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.”

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