Children's Oral Health Initiative: workers' perspectives on its impact in First Nations communities. / Initiative en santé buccodentaire des enfants : le point de vue des intervenants quant à ses effets dans les communautés des Premières Nations.

INTRODUCTION: Since 2004, the Children's Oral Health Initiative (COHI) has been working in many First Nations and Inuit communities in Canada to address oral health disparities, specifically early childhood caries (ECC). The COHI community-based approach improves early childhood oral health (ECOH) by balancing prevention with minimally invasive dentistry. The goal is to reduce the burden of oral disease, mainly by minimizing the need for surgery. We investigated program success in First Nations communities in the province of Manitoba, from the perspective of COHI staff. METHODS: First Nations community-based dental therapists and dental worker aides participated in three focus groups and an in-depth semistructured interview. The collected data were thematically analyzed. RESULTS: Data from 22 participants yielded converging and practitioner-specific themes. Participants reported that dental therapists and dental worker aides provide access to basic oral care in their communities including oral health assessments, teeth cleaning, fluoride varnish applications and sealants. The participants agreed that education, information sharing and culturally appropriate parental engagement are crucial for continuous support and capacity building in the community programs. Low enrolment, difficulty accessing homes and getting consent, limited human resources as well as lack of educational opportunities for dental worker aides were identified challenges. CONCLUSION: Overall, the participants reported that the COHI program positively contributes to ECOH in First Nations communities. However, increased community-based training for dental workers, community awareness about the program, and engagement of parents to facilitate culturally appropriate programming and consent processes are critical to improving program outcomes.

An investigation of data from the first year of the interim Canada Dental Benefit for children <12 years of age.

Introduction: In 2022, the federal government announced a commitment of $5.3B to provide dental care for the uninsured, beginning with children <12 years of age. Now referred to as the Interim Canada Dental Benefit (CDB), the program targets those <12 years of age from families with annual incomes <$90,000 without private dental insurance. The purpose of this study was to review federal data from the Government of Canada on public uptake and applications made to the Canada Revenue Agency (CRA) during the first year of the Interim CDB. Methods: Data for the first year of the Interim CDB (up to June 30, 2023) were accessed from the Government of Canada Open Data Portal through Open Government Licence-Canada. Rates of children receiving the Interim CDB per 1,000 were calculated by dividing the number of beneficiaries by the total number of children 0-11 years by province or territory, available from Statistics Canada for the year 2021. Results: During the first year of the program, a total of 204,270 applications were approved, which were made by 188,510 unique applicants for 321,000 children <12 years of age. Over $197M was distributed by the CRA. Overall, the national rate for receiving the Interim CDB was 67.8/1,000 children. Ontario (82.5/1,000), Manitoba (77.1/1,000), Nova Scotia (73.4/1,000), and Saskatchewan (72.3%), all had rates of children with the Interim CDB above the national rate. Conclusions: Data from the first year of the Interim CDB suggests that this federal funding is increasing access to care for children <12 years by addressing the affordability of dental care. Governments and the oral health professions need to address other dimensions of access to care including accessibility, availability, accommodation, awareness, and acceptability of oral health care.

Early childhood oral health promotion for First Nations and Métis communities and caregivers in Manitoba. / Promotion de la santé buccodentaire des jeunes enfants auprès des collectivités et des fournisseurs de soins des Premières Nations et des Métis du Manitoba.

INTRODUCTION: Early childhood caries is a public health concern, and the considerable burden exhibited by Indigenous children highlights the oral health inequities across populations in Canada. Barriers include lack of access to oral health care and lack of culturally appropriate oral health promotion. The purpose of this study was to determine where and how First Nations and Métis parents, caregivers and community members learn about caring for young children's oral health, and what ideas and suggestions they have on how to disseminate information and promote early childhood oral health (ECOH) in Indigenous communities. METHODS: Sharing circles and focus groups engaged eight groups of purposively sampled participants (n = 59) in four communities in Manitoba. A grounded theory approach guided thematic analysis of audiorecorded and transcribed data. RESULTS: Participants said that they learned about oral health from parents, caregivers and friends, primary care providers, prenatal programs, schools and online. Some used traditional medicines. Participants recommended sharing culturally appropriate information through community and prenatal programs and workshops; schools and day care centres; posters, mailed pamphlets and phone communication (calls and text messages) to parents and caregivers, and via social media. Distributing enticing and interactive oral hygiene products that appeal to children was recommended as a way to encourage good oral hygiene. CONCLUSION: Evidence-based oral health information and resources tailored to First Nations and Métis communities could, if strategically provided, reach more families and shift the current trajectory for ECOH.

Prenatal, Maternal, and Early Childhood Factors Associated with Dental General Anesthesia to Treat Severe Early Childhood Caries.

