Oral health is an integral component of physical, mental and social wellbeing. It has a primary role in preventing tooth loss and subsequent malnutrition. Poor oral health can cause pain and diminished quality of life, and contribute to diabetes, cardiovascular disease and lung disease. Arguably as important, is its effect through crooked and poorly positioned teeth, on the self esteem and mental wellness of children, youth and adults. First Nations have high dental needs, as reported in the First Nations Regional Longitudinal Health Survey (RHS) and other surveys. The reasons for poor oral health is thought to be associated with the socioeconomic environment, though a myriad of psychosocial, economic, environmental and political factors that can influence an individual_s stress levels and lifestyle choices in dental hygiene and diet. Geographic location can also limit access to timely dental care needed to prevent the exacerbation of cavities and periodontal disease. Compared to the general Canadian population, First Nations are less likely to access dental services. On a per capita basis, dental costs are 55% of what the Canadian population spends on dental services. The introduction of the Children_s Oral Health Initiative (COHI) to supplement Primary Health Care and Public Health (PHCPH) dental providers in First Nations communities has increased access by children to dental hygiene and oral health promotion services, and raised the percentage of 0-4 year old children who have caries free teeth. However, the severity of need remains as over one quarter of children less than five years old who receive services from PHCPD dental providers had eight or more decayed teeth in 2008/09. Early childhood caries is a serious health issue among First Nations children, and has been estimated in this report to cost over $16 million annually to federal, provincial and territorial health systems. Other issues facing First Nations as they seek to improve their oral health include the Non Insured Health Benefits (NIHB) Program policy on extracting posterior second molar teeth (unless needed for stable occlusion) rather than using tooth saving measures, the limitations of orthodontic care to include only severe and functionally handicapping malocclusions, the lack of COHI services in many First Nations communities, administrative barriers which discourage dentists from participating in the NIHB Program, and limited access of communities to dental hygienists and dental therapists.