Tri-national study promotes early intervention strategies to improve indigenous oral health
A first of its kind, a study funded by the Canadian Institutes of Health Research, involving indigenous populations in Canada, Australia and New Zealand is attempting to tackle a growing problem in indigenous populations: early childhood caries.
Causing pain and often requiring treatment under general anaesthetic, early childhood caries also predispose children to ear infections as well as adult caries. Accessing care, meanwhile, often involves flying from remote communities to hospitals in more populated areas – placing a tremendous strain on resources as well as on families.
U of T's Dr. Herenia Lawrence is lead investigator in the massive pan-nation community study that recruited 544 pregnant Canadian First Nations and Métis women, 446 Australian aboriginals and 222 New Zealand Māori.
The study focuses on several intervention strategies: It provided dental care for the pregnant mothers; applied a twice-yearly fluoride varnish to one group of children's teeth from ages 6 months to 2 years (often in remote aboriginal communities water is not fluoridated); and in the second group, varnish at 2 years; and engages mothers in respectful, culturally-relevant discussions to help educate and guide the way to better oral health. The study will follow the children until 3 years of age.
Pre-natal intervention strategies
The study provided several intervention strategies: Working with dental professionals, the researchers provided dental care to the pregnant recruits, as well as motivational interviewing (a culturally-sensitive and respectful form of guidance) and education – which are ongoing throughout the study, and often provided by aboriginal field workers.
The study then provides the children born of these women twice-yearly fluoride treatments and tracks their progress for three years, with the hopes of creating sustainable, culturally relevant prevention strategies.
Currently, the study is collecting data as the children turn two and three. The team of researchers hopes to conclude the study in late 2015-early 2016.
Featured in CIHR's Annual Report (2013-14), the study involves Health Canada, Canadian Institutes for Health Research (CIHR), the Australian Research Centre for Population Oral Health, University of Adelaide, and in Aotearoa, New Zealand, the Raukura Hauora O Tainui, Waikato-Tainui College for Research and Development, as well as the University of Otago. Critical partnerships were also formed with numerous indigenous governments in the three study nations.
In mid-March of this year, Dr. Lawrence presented a segment of the study at the International Association for Dental Research meeting in Boston, MA. Focusing on some of the social determinants of health, the researchers concluded that levels of education, aboriginal identity and racism all played a determinant part in the health of the aboriginal women interviewed.