Purpose: The purpose of this study was to identify prenatal, maternal, and early childhood factors associated with surgery to treat severe-early-childhood-caries (S-ECC) using general anesthesia (GA). Methods: A case-control study using administrative health care and social services data examined factors associated with surgery under GA. Subjects included children <72 months old undergoing GA for caries between fiscal years 2005/06 and 2010/11. Controls were children of the same age randomly chosen from the general population. Prenatal, birth, child, and maternal and family characteristics and use of health services were considered. Adjusted odds ratios (OR) and 95 percent confidence intervals (95% CI) were calculated using logistic regressions. Results: There were 16,015 cases reviewed. Variables with a higher likelihood of surgery included: child's age (1.02 (OR), 1.02 to 1.02 (95% CI)); large-for-gestational-age (1.24, 1.19 to 1.30); young maternal age at birth (1.47, 1.04 to 2.07); lower income quintiles (3.24, 3.04 to 3.45); receiving income assistance (1.61, 1.54 to 1.69); more hospital visits (1.17, 1.15 to 1.18); and a history of being "in care/foster care" (1.11, 1.04 to 1.19). Variables with less likelihood of surgery included: initiating breastfeeding before discharge (0.69, 0.67 to 0.72); low five-minute Apgar score (0.88, 0.79 to 0.97); being female (0.96, 0.93 to 0.99); mothers ≥ 30 years old at birth (0.86, 0.82 to 0.89); urban dwellers (0.47, 0.45 to 0.49); and higher physician visits (0.995, 0.99 to 1.00). Conclusion: Understanding risk factors associated with surgery for S-ECC may provide clues about promising prenatal and early childhood oral health interventions.

The Oral Health of Preschool Children of Refugee and Immigrant Families in Manitoba.

INTRODUCTION: Children of newcomers to Canada have been identified as at moderately high risk for developing early childhood caries (ECC). The purpose of this study was to investigate the oral health of preschool children of refugee and immigrant families in Winnipeg. METHODS: Children < 72 months of age and their parent or primary caregiver were recruited through several newcomer settlement agencies, dental clinics and community programs. Parents and caregivers completed a short questionnaire with the assistance of a research team member. Children underwent a dental examination. Results of the questionnaire were combined with those of the clinical examination and subjected to statistical analysis. RESULTS: We recruited 211 children. Their mean age was 40.2 ± 15.4 months, and 54.0% were boys. Overall, 45.5% of the children had ECC and 31.8% had severe ECC (S-ECC). The mean decayed, missing and filled teeth (dmft) score was 2.2 ± 3.8 (range 0-19), while the mean decayed, missing, filled surfaces (dmfs) score was 4.8 ± 11.0 (range 0-63). Infant dental enucleation was observed in 6 children. Logistic regression analyses showed that increasing age, the presence of debris on teeth, parents believing their child has dental problems and the presence of enamel hypoplasia were significantly and independently associated with ECC and S-ECC (p ≤ 0.05). CONCLUSIONS: ECC is prevalent in children of newcomer families in Manitoba. These data will inform advocacy efforts to improve access to dental care and tailor early childhood oral health promotion and ECC prevention activities for refugees and recent immigrants.

Parents' and caregivers' perspectives on the Manitoba Dental Association's Free First Visit program.

OBJECTIVES: The Free First Visit (FFV) program was implemented in 2010 to promote early preventive dental visits for children <36 months of age in Manitoba, Canada. The purpose was to understand parents' and caregivers' perspectives on the program. METHODS: Three focus groups with 21 participants were conducted in Winnipeg, Canada using an interview guide in this qualitative study. RESULTS: Most participants were aware of the FFV program and the appropriate age for a child's first visit. Almost all agreed with the recommendation to see a dentist by one year of age. Some reported that general dentists advised them to bring their child after three years of age. Participants appreciated that the program was free, and some noted that the program made them aware of the appropriate age for a first visit. About half of the participants had taken their child for a FFV. Reasons for not taking their child for a FFV included: nothing wrong with their child's teeth, they believed there was still time as their child was not three years old, they had government insurance, child's temperament, and feelings of apathy. There were mixed opinions regarding whether the program was helping those who needed it the most. CONCLUSIONS: The majority of participants liked the FFV program and believed that it should continue. Parents would benefit from further education and encouragement to seek oral care for their child by age one. Some general dentists may need further training and skills to meet the recommendations for first dental visits.

DENTISTS' PERSPECTIVES ON THE MANITOBA DENTAL ASSOCIATION'S FREE FIRST VISIT PROGRAM.

BACKGROUND: In 2010, the Manitoba Dental Association implemented the Free First Visit (FFV) program to provide access to dental screenings for children under 3 years of age and promote the concept of the age 1 dental visit. In this article, we report on dentists' views of the program. METHODS: This qualitative study included 3 focus groups held in Winnipeg, Canada. An interview guide was developed to structure discussions. RESULTS: Thirty dentists participated. They were extremely supportive of the FFV program and its continuation. Promoting early visits and providing parents with anticipatory guidance were some reasons dentists participated. The most common reason for not participating was that dentists were already providing free dental care for children. Dentists viewed the goals of the program as increasing public awareness of the importance of early dental visits, establishing dental homes, educating parents, identifying early signs of caries and increasing children's level of comfort in the dental clinic. They indicated that the FFV program prompted some parents to take their children earlier than they might have otherwise. They said that most FFVs were provided to families who were already part of their practice. According to participating dentists, most parents were unaware of the FFV program and did not know about the age 1 visit recommendation. Dentists recommended that the FFV program concentrate on promoting the first visit by age 1 message with the free component as a secondary message. Participants recommended increasing general dentists' involvement in the program as most FFVs are currently provided by pediatric dentists. CONCLUSIONS: Most dentists participating in this study were supportive of the FFV program and advocated its continuation in Manitoba.

