Academic journal article Canadian Journal of Public Health

The Children's Oral Health Initiative: An Intervention to Address the Challenges of Dental Caries in Early Childhood in Canada's First Nation and Inuit Communities

Academic journal article Canadian Journal of Public Health

The Children's Oral Health Initiative: An Intervention to Address the Challenges of Dental Caries in Early Childhood in Canada's First Nation and Inuit Communities

Article excerpt

Approximately 4% (1.4 million people) of the Canadian population self-identify as being of Aboriginal descent. Of these individuals, over 314,000 live in 636 communities, also referred to as federal reserves, located on lands held in trust for bands by the Crown.1 Aboriginal people living in these small, geographically isolated communities do not have equitable access to the full range of health services enjoyed by individuals living in southern Canada.2,3 Geographic and political obstacles coupled with workforce constraints perpetuate these inequities and make oral health care delivery particularly challenging.2 As a consequence, Aboriginal children bear a disproportionately higher burden of dental disease than other Canadian children, despite the availability of federally funded reimbursement for dental care.

Both the 2009 Inuit Oral Health Survey3 and the 2010 First Nations Oral Health Survey4 demonstrated that significant oral health disparities exist between indigenous and non-indigenous Canadians. First Nations and Inuit (FN/I) children were more likely to experience a greater prevalence of dental caries (tooth decay) as well as higher levels of untreated dental caries than other Canadians. Of 3-5-year-old children, 85% had experienced dental decay. The average number of decayed, missing and filled (dmft) primary teeth in this age group was 8.22, with nearly half (49%) of decayed teeth untreated. Among 6-11-year-old children, 80% of First Nations children and 71% of Inuit children had experienced dental caries in their primary dentition compared with 48% of other Canadian children.

In 2004, through the joint effort of Health Canada and FN/I communities, an innovative community-based preventive program - the Children'sOralHealthInitiative(COHI)- was started in an effort to reduce the prevalence of dental caries in early childhood.5,6 The objective of this paper is to describe the COHI intervention and its implementation, and to present evidence that it has improved access to preventive dental services for FN/I children living on federal reserves and in remote Northern communities.

THE INTERVENTION: THE CHILDREN'S ORAL HEALTH INITIATIVE

Description

COHI specifically aims to shift the emphasis from a primarily restorative/surgical treatment-based approach in managing dental caries (i.e., restorations and extractions) to a more balanced approached with a community-based focus on prevention and non-surgical care.7 COHI was integrated with the existing Health Canada dental public health infra-structure operated by dental therapists and dental hygienists. Therefore, COHI has been implemented primarily in communities located on federal reserves and the Northern Region (Northwest Territories, Yukon, Nunavut). The program is directed at four target groups: 1) pre-school children, birth to 4 years of age; 2) school children, 5-7 years of age; 3) parents/primary caregivers; and 4) pregnant women. Dental caries has a multifactorial etiology, which includes social determinants of health (nutrition, oral self-care), as well as biological determinants of health (cariogenic bacteria). Therefore, a combination of preventive dental services has been applied for a population-level approach to controlling dental caries in children. COHI utilizes preventive approaches that are supported by scientific evidence and represent recognized standards of care in controlling dental caries. They include fluoride varnish, fissure sealants, oral health counselling and atraumatic restorative therapy (ART), which uses a glass ionomer biomaterial to stabilize active dental caries.

Generally, the services of the program are linked to the school year. Either the dental therapist or dental hygienist completes the screening of COHI-eligible children in the fall and performs the first fluoride varnish application. Over the course of the programmatic year, further preventive services are delivered, including additional fluoride varnishes, sealant application and treatment of carious lesions, as necessary, with ART. …

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