First Nations and Metis peoples' access and equity challenges with early childhood oral health: a qualitative study

doi:10.1186/s12939-021-01476-5

. 2021 Jun 7;20(1):134.

doi: 10.1186/s12939-021-01476-5.

First Nations and Metis peoples' access and equity challenges with early childhood oral health: a qualitative study

Grace Kyoon-Achan^{1

2

3

4}, Robert J Schroth^{5

6

7

8

9}, Daniella DeMaré^{10

11}, Melina Sturym^{10

11}, Jeannette M Edwards¹², Julianne Sanguins¹³, Rhonda Campbell¹⁴, Frances Chartrand¹³, Mary Bertone¹⁰, Michael E K Moffatt^{10

15}

Affiliations

¹ Department of Preventive Dental Science, Dr. Gerald Niznick College Of Dentistry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, R3E 3P4, Canada. Grace.KyoonAchan@umanitoba.ca.
² Children's Hospital Research Institute of Manitoba, Winnipeg, Canada. Grace.KyoonAchan@umanitoba.ca.
³ Ongomiizwin Research - Indigenous Institute of Health and Healing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, R3E 3P4, Canada. Grace.KyoonAchan@umanitoba.ca.
⁴ Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada. Grace.KyoonAchan@umanitoba.ca.
⁵ Department of Preventive Dental Science, Dr. Gerald Niznick College Of Dentistry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, R3E 3P4, Canada. Robert.Schroth@umanitoba.ca.
⁶ Children's Hospital Research Institute of Manitoba, Winnipeg, Canada. Robert.Schroth@umanitoba.ca.
⁷ Ongomiizwin Research - Indigenous Institute of Health and Healing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, R3E 3P4, Canada. Robert.Schroth@umanitoba.ca.
⁸ Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada. Robert.Schroth@umanitoba.ca.
⁹ Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada. Robert.Schroth@umanitoba.ca.
¹⁰ Department of Preventive Dental Science, Dr. Gerald Niznick College Of Dentistry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, R3E 3P4, Canada.
¹¹ Children's Hospital Research Institute of Manitoba, Winnipeg, Canada.
¹² Shared Health Manitoba, 1610-155 Carlton St, Winnipeg, MB, R3C 3H8, Canada.
¹³ Health & Wellness Department, Manitoba Metis Federation, 150 Henry Avenue, Winnipeg, MB, R3B 0J7, Canada.
¹⁴ First Nations Health and Social Secretariat of Manitoba, 600-275 Portage Ave, Winnipeg, MB, R3B 2B3, Canada.
¹⁵ Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.

PMID: 34098968
PMCID: PMC8183050
DOI: 10.1186/s12939-021-01476-5

First Nations and Metis peoples' access and equity challenges with early childhood oral health: a qualitative study

Grace Kyoon-Achan et al. Int J Equity Health. 2021.

. 2021 Jun 7;20(1):134.

doi: 10.1186/s12939-021-01476-5.

Authors

Affiliations

¹ Department of Preventive Dental Science, Dr. Gerald Niznick College Of Dentistry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, R3E 3P4, Canada. Grace.KyoonAchan@umanitoba.ca.
² Children's Hospital Research Institute of Manitoba, Winnipeg, Canada. Grace.KyoonAchan@umanitoba.ca.
³ Ongomiizwin Research - Indigenous Institute of Health and Healing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, R3E 3P4, Canada. Grace.KyoonAchan@umanitoba.ca.
⁴ Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada. Grace.KyoonAchan@umanitoba.ca.
⁵ Department of Preventive Dental Science, Dr. Gerald Niznick College Of Dentistry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, R3E 3P4, Canada. Robert.Schroth@umanitoba.ca.
⁶ Children's Hospital Research Institute of Manitoba, Winnipeg, Canada. Robert.Schroth@umanitoba.ca.
⁷ Ongomiizwin Research - Indigenous Institute of Health and Healing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, R3E 3P4, Canada. Robert.Schroth@umanitoba.ca.
⁸ Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada. Robert.Schroth@umanitoba.ca.
⁹ Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada. Robert.Schroth@umanitoba.ca.
¹⁰ Department of Preventive Dental Science, Dr. Gerald Niznick College Of Dentistry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, R3E 3P4, Canada.
¹¹ Children's Hospital Research Institute of Manitoba, Winnipeg, Canada.
¹² Shared Health Manitoba, 1610-155 Carlton St, Winnipeg, MB, R3C 3H8, Canada.
¹³ Health & Wellness Department, Manitoba Metis Federation, 150 Henry Avenue, Winnipeg, MB, R3B 0J7, Canada.
¹⁴ First Nations Health and Social Secretariat of Manitoba, 600-275 Portage Ave, Winnipeg, MB, R3B 2B3, Canada.
¹⁵ Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.

