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U.S. and Canadian Pediatricians Fight Tooth Decay Among Indigenous Children

Early childhood tooth decay is one of the most common infectious diseases found in indigenous children in the United States and Canada, resulting in additional adverse health effects.

In a new policy statement, "Early Childhood Caries in Indigenous Communities," in the June 2011 issue of Pediatrics (published online Monday, May 30), the American Academy of Pediatrics (AAP) and the Canadian Paediatric Society (CPS) provide recommendations for the prevention of dental disease in young children and pregnant women, through collaboration with primary health care providers, policy makers, and public health practitioners in indigenous communities.

Good oral health for mothers and their babies should be promoted during the prenatal period and continue as children enter school. Unfortunately, in some Canadian indigenous communities, more than 90 percent of children have caries (tooth decay), and the prevalence may be increasing. A survey of 2,633 American Indian and Alaskan Native children between 2 and 5 years of age determined that 68 percent had untreated early childhood caries - more than three times greater than the rate found in the general population.

"The influence of early childhood caries on overall childhood health and well being goes well beyond the mouth, and many of our indigenous children have not benefitted fully from the many advances to improve oral health in North American children," said James Irvine, MD, FRCPC, co-author of the statement. "In fact, there are remarkable similarities in health issues and living circumstances of indigenous children in the U.S. and Canada. This position statement places emphasis on the reduction in health disparities in both the U.S. and Canada."

The statement stresses the need for indigenous children to have access to early oral health care. However, the severity of dental disease and the barriers to care in these communities require special consideration.

"Many physicians continue to view early childhood caries as a dental problem to be treated by dentists," noted Steve Holve, MD, FAAP, another co-author. "We want to emphasize that early childhood caries is an infectious disease, knowing that infectious diseases are problems in which pediatricians and primary care providers are experts. The skills of our dental colleagues are highly valued, but we hope to shift the focus of treatment for early childhood caries to primary care providers and preventive measures such as topical fluoride varnishes."

AAP and CPS recommendations include:

  • Use well-child visits to educate parents and caregivers of infants and children on proper oral hygiene and diet.
  • Promote supervised use of fluoridated toothpaste in all indigenous and other high-risk children after the first tooth has erupted.
  • Provide pregnant indigenous women access to prenatal screening for dental health, and referral for dental care if needed.
  • Ensure that indigenous children have access to fluoride varnish programs and other oral health prevention and treatment services.

"AAP and CPS statements are read not only by pediatricians, but also by family physicians, nurse practitioners, community health nurses, physician assistants, and other health professionals," said Dr. Irvine. "The role that primary care pediatricians and other providers play in various indigenous communities in North America place them in a unique position to complement the work of our dental health professional colleagues."

5/30/2011 12:00 AM
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