Early childhood caries in Indigenous communities

Question 1

What is early childhood caries (ECC)?

Answer 1

Presence of tooth decay involving any primary tooth in a child younger than 6yo

Question 2

What is the most common causative organism for ECC?

Answer 2

Streptococcus mutans

Question 3

What is the causatic triad for ECC?

Answer 3

1. Presence of cariogenic bacteria
2. Diet (exposure to fermentable carbohydrates)
3. Host susceptibility (integrity of tooth enamel)

Question 4

What are some risks of ECC?

Answer 4

1. Associated with respiratory tract infections and AOM in first year of life
2. Resultant altered chewing, eating, and sleep and potential growth restriction due to pain
3. Early tooth loss resulting in speech difficulties & self-esteem issues
4. Malalignment and crowding of permanent teeth with poor bite
5. Increased risk of decay in both primary and permanent dentition
6. Associated with obesity
7. Increased exposure to general anesthesia

Question 5

What is the prevalence of ECC in Canadian Indigenous communities?

Answer 5

> 90%

Question 6

What is the most common outpatient surgical procedure performed in many Canadian pediatric hospitals?

Answer 6

Pediatric dental surgery

Question 7

What are risk factors for ECC?

Answer 7

1. Poverty (52% of Canadian First Nations children live in poverty)
2. Household crowding
3. Family size
4. Poor nutrition
5. Availability of fermentable carbohydrates
6. Prolonged use of bottle or training cups with sugar-containing drinks
7. High frequency of sugary snacks per day
8. Environmental tobacco smoke
9. Poor parental oral hygiene and parental caries

Question 8

What are prevention strategies for ECC?

Answer 8

1. Oral health promotion
2. Regular dental visits
3. Education on the importance of oral health
4. Better oral health screening, dental treatment, and nutrition for pregnant women
5. Community water fluoridation (45% Canadians, <10% of First Nations living on reservations)
6. > 4 Topical applications of fluoride varnish between 9-24mo
7. Fluoridated toothpaste use BID
8. Consider fluoride supplementation (weak evidence)
9. Use of dental sealants

Question 9

At what age should comprehensive dental health care through dentists and an oral health examination occur?

Answer 9

Within six months of the first tooth eruption

OR by 12mo

Question 10

What are the recommendations for oral health?

Answer 10

1. Utilize motivational interviewing and anticipatory guidance for caregivers of infants and children on oral hygiene and diet
2. Promote supervised use of flouridated toothpaste in all high risk children after the first tooth has erupted
3. Community health nurses, family physicians, or paediatricians should perform oral health screening during child health assessments and provide referrals as needed to dental health providers
4. Provide women with preconception and prenatal screening for oral health, anticipatory guidance for oral health and hygiene, and referral for dental care if required
5. Ensure that all Indigenous children have access to the series of fluoride varnish
6. Ensure that all Indigenous children have access to an assessment to determine the need for sealant placement on deep grooves and fissures.

Question 11

What amount of toothpaste should be used?

Answer 11

Green pea sized amount in children

Smear or rice sized amount in infants

Question 12

What are some other recommendations regarding dental care access?

Answer 12

1. Consider the roles of other dental and primary health care providers
2. Provide adequate cultural competency training
3. Oral health training should be incorporated into pediatric and family medicine training programs

Question 13

What are some recommendations regarding advocacy for ECC?

Answer 13

1. Indigenous communities should be provided with information regarding water fluoridation, and opportunities for fluoridation (capital and maintenance costs, and training for operators) of the community drinking water should be advocated within and for Indigenous communities.
2. Appropriate funding for access to fluoride varnish programs as well as for other oral health prevention and treatment services to Indigenous populations should be advocated

Question 14

What are recommendations regarding research and ECC?

Answer 14

Additional community-based participatory research on the epidemiology, prevention, management and microbiology of ECC in Indigenous communities and ECC prevention projects should be supported.