PMID: 34098968
PMCID: PMC8183050
DOI: 10.1186/s12939-021-01476-5

Abstract

Background: Inequities in early childhood oral health are evident amongst Indigenous peoples and communities in Manitoba, Canada. Early childhood caries (ECC) is decay in primary dentition in children under 6 years of age. A severe form of the disease occurs at a higher rate in Indigenous populations compared to the general population. ECC has been strongly associated with social determinants of health.

Methods: Focus groups and sharing circles were conducted with four First Nations and Metis communities in urban and rural communities in Manitoba. There were eight groups in total of purposively sampled participants (n = 59). A grounded theory approach guided thematic analysis of audio recorded and transcribed data.

Results: Indigenous participants experienced challenges similar to those found in the general population, such as encouraging and motivating parents and caregivers to establish regular oral hygiene routines for their children. However other challenges reported, disproportionately affect Indigenous communities. These include poor access to dental care, specifically no dental offices within 1 h driving radius and not having transportation to get there. Not having evidence-based oral health information to support good oral hygiene practices, preventing parents from making the best choices of oral hygiene products and oral health behaviours for their children. Poverty and food insecurity resulting in poor nutritional choices and leading to ECC. For example, feeding children sugary foods and beverages because those are more readily avialble than healthy options. Confusing or difficult encounters with dental professionals, highlighted as a factor that can erode trust, reduce compliance and impact continued attendance at dental offices.

Conclusion: Closing existing early childhood oral health gaps for First Nations and Metis peoples and communities requires equity-oriented healthcare approaches to address specific problems and challenges faced by these populations. Family, community and systemic level interventions that directly implement community recommendations are needed.

Keywords: Access; Early childhood Oral health; Early childhood caries; Equity; First Nations; Indigenous; Metis.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

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References

1. Tinanoff N, Baez RJ, Diaz Guillory C, Donly KJ, Feldens CA, McGrath C, Phantumvanit P, Pitts NB, Seow WK, Sharkov N, Songpaisan Y, Twetman S. Early childhood caries epidemiology, aetiology, risk assessment, societal burden, management, education, and policy: global perspective. Int J Paediatr Dent. 2019;29(3):238–248. doi: 10.1111/ipd.12484. - DOI - PubMed
1. Phantumvanit P, Makino Y, Ogawa H, Rugg-Gunn A, Moynihan P, Petersen PE, Evans W, Feldens CA, Lo E, Khoshnevisan MH, Baez R, Varenne B, Vichayanrat T, Songpaisan Y, Woodward M, Nakornchai S, Ungchusak C. WHO global consultation on public health intervention against early childhood caries. Community Dent Oral Epidemiol. 2018;46(3):280–287. doi: 10.1111/cdoe.12362. - DOI - PubMed
1. Jamieson L, Haag D, Schuch H, Kapellas K, Arantes R, Thomson WM. Indigenous Oral Health Inequalities at an International Level: A Commentary. Int J Environ Res Public Health. 2020;17(11):3958-13. - PMC - PubMed
1. Schroth RJ, Moore P, Brothwell DJ. Prevalence of early childhood caries in 4 Manitoba communities. J Can Dent Assoc. 2005;71(8):567. - PubMed
1. Irvine J, Holve S, Krol D, Schroth R. Early childhood caries in indigenous communities: a joint statement with the American Academy of Pediatrics. Paediatr Child Health. 2011;16(6):351–364. doi: 10.1093/pch/16.6.351. - DOI - PMC - PubMed