Evaluating the impact of a community developed collaborative project for the prevention of early childhood caries: the Healthy Smile Happy Child project.

INTRODUCTION: To determine the effectiveness of the Healthy Smile Happy Child (HSHC) project, a community-developed initiative promoting early childhood oral health in Manitoba, Canada. Specific aims were to assess improvements in caregiver knowledge, attitudes, and behaviours relating to early childhood oral health, and the burden of early childhood caries (ECC) and severe ECC (S-ECC). METHODS: A serial cross-sectional study design was selected to contrast findings following the Healthy Smile Happy Child (HSHC) campaign in four communities with the previous baseline data. One community was a remote First Nation in northern Manitoba and another was a rural First Nation in southern Manitoba. The other two communities were urban centres, one of which was located in northern Manitoba. A community-development approach was adopted for the project to foster community solutions to address ECC. Goals of the HSHC program were to promote the project in each community, use existing community-based programs and services to deliver the oral health promotion and ECC prevention activities, and recruit and train natural leaders to assist in program development and to deliver the ECC prevention program. The HSHC coordinator worked with communities to develop a comprehensive list of potential strategies to address ECC. Numerous activities occurred in each community to engage members and increase their knowledge of early childhood oral health and ultimately lead them to adopt preventive oral health practices for their young children. Children under 71 months of age and their primary caregivers participated in this follow-up study. A -value ≤0.05 was statistically significant. RESULTS: 319 children (mean age 38.2±18.6 months) and their primary caregivers participated. Significant improvements in caregiver knowledge and attitudes were observed following the HSHC campaign, including that baby teeth are important (98.8%), that decay involving primary teeth can impact on health (94.3%), and the importance of a dental visit by the first birthday (82.4%). Significantly more respondents indicated that their child had visited the dentist (50.2%) and had started brushing their child's teeth (86.7%) when compared to baseline. Overall, 52.0% had ECC, 38.6% had S-ECC. The mean deft score was 3.85±4.97 (range 0-20). There was no significant change is ECC prevalence between the follow-up and baseline investigations. However, age-adjusted logistic regression for S-ECC in this follow-up study revealed a significant reduction in prevalence compared with the baseline study (=0.021). Similarly, age-adjusted Poisson regression revealed that there were significant reductions in both the decayed teeth and decayed, extracted and filled teeth scores between follow-up and baseline study periods (0.016 and .0001, respectively). CONCLUSIONS: Follow-up study results suggest that the HSHC initiative may have contributed to improvements in caregiver knowledge, attitudes, and behaviours towards early childhood oral health and subsequently modest yet statistically significant reductions in caries scores and the prevalence of S-ECC.

Dentist's views on a province-wide campaign promoting early dental visits for young children.

INTRODUCTION: The Canadian Dental Association recommends that children have their first visit to a dental professional no later than 12 months of age. In 2010, the Manitoba Dental Association launched the Free First Visit (FFV) program to increase access to early visits in the province. The purpose of the study reported here was to survey dentists about their views on the FFV program and to gain an understanding of their attitudes and practice patterns relating to the oral health of infants and toddlers and first dental visits. METHODS: A survey was mailed to registered general and pediatric dentists in Manitoba according to a modified Dillman methodology. Dentists were asked about their views on the FFV, their knowledge of early childhood oral health and the timing of first dental visits. Descriptive statistics, bivariate analyses and logistic regression analyses were performed. A p value of 0.05 or less was considered significant. RESULTS: The overall response rate was 63.2% (375 eligible responses out of 593 surveys mailed). The majority of respondents were men (255/373 [68.4%]), and most respondents were general dentists (355/372 [95.4%]). A total of 63.5% (231/364) felt that the FFV program improved access to care, 64.6% (223/345) believed that public awareness of young children's oral health has increased, and 76.2% (266/349) thought that the FFV initiative should continue past the planned end date of March 31, 2013. On average (± standard deviation), respondents thought that the first dental visit should occur at 18.1 ± 10.0 months, but in their practices, they actually recommended a slightly older age (18.9 ± 10.4 months). Compared with results from a previous survey, conducted in 2005, dentists who responded to this survey recommended that children have their first visit at a significantly younger age. A greater proportion of dentists reported seeing children 12-23 months of age in their practices than in the past (81.9% vs. 73.7%). CONCLUSIONS: A majority of dentists who responded to the survey approved of the FFV program and thought it should continue. Although these dentists recommended early first dental visits, the average age recommended by respondents was 6 months later than the target age of 12 months. It appears that, over time, dentists are becoming more aware of prevention and management techniques relating to infants and toddlers.