Rosamund Harrison

Oral Health of Indigenous Children and the Influence of Early Childhood Caries on Childhood Health and Well-being

Dental caries in Indigenous children is a child health issue that is multifactorial in origin and strongly influenced by the determinants of health. The evidence suggests that extensive dental caries has an effect on health and well-being of the young child. This article focuses on early childhood caries as an overall proxy for Indigenous childhood oral health because decay during early life sets the foundation for oral health throughout childhood and adolescence. Strategies should begin with community engagement and always include primary care providers and other community health workers.

Understanding Parents' Oral Health Behaviors for Their Young Children

Young children with extensive dental decay often require a general anesthetic (GA) to enable dental treatment. The purpose of this study was to develop a grounded theory to help our understanding of the processes that influence parental adoption of dentally healthy behaviors following the experience of their childs “dental general anesthetic.” Twenty six interviews were conducted. Data were analyzed and a conceptual model was generated. Overall, the dental GA experience had an immediate, but short-lived, impact on parental behavior change. Parents had difficulty over time maintaining these behaviors. Social influences, family context, and parenting strategies were the key categories that influenced parental behavior change; however, parenting strategies occupied the central position in the model. Cultural beliefs, actions of dental professionals, and media/advertising were some of the identified barriers to behavior change. Those parents who were more confident in their ability to successfully carry out dentally healthy practices were more likely to maintain them over time.

Effectiveness of Maternal Counseling in Reducing Caries in Cree Children

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).

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

OBJECTIVE: The objective of the Children’s Oral Health Initiative (COHI) is to increase access to preventive oral health services provided to First Nations and Inuit (FN/I) children living on federal reserves and in remote communities.PARTICIPANTS: COHI targets preschool children; 5–7-year-olds; pregnant women; and parents/caregivers in FN/I communities.SETTING: The program was piloted in 2004 by Health Canada and is potentially available to all FN/I communities. However, the community must consent to the program’s implementation and agree to support a community member to be trained as a COHI aide.INTERVENTION: Dental therapists and hygienists screen eligible children, apply fluoride varnish and sealants to children’s teeth, and stabilize active dental caries with glass ionomer. An innovation was the development of a community oral health worker, the COHI Aide. The COHI Aide is a community member who serves as an advocate for preventive oral health in the community and provides instruction to children, parent/caregivers and expectant mothers in preventing dental caries.RESULTS: COHI was piloted in 41 communities in 2004. By 2014, the program had expanded to 320 FN/I communities, which represents 55% of all eligible FN/I communities. In 2012, 23,085 children had received COHI preventive oral health services.CONCLUSION: The results demonstrate COHI’s success as a preventive oral health care delivery model in remote communities. Implementation and delivery of preventive oral health services has been enhanced by the sustained presence of a community-based COHI Aide.RésuméOBJECTIF: L’Initiative en santé buccodentaire des enfants (ISBE) vise à élargir l’accès aux services de santé buccodentaire préventifs offerts aux enfants inuits et des Premières Nations (IPN) vivant dans les réserves fédérales et les communautés éloignées.PARTICIPANTS: L’ISBE cible les enfants d’âge préscolaire, les enfants de 5 à 7 ans, les femmes enceintes, et les parents et aidants vivant dans les communautés IPN.LIEU: Mis à l’essai par Santé Canada en 2004, le programme est potentiellement disponible dans toutes les communautés IPN. Toutefois, la communauté doit consentir à la mise en œuvre du programme et accepter de soutenir la formation d’un membre de la communauté comme représentant ou représentante en santé dentaire pour l’ISBE.INTERVENTION: Des thérapeutes et des hygiénistes dentaires filtrent les enfants admissibles, appliquent un vernis fluoré et un scellant sur les dents des enfants et stabilisent les caries dentaires actives avec du verre ionomère. L’une des innovations du programme a été la création du poste de représentant ou représentante en santé dentaire pour l’ISBE. Cette personne plaide en faveur de la santé buccodentaire préventive dans la communauté et donne des instructions aux enfants, aux parents ou aidants et aux femmes enceintes sur la prévention de la carie dentaire.RÉSULTATS: L’ISBE a été mise à l’essai dans 41 communautés en 2004. Dix ans plus tard, l’initiative était présente dans 320 communautés IPN, soit 55% des communautés IPN admissibles. En 2012, 23 085 enfants avaient reçu des services de santé buccodentaire préventifs de l’ISBE.CONCLUSION: Ces résultats indiquent que l’ISBE est un modèle efficace de prestation de soins buccodentaires préventifs dans les communautés éloignées. La mise en œuvre et la prestation des services de santé buccodentaire préventifs sont rehaussées par la présence continue d’un représentant ou d’une représentante en santé dentaire pour l’ISBE.

Motivational interviewing (MI) compared to conventional education (CE) has potential to improving oral health behaviors.