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[1] Tinanoff N, Baez RJ, Diaz Guillory C, Donly KJ, Feldens CA, McGrath C, Phantumvanit P, Pitts NB, Seow WK, Sharkov N, Songpaisan Y, Twetman S. Early childhood caries epidemiology, aetiology, risk assessment, societal burden, management, education, and policy: global perspective. Int J Paediatr Dent. 2019;29(3):238–248. doi: 10.1111/ipd.12484. - DOI - PubMed

[2] Tinanoff N, Baez RJ, Diaz Guillory C, Donly KJ, Feldens CA, McGrath C, Phantumvanit P, Pitts NB, Seow WK, Sharkov N, Songpaisan Y, Twetman S. Early childhood caries epidemiology, aetiology, risk assessment, societal burden, management, education, and policy: global perspective. Int J Paediatr Dent. 2019;29(3):238–248. doi: 10.1111/ipd.12484. - DOI - PubMed

[3] Phantumvanit P, Makino Y, Ogawa H, Rugg-Gunn A, Moynihan P, Petersen PE, Evans W, Feldens CA, Lo E, Khoshnevisan MH, Baez R, Varenne B, Vichayanrat T, Songpaisan Y, Woodward M, Nakornchai S, Ungchusak C. WHO global consultation on public health intervention against early childhood caries. Community Dent Oral Epidemiol. 2018;46(3):280–287. doi: 10.1111/cdoe.12362. - DOI - PubMed

[4] Phantumvanit P, Makino Y, Ogawa H, Rugg-Gunn A, Moynihan P, Petersen PE, Evans W, Feldens CA, Lo E, Khoshnevisan MH, Baez R, Varenne B, Vichayanrat T, Songpaisan Y, Woodward M, Nakornchai S, Ungchusak C. WHO global consultation on public health intervention against early childhood caries. Community Dent Oral Epidemiol. 2018;46(3):280–287. doi: 10.1111/cdoe.12362. - DOI - PubMed

[5] Jamieson L, Haag D, Schuch H, Kapellas K, Arantes R, Thomson WM. Indigenous Oral Health Inequalities at an International Level: A Commentary. Int J Environ Res Public Health. 2020;17(11):3958-13. - PMC - PubMed

[6] Jamieson L, Haag D, Schuch H, Kapellas K, Arantes R, Thomson WM. Indigenous Oral Health Inequalities at an International Level: A Commentary. Int J Environ Res Public Health. 2020;17(11):3958-13. - PMC - PubMed

[7] Schroth RJ, Moore P, Brothwell DJ. Prevalence of early childhood caries in 4 Manitoba communities. J Can Dent Assoc. 2005;71(8):567. - PubMed

[8] Schroth RJ, Moore P, Brothwell DJ. Prevalence of early childhood caries in 4 Manitoba communities. J Can Dent Assoc. 2005;71(8):567. - PubMed

[9] Irvine J, Holve S, Krol D, Schroth R. Early childhood caries in indigenous communities: a joint statement with the American Academy of Pediatrics. Paediatr Child Health. 2011;16(6):351–364. doi: 10.1093/pch/16.6.351. - DOI - PMC - PubMed

[10] Irvine J, Holve S, Krol D, Schroth R. Early childhood caries in indigenous communities: a joint statement with the American Academy of Pediatrics. Paediatr Child Health. 2011;16(6):351–364. doi: 10.1093/pch/16.6.351. - DOI - PMC - PubMed

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First Nations and Metis peoples' access and equity challenges with early childhood oral health: a qualitative study

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First Nations and Metis peoples' access and equity challenges with early childhood oral health: a qualitative study

Authors

Affiliations

Abstract

Conflict of interest statement

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Abstract

Conflict of interest statement

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