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

Inuit

Percentage of Aboriginal People in Canada, 2006

Source: Statistics Canada 2006

USA: 1% [Alaska: 15% New Mexico: 10%]

Population Percentage as Aboriginalby Region

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

Infant Mortality Rates

AI / AN

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

http://oralhealth.circumpolarhealth.org/

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

Cree territory of Northern Quebec:Eeyou IstcheeEeyou Istchee

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.