Article Title and Bibliographic Information Motivational interviewing in improving oral health: a systematic review of randomized controlled trials. Gao X, Lo ECM, Kot SCC, Chan KCW. J Periodontol 2014;85(3):426-437. Reviewer Rosamund Harrison, DMD, MS, MRCD(C) Purpose/Question Is motivational interviewing more effective than conventional dental education in changing oral health behaviors? Source of Funding Government: General Research Fund (#106120135; HKU 766012M), granted by the Research Grants Council of Hong Kong Type of Study/Design Systematic review Level of Evidence Level 1: Good-quality, patient-oriented evidence Strength of Recommendation Grade Grade B: Inconsistent or limited-quality patient-oriented evidence

Community dental clinics: providers' perspectives.

OBJECTIVES Not-for-profit community dental clinics attempt to address the inequities of oral health care for disadvantaged communities, but there is little information about how they operate. The objective of this article is to explain from the perspective of senior staff how five community dental clinics in British Columbia, Canada, provide services. METHODS The mixed-methods case study included the five not-for-profit dental clinics with full-time staff who provided a wide range of dental services. We conducted open-ended interviews to saturation with eight senior administrative staff selected purposefully because of their comprehensive knowledge of the development and operation of the clinics and supplemented their information with a years aggregated data on patients, treatments, and operating costs. RESULTS The interview participants described the benefits of integrating dentistry with other health and social services usually within community health centres, although they doubted the sustainability of the clinics without reliable financial support from public funds. Aggregated data showed that 75% of the patients had either publically funded or no coverage for dental services, while the others had employer-sponsored dental insurance. Financial subsidies from regional health authorities allowed two of the clinics to treat only patients who are economically vulnerable and provide all services at reduced costs. Clinics without government subsidies used the fees paid by some patients to subsidize treatment for others who could not afford treatment. CONCLUSIONS Not-for-profit dental clinics provide dental services beyond pain relief for underserved communities. Dental services are integrated with other health and community services and located in accessible locations. However, all of the participants expressed concerns about the sustainability of the clinics without reliable public revenues.

The perceptions of first nation participants in a community oral health initiative

ABSTRACT The Children’s Oral Health Initiative (COHI) is a federally funded community-based preventive dental program for children and their caregivers living in geographically isolated Canadian Aboriginal communities. The goal of the program is to improve access to preventive dental services for children of 0–7 years of age. It utilises community health workers in collaboration with dental therapists to promote and deliver the program. Almost half of the province of Manitoba’s (n=27) First Nations communities have implemented COHI since 2005. The objective of this investigation was to explore the opinions of COHI from the perspective of community members whose children had participated in the program. Purposeful selection identified caregivers of enrolled children for a semi-structured interview. The targeted caregivers had children who met at least one of the following criteria: (1) 0–2 years old; (2) 5–7 years old; (3) had two or more children either currently or formerly enrolled in COHI. Six open-ended questions guided the interview process. Content analysis was used to code transcripts and identify themes. One hundred and forty-one interviews were completed in 13 communities. Participants defined good oral health as the absence of dental cavities, which reflects a Western biomedical model of disease. The local, community-based nature of COHI was viewed as essential to its success in increasing access to preventive dental services and improving children and caregivers’ oral health knowledge and behaviours. In conclusion, a local, community-based oral health prevention programme is perceived as having a beneficial effect on children and caregivers’ oral health knowledge and behaviours. However, oral health preventive messages need to be further integrated into traditional Aboriginal holistic models of wellness.

504 EVALUATION OF AN ORAL HEALTH PROMOTION PROGRAM IN A REMOTE FIRST NATIONS COMMUNITY

Background Poor oral hygiene is associated with an increased risk of diabetes, coronary artery disease and premature labor; all major issues for First Nations populations. For over 3 years our university has shared a collaborative health prevention and education partnership with a remote Tsimshian community in Northern British Columbia promoting oral health amongst their children and providing unique educational opportunities for pediatric residents. Method After an extensive dialogue between the Band Council and our Residency Training Committee, a school-based program centered on brushing, flossing, and topical fluoride began. Pre-intervention assessment and training were done jointly by the departments of Dentistry and Pediatrics. Residents and a faculty supervisor stay in the community every 2 months to contribute ongoing support, age-appropriate educational modules for the children, and collaborative health care services (acute and preventive) with the Health Director and the local nursing station. Multidisciplinary evaluation is ongoing and includes oral, general health, community awareness and involvement and educational parameters. Results 80 children (100% of those of school age) were enrolled. Initially the majority of children had evidence of poor oral health, and knowledge and practices were limited. Less than 20% of the children were decay free, and the mean decay missing filled score (DMFS) for preK children was 9.9 (SD 12.1); for school aged children (k–12) the DMFS score was 5.7 (SD 6.2). One year later, 41% of the children enrolled in the study have no new cavities. Currently, all the children in the community remain enrolled in the program. The results are seen as significant by the community. 45 pediatric trainees and 18 faculty members have spent time in the community; our trainees evaluate their involvement as an educational highlight in their training; and the program has received awards from Aboriginal and University agencies. Conclusion The ‘Brighter Smiles program’ has synergistically combined the culture and knowledge of a vibrant First Nation’s community with those of a University Residency program committed to advocacy for child health and innovative resident education. Key attitudes have changed for both groups and a measurable improvement in oral health has occurred.