provides the results of the First Nations Oral Health Survey (FNOHS) conducted by the First Nations Information Governance Centre with support from the Office of the Chief Dental Officer of Canada, which supplied examiners and expert advice. The survey was carried out in 2009–10 in five provinces and one territory of Canada, and consisted of face-to-face household interviews and clinical oral examinations. Overall, 1,188 First Nations aged 3 years and over participated in the survey interview (proxy interviews were conducted with parents/caregivers of children younger than 12 years of age), with 1,125 respondents completing the oral health examination component of the survey. The 2009–10 FNOHS aimed to describe levels of oral disease within a representative sample of First Nations living in remote and nonremote communities across Canada. A further aim of the survey was to evaluate differences in the oral health status of First Nations and non-First Nations Canadians. To this end, this report presents comparisons of the self-reported and clinical oral health outcomes of participants in the FNOHS with those of participants in the oral health component of the 2007–09 Canadian Health Measures Survey (CHMS) and the 2008–09 Inuit Oral Health Survey (IOHS). The results can be reliably compared because these three national surveys shared the same standardized protocol originally developed for the CHMS. Household interviews revealed that when compared to non-Aboriginal Canadians, fewer First Nations of all ages reported visiting a dental professional in the previous 12 months. Among adults, 56.8% of First Nations had visited a dental professional in the previous year, while 71.6%of participants in the CHMS reported a dental visit within the same time frame. The main reason reported by First Nations for not going to a dental care provider was that services were not available in their communities and interviewers found that more than 75% of the survey respondents usually received care outside their communities. Cost, however, was not a barrier to accessing oral health services for First Nations. Only a small minority of respondents had avoided dental care due to the cost or declined recommended routine dental treatment in the previous year for the same reason. First Nations were also more likely to rate their oral health as fair or poor, to have experienced oro facial pain in the preceding month or, in the previous 12months, to have suffered from chronic mouth pain, toothache or other oral symptoms, and to have avoided some foods due to problems with their teeth, mouth or dentures.The presence of chronic dental pain and what appears to be poorer overall oral health among Canadian First Nations should translate into more dental sick-days. However, time lost from school, work or other normal activities for oral health reasons was reported by 17.9% of First Nations aged 12 years and over as compared to 39.1% of non-Aboriginal Canadians aged 6–79years. That said, the number of hours per year clocked in the dental chair by First Nations was greater than the hours per year lost due to oral disease and professional treatment among non-Aboriginal Canadians.The clinical examination component of the survey found that, overall, the oral health of most First Nations children and adolescents was poor. Approximately 86% of preschool children aged3–5 years had experienced dental caries, with a mean of 7.62 primary (baby) teeth affected, and out of those 2.68 (35.2%) teeth remained untreated. The prevalence of coronal caries in schoolchildren aged 6–11 years was 93.9% and the mean caries severity score showed 6.58 teeth8affected, whereas only 1.10 (16.7%) teeth remained untreated. Adolescents aged 12–19 years,like their younger age cohorts, also had poor oral health, with 91.4% of children affected by dental caries and a total number of decayed, missing or filled teeth (DMFT) equal to 6.15, although much of this disease had been treated. In general, the prevalence and mean severity scores for First Nations exceeded those for their age-matched, non-Aboriginal Canadians counterparts by 1.6–2.9 times. Fewer First Nations children and adolescents examined had dental sealants on their permanent molar teeth than their non-Aboriginal counterparts. The survey also revealed disparities in the prevalence of malocclusion and in accessing orthodontic treatment between First Nations and non-Aboriginal adolescents in Canada. Almost half (48.1%) of First Nations aged 12–17 years were judged to have less than acceptable occlusion. This estimate compares to a figure nearly 2.5times lower (17.0%) for non-Aboriginals aged 12–19 years. Orthodontic treatment is more commonly provided in the adolescent years, but only 3.5% of First Nations adolescents were undergoing or had undergone orthodontics at the time of the FNOHS. That compares with 36.7%of non-Aboriginal adolescents who were receiving or had received orthodontic treatment at the time of the CHMS. One in four First Nations adolescents reported being denied orthodontic treatment because their case did not meet the Non-insured Health Benefits Program (NIHB)criteria.Approximately 1 in 20 First Nations adults (6.3%) had lost all their natural teeth, compared to an equivalent finding in the CHMS of 6.4% for non-Aboriginal Canadians. Among the 93.7% of dentate First Nations, the average number of teeth present was 23.5 with 79.4% having a functional natural dentition, defined as 21 teeth or more. This proportion was 6% lower than that of non-Aboriginals, with 85.3% retaining their functional natural dentition. Despite similar overall levels of edentulism among adults surveyed in the FNOHS and the CHMS, mandibular dentures were less common among the First Nations.Coronal caries experience was ubiquitous among First Nations adults. 