A review of dental caries in Australian Aboriginal children: the health inequalities perspective

A review of dental caries in Australian Aboriginal children: the health inequalities perspective

Submitted: 17 December 2011, Revised: 21 July 2012 , Published: 16 October 2012

Full text: View a printable version.

Author(s) : Christian B, Blinkhorn AS.

Introduction: The purpose of this study was to: (1) describe caries prevalence and experience among Aboriginal children; and (2) investigate the disparity in dental caries between Aboriginal and non-Aboriginal Australian children. As background, dental caries is a widespread disease within Aboriginal communities and it has a particularly severe impact on children. In recognition of the extent and severity of this disease, its impact on childhood nutrition, socialisation and schooling, the control of dental caries has been identified as a key indicator in the reduction of disadvantage among Aboriginal communities.
Methods: Medline was the primary database used in the literature search. Other databases included: PubMed, Web of Science and Google Scholar. Australian National and State departments of health websites were also searched for relevant documents. Articles were included in the review if they reported information on either caries prevalence rates or experience scores or both, for Aboriginal children in Australia. Articles were excluded if the study sample was special needs children, and/or caries statistics were reported only for children over 12 years.
Results: Caries prevalence among 6-year-olds in rural non-fluoridated Western Australia in 1963 was 27%, and in 2004 was 85% among 6-year-olds in rural non-fluoridated Queensland. There was a corresponding increase in caries experience scores in this period from 2.07 in 1963 to 6.37 in 2004. National estimates for 2000-2003 reported a caries prevalence of 72% and caries experience (dmft: decayed, missing and filled primary teeth) of 3.68 for 6-year-old Aboriginal Australian children. For 12-year-olds the national estimates were a caries prevalence of 45% and experience (DMFT, Decayed, Missing and Filled Permanent Teeth) of 1.25 (SE=0.07). The magnitude of disparity (relative difference) in 6-year-old caries experience between Aboriginal and non-Aboriginal children was relatively consistent over the period 1983-2007, with Aboriginal children having an approximately two-fold higher caries experience score. The 2000-2003 national estimates for caries experience showed that Aboriginal 6-year-olds had a dmft score that was 2.38 times higher than non-Aboriginal children (3.68 vs 1.54). For the 12-year-olds, the magnitude of disparity was not as marked, though the direction was similar.
Conclusion: Both caries prevalence and experience are higher in the primary dentition. In rural Queensland and the Northern Territory there are high caries rates for both 6- and 12-year-olds. Rural Aboriginal children are generally at a disadvantage compared with their urban counterparts. The magnitude of disparity in caries rates appears to be relatively unchanged over time but there is indication that it may be increasing. This raises the issue of health inequity and the need to fund practical, culturally appropriate and sustainable preventive programs. It also indicates the urgent need for more research on the determinants of oral health inequalities.

Effectiveness of Maternal Counseling in Reducing Caries in Cree Children

Authors: R.L. Harrison, J. Veronneau and B. Leroux

This cluster-randomized pragmatic (effectiveness)
trial tested maternal counseling based on
Motivational Interviewing (MI) as an approach to
control caries in indigenous children. Nine Cree
communities in Quebec, Canada were randomly
allocated to test or control. MI-style counseling
was delivered in test communities to mothers during
pregnancy and at well-baby visits. Data on
outcomes were collected when children were 30
months old. Two hundred seventy-two mothers
were recruited from the 5 test and 4 control communities.
Baseline characteristics were comparable
but not equivalent for both groups. At trial’s
end, 241 children had follow-up. The primary
analysis outcome was enamel caries with substance
loss (d2); no statistically significant treatment
effect was detected. Prevalence of treated
and untreated caries at the d2 level was 76% in
controls vs. 65% in test (p = 0.17). Exploratory
analyses suggested a substantial preventive effect
for untreated decay at or beyond the level of the
dentin, d3 (prevalences: 60% controls vs. 35%
test), and a particularly large treatment effect when
mothers had 4 or more MI-style sessions. Overall,
these results provide preliminary evidence that, for
these young, indigenous children, an MI-style
intervention has an impact on severity of caries
(clinical trial registration ISRCTN41467632).

http://jdr.sagepub.com.proxy2.lib.umanitoba.ca/content/early/2012/09/12/0022034512459758.full.pdf+html

Toothbrushing Habits and Risk Indicators of Severe Early Childhood Caries Among Aboriginal Taiwanese

Abstract

AIM:

The purpose of this study was to investigate the toothbrushing habits and risk indicators among aboriginal children with severe early childhood caries (S-ECC).

METHODS:

This was a cross-sectional purposive sampling study that included 281 aboriginal children aged 2 to 5 years living in remote regions in southern Taiwan. Participant received dental examinations and questionnaires that were completed by caretakers.

RESULTS:

From among the 281 participants, 238 children (84%) presented with S-ECC. A low-frequency toothbrushing habit among the children with S-ECC was associated with caretakers with low-frequency toothbrushing (P = .001). The odds ratio of a child using improper toothbrushing methods having a caretaker with a low brushing frequency was 3.45 (P = .0157).

CONCLUSIONS:

Low-frequency toothbrushing and improper toothbrushing methods were associated with S-ECC. The caretakers’ brushing frequency was a risk indicator associated with the children’s poor oral hygiene.

PMID: 22426556 [PubMed - as supplied by publisher]