A situational Assessment tool for early childhood caries. This blog post is still a work in progress.
What is the Situation?
Early Childhood Caries (ECC) is a multifactorial and largely preventable disease that is influenced by biomedical factors such as diet, oral bacteria, and the social determinants of health (CDA, 2010; WHO 2019). ECC has lifelong effects on both the primary and permanent dentition. It affects quality of life, self-esteem, communication, and social skills during childhood and throughout life (CIHI, 2013). The primary dentition is necessary for proper mastication, esthetics, establishing proper phonetics, and maintaining space for the permanent dentition to erupt (Anil & Anand, 2017). When caries for both children and adults can lead to pain, abscess, and infection. This can compromise the ability to eat, sleep, and restrict daily living activities. If left untreated dental abscess and infection can progress becoming life-threatening (WHO 2019; Nicolae et al., 2018).
Globally there are 530 million children who have dental caries, and it is the most common chronic disease affecting children less than six years of age (WHO, 2019; CDA, 2010). Within Canadian Pediatric hospitals, the treatment of ECC is the most common surgical procedure, accounting for one third of all surgeries performed on children less than four years of age (CDA, 2017; Pierce et al., 2019).
CIHI (2013) reports that the average cost per day surgery for the treatment of ECC is $1657. Alternatively, in the Nova Scotia Dental Fee Guide a recall exam (primary dentition), is $32.00, two radiographs are $24.00, and a fluoride treatment is $19.00, totalling $75.00 (Nova Scotia Dental Association, 2020).
What influences are making the situation better and worse?
Worse
Both low education, and low income have a negative correlation with the rate of visiting the dentist, and those who are in these groups and unlikely to visit the dentist are the most likely to have dental caries (Health Canada 2010). ECC Is significantly prevalent in aboriginal children (83.9%), children living in families with only public dental insurance (60.9%), and families who’s highest level of education is less than a degree/diploma (60.1%). Like the prevalence of those with caries, the rates for children who require day surgery for treatment is more prevalent for aboriginal children (93.1%), children in low income families (27.2%), and those from rural areas (31.7%) due to severity of disease (CIHI, 2013).
While there is a COHP program in Nova Scotia, it is under utilized, and unknown to many families. A study completed at the main pediatric hospital in Atlantic Canada found that of families receiving treatment for ECC within hospital, only 27.4% had been made aware of this program by primary care. Utilization of this COHP has decreased from 42% of eligible participants in 2016/2017 to 30% for 2020/2021 (Nova Scotia Department of Health & Wellness, 2021).
Better
As discussed in a reading last unit it is difficult to determine the effectiveness of public health initiatives (Kemm, 2016). However, we know that the currently implemented Children’s Oral Health Program (COHP) in Nova Scotia is able to provide access to Nova Scotian Children without private dental coverage. However, we also know that many families do not know about this program, and instead avoid care due to fear of financial barriers.
The significance of oral health and its relation to overall health is becoming increasingly recognized as crucial to families for their overall health. Those in primary health are beginning to see the link oral health can play on overall health, and it is beginning to become increasingly integrated within general healthcare (Choi et al., 2020).
What possible actions can you take to address the situation?
Currently, as mentioned Nova Scotia has a COHP program to fund dental care for children until they are fifteen years old (NS Government 2019). It is difficult to determine how beneficial this program is to keeping children from needing hospital level dental care and preventing ECC in general. We do know that this program is declining in use. In 2016/17 it had a 42% utilization rate which decreased to 30% for 2020/2021 (Nova Scotia Department of Health & Wellness, 2021).
We know that early intervention and preventative care can lead to less restorative treatment throughout childhood, and through the entire lifespan (Nowak et al., 2014). Several associations such as the Canadian Dental Association (CDA), Canadian Pediatric Society (CPS), Canadian Association for Pediatric Dentistry (CAPD), American Dental Association (ADA), American Association of Public Health Dentistry (AAPHD), and American Association of Pediatrics (AAP) recommend that all children establish a dental home by the age of 12 months and then continue to receive regular preventative care (CDA, 2010; Herndon et al., 2010; Rowan-Legg, 2013).
One of the initial contacts for children and their families is the primary healthcare team (Family physicians, Pediatricians, and Nurse practitioners). They on average see children and their caregivers seven times more frequently than oral health professionals before the age of two, therefore have an ideal opportunity to provide oral health education and recommendations for children to visit a dental professional to establish a dental home, especially with COHP within Nova Scotia (Shimpi et al., 2016). However of children receiving in hospital treatment for ECC only 27.4% had been made aware by primary healthcare of the first dental visit by 12 months of age (Hachey et al. 2019).