99.9% had had coronal caries with a mean of 13.72 decayed, missing or filled teeth. Much of the decay had been treated,predominantly by fillings (55.1%) and by extractions (31.6%). Just over half of First Nations adults (56.5%) had one or more untreated coronal caries compared to 19.3% of non-Aboriginal Canadians. Root caries, or decay of tooth roots that have become exposed because of periodontal disease and/or ageing, was more prevalent in First Nations adults (32.9%) than in non-Aboriginal adults(20.5%) and nearly 72% of the disease in First Nations remained untreated.A small proportion of dentate First Nations adults were affected by periodontal disease. Despite abundant accumulation of soft debris and calculus, signs of periodontitis were found in only16.8% of adults who had loss of attachment of 4 mm or more at one or more sites on indicator teeth and in 23.0% who had probing depths of 4 mm or more on at least one tooth. Additionally,43.9% had moderate/severe gingivitis, which can be a precursor to destructive periodontitis.Gingivitis is reversible with proper and regular tooth brushing and flossing, but the FNOHS found that First Nations adolescents and adults were not brushing enough. Just over half (54.7%)9reported brushing their teeth at least twice daily with only a quarter of dentate First Nations flossing at least five times per week.Compared to the Inuit, First Nations had higher rates of dental visitation within the last year,lower severity of coronal and root caries, lower prevalence of untreated coronal and root caries,lower rates of edentulism, more teeth present and greater numbers with a functional natural dentition, but higher debris, calculus and gingivitis scores.There was also a group of oral health conditions that had a relatively low prevalence and did not vary meaningfully among the three survey populations. This was the case for oral mucosal lesions, found among 15.3% of First Nations aged 12 years and over. Another condition was dental fluorosis, which was primarily of the very mild or mild types (which are of little aesthetic concern) that affected 14.8% of First Nations children, aged 6–11. This can be compared to a somewhat similar prevalence (about 17.1%) among non-Aboriginal children, aged 6–12. Lastly,evidence of trauma to one or more incisor teeth was found among 6.9% of adolescents and in25.9% of First Nations adults.Consistent with the findings that First Nations have generally poorer oral health than non-Aboriginal Canadians, treatment needs were much higher among First Nations – 83.1% of dentate First Nations aged 6 years and over needed one or more types of treatment, compared to33.9% of non-Aboriginal Canadians. The survey also found a mismatch between the clinically measured oral health needs and the perceived need for dental treatment among First Nations. For example, 67.7% of parents or caregivers of First Nations preschool children aged 3–5 felt their child needed fillings, when in fact 90.3% were judged by the dentist-examiners to require fillings. Taken together, the findings of the FNOHS indicate that the oral health of First Nations Canadians is poor across a range of clinical oral health indicators. When compared to the findings for non-Aboriginal Canadians, the amount of unmet dental care needs remains a significant problem in First Nations communities. Dental decay continues to be the most prevalent chronic disease among First Nations, particularly in children and adolescents, while coronal and root caries in adults are also of concern. On a more positive note, First Nations adults are retaining more of their natural teeth at levels on par with those of non-Aboriginal adults. The results of this FNOHS study indicate that the oral conditions found among Canadian First Nations are closely associated with various determinants of health, such as age, income,education, and geographic barriers such as the remoteness of communities and also with risk factors, such as regular dental visits and smoking. Since this is the first nationwide survey to collect information on the oral health status of First Nations of all ages, future studies may wish to examine the effects of these health determinants and risk factors on reducing the burden of disease and improving the oral health of Canadian First Nations. In providing essential, baseline data to health professionals, stakeholders and policy makers, we believe the FNOHS marks anew beginning for the oral health of First Nations in Canada, and will serve as a platform to launch oral health care interventions and initiatives that will assist in reducing the disparities that are in evidence on the pages of this report.

FNOHS - National Report

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