More training modules in the form of continuing medical education for primary healthcare providers could help improve the knowledge, as well as resources to provide evidence based recommendations/referrals to aid families in preventing ECC, in particular the recommendations of establishing a dental home by age 12 months.
References
Anil, S., & Anand, P. (2017). Early Childhood Caries: Prevalence, Risk Factors, and Prevention. Frontiers in Pediatrics. 5:157. doi:10.3389/fped.2017.00157
Canadian Dental Association (2010). Early Childhood Caries. https://www.cda-
adc.ca/en/about/position_statements/ecc/
Canadian institute for Health Information. (2013). Treatment of Preventable Dental Cavities in
Preschoolers. https://cdn.ymaws.com/www.alphaweb.org/resource/collection/822EC60D- 0D03-413E-B590-AFE1AA8620A9/CIHI_Caries_Surgery_2013.pdf
Choi, S., Simon, L., Barrow, J., Palmer, N., Basu, S. & Phillips, R. (2020). Dental Practice Integration into Primary Care: A Microsimulation of Financial Implications for Practices. International Journal of Environmental Research and Public Health. https://doi.org/10.3390/ijerph17062154
Hachey, S., Clovis, J., Lamarche, K. (2019). Children’s Oral Health and Barriers to Seeking Care: Perspectives of Caregivers Seeking Pediatric Hospital Dental Treatment. Healthcare Policy. 15(1):29-39. https://doi.org/10.12927/hcpol.2019.25940
Health Canada. (2010). Report on the Findings of the Oral Health Component of the Canadian
Health Measures Survey: 2007-2009. https://www.caphd.ca/sites/default/files/CHMS-E- tech.pdf
Herndon, J.B., Tomar, S.L., Lossius, M.N., Catalanotto, F.A. (2010). Preventive Oral Health Care in Early Childhood: Knowledge, Confidence, and Practices of Pediatricians and Family Physicians in Florida. The Journal of Pediatrics. 157(6):1018-1024. https://doi.org/10.1016/j.jpeds.2010.05.045
Kemm, J. (2006). The limitations of 'evidence-based' public health. Journal of Evaluation in Clinical Practice, 12, 319-324. http://0-search.ebscohost.com.aupac.lib.athabascau.ca/login.aspx?direct=true&db=edsbl&AN=RN187679448&site=eds-live
Nicolae, A., Levin, L., Wong, P.D., Dave, M.G., Taras, J., Misty, C., Ford-Jones, E.L., Wong,
M., Schroth, R. (2018). Identification of early childhood caries in primary care settings. Paediatrics & Child Health. 23:2 (111-115). https://doi.org/10.1093/pch/pxx155
Nova Scotia Government. (2019). Nova scotia children’s oral health program. https://novascotia.ca/dhw/children-dental/
Nova Scotia Department of Health and Wellness MSI Health Information Department. 2021. Medical Services Insurance R70-Annual Statistical Tables. https://novascotia.ca/dhw/publications/annual-statistical-reports/DHW_Annual_Stats_Report_MSI_2020_21.pdf
Nowak, A.J., Casamassimo, P.S., Scott, J., Moulton, R., (2014) Do Early Dental Visits Reduce Treatment and Treatment Costs for Children? Journal of Pediatric Dentistry. 36(7).
Pierce, A., Singh, S., Lee, J., Grant, C., Cruz de Jesus, V., & Schroth, R. J. (2019). The Burden
of Early Childhood Caries in Canadian Children and Associated Risk Factors. Frontiers in Public Health. 7, 328. https://doi.org/10.3389/fpubh.2019.00328
Rowan-Legg, A. (2013). Position statement: Oral health care for children – a call to action. Paediatrics & Child Health. 18(1):37-43. https://doi.org/10.1093/pch/18.1.37
Shimpi, N., Schroeder, Kilsdonk, J., Chyou, P., Glurich, I., Penniman, E., Acharya, A. (2016). Medical Providers’ Oral Health Knowledgeability, Attitudes, and Practice Behaviours: An Opportunity for Interprofessional Collaboration. The Journal of Evidence-Based Dental Practice. 16(1)19-29. https://doi.org/10.1016/j.jebdp.2016.01.002
World Health Organization. (2019). Ending Childhood Dental Caries. WHO Implementation
Manual. https://apps.who.int/iris/rest/bitstreams/1266137/retrieve
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