Saskatoon Health Region Young Children’s Oral Health Status: 2006-2015

Maryam Jafari

School of Public Health, U of S

Ms. Leslie Topola

Manager, SHR, Population and Public Health

Overview

• Oral Health Program-Population and Public Health

• Background Information: Oral Health in Young Children

• The Current Report

Oral Health Program, Population and Public Health

Primary Health Services • School Services

Dental Screening

• Fluoride Services Fluoride Varnish Clinics

Public Health Dental Clinic

Tooth Decay: 5 times more common than asthma

• 57% of 6–11 years old (Canadian Health Measure Survey 2007-2009)

Early Childhood Tooth Decay (ECTD) • Younger than 6 year old (primary teeth)

• No national information

• More than one fourth of children ( Ontario)

• Heath Impact:

• Economic Impact: Day surgery

$3.4 million (Saskatchewan)

$1.9 million (Saskatoon Health Region)

ECTD

Severe ECTD

Background

Etiology

• Streptococcus Mutans

• Fermentable Carbohydrate

• Socioeconomic Status

Overnight Feeding!

Prevention Strategies

• Reduce the bacteria of mother Prevention and Treatment

• Minimize the transmission of bacteria of mother

• Fluoride Community (Water, Milk, Salt) Individual (Fluoride Varnish,…)

• Antibacterial agents

• Fissure sealants

NO Saliva Sharing!

Objectives

• Monitor the trends of oral health status children 0-6year olds

• Provide baseline for future screening/analysis for children 0-5 year old

• Assess oral health of 6 year old against Canadian Oral Health Framework 2013-2018

• Establish oral health target for 0-5 year old

• Determine disparities in the oral health status

• Child’s Residence, Neighborhood Income Status

Methods

• Data Collection (already done)

• Dental Assistants

• Dental Therapists

• Public Health Nurses

• Nurse Practitioners

Methods

• Data Analysis

• Oral Health Indicators

• “deft”, “DMFT”, “deft+DMFT”

• Early Childhood Tooth Decay

• Severe Childhood Tooth Decay

• Caries-Free

• Untreated Cavities

• No Evidence of Care

• Priority

deft : decayed, extracted, filled teeth DMFT: Decayed, Missing, Filled Teeth

Results

1- Trend of oral health status

(in general):

2- Trend of oral health

(Urban vs. Rural ; Non-low Income vs Low Income Neighborhoods)

Oral Health Status Trend

• N=23,787

• Age groups:

• Younger than 1 Year Old ( 2006-2014)

• 1 Year Old

• 2 Year Old

• 3 Year Old

• 4 Year Old

• 5 Year Old

• 6 Year Old ( 2008-2014)

% Early Childhood Tooth Decay+ Severe-Early Childhood Tooth Decay

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

2006 2007 2008 2009 2010 2011 2012 2013 2014

% E

CTD

+S-E

CTD

<1y/o 1y/o 2y/o 3y/o 4y/o 5y/o

2014 48% 35% 33% 21% 5% 3%

Early Childhood Tooth Decay+ Severe-ECTD : 0-2 Year Old Children

0.00%

2.00%

4.00%

6.00%

8.00%

10.00%

12.00%

14.00%

16.00%

2006 2007 2008 2009 2010 2011 2012 2013 2014

% S

-EC

TD

Early Childhood Tooth Decay and Severe-ECTD: 3-5 Year Old Children

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

2006 2007 2008 2009 2010 2011 2012 2013 2014

% E

CTD

+ S

-EC

TD

Early Childhood Tooth Decay and Severe-ECTD: 3-5 Year Old Children

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

2006 2007 2008 2009 2010 2011 2012 2013 2014

% E

CTD

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

35.00%

2006 2007 2008 2009 2010 2011 2012 2013 2014

% S

-EC

TD

Canadian Oral health Framework (COHF) 2013-2018 Target:

6 Year Old Children

# Objective Indicator

1.a Reduce the number of teeth affected

by cavities in 6-Year Olds

deft +DMFT of <2.5

1.b Reduce the percentage of 6 year old

children who experienced cavities

55% of 6 year old children

have deft +DMFT=0 (Cavity-Free)

1.c Reduce the percentage of 6 year old

children with untreated cavities

<15% of 6 year old children

have d+D>0 (Untreated Cavities)

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

2008 2009 2010 2011 2012 2013 2014

Ave

rage

“d

eft+

DM

FT”

COHF Target: 6 Year Old Children

2.5

COHF Target: 6 Year Old Children

55%

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

2008 2009 2010 2011 2012 2013 2014

Pe

rce

nta

ge C

avit

y -F

ree

COHF Target: 6 Year Old Children

55%

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

2008 2009 2010 2011 2012 2013 2014

Pe

rce

nta

ge C

avit

y -F

ree

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

35.00%

40.00%

2008 2009 2010 2011 2012 2013 2014

% U

ntr

eat

ed

Cav

itie

s

15%

Saskatoon Health Region Recommended Target: 0-5 Year Old Children

# Objective Indicator

1.a Reduce the percentage of 5 Year Olds

who experienced cavities.

64% of 5 Year Olds have deft +DMFT=0

1.b Reduce the percentage of 4 Year Olds

who experienced cavities.

73% of 4 Year Olds have deft +DMFT=0

1.c Reduce the percentage of 3 Year Olds

who experienced cavities.

82% of 3 Year Olds have deft +DMFT=0

1.d Reduce the percentage of 2 Year Olds

who experienced cavities.

91% of 2 Year Olds have deft +DMFT=0

1.e Reduce the percentage of ≤1 Year Olds

who experienced cavities.

100% of ≤1 Year Olds have deft

+DMFT=0

• Oral health in 1, 2, 3, 4, 5 year old children has improved.

• Oral health in children younger than 1 has declined.

• Oral health in 6 year old children has declined • The best measurements were seen in 2008

• The best measurements in recent year were seen in 2013

Oral Health Status (Income Status/ Child’s Residence )

LIM vs. Non-LIM Neighborhoods:

• Low Income Measure (LIM)

• Low Income: 30% of families in the neighborhood meet the definition of LIM (Statistics Canada)

• Age groups:

• 0-2 Year Old

• 3-5 Year Old

• 6 Year Old

Average “ deft+DMFT”: 0-2 Year Old Children

0

0.2

0.4

0.6

0.8

1

2006 2007 2008 2009 2010 2011 2012 2013 2014

Ave

rage

“d

eft+

DM

FT”

Non-LIM LIM

Urban vs. Rural areas:

• Urban: Saskatoon, Humboldt

• Age groups:

• 0-2 Year Old

• 3-5 Year Old

• 6 Year Old

Average “ deft+DMFT”: 3-5 Year Old Children

0

0.5

1

1.5

2

2.5

3

3.5

4

2006 2007 2008 2009 2010 2011 2012 2013 2014

Ave

rage

“ d

eft+

DM

FT”

Urban Rural

Summary • Oral health in Non-Low Income Neighborhoods has improved.

• Oral health in Low Income Neighborhoods has remained stable/showed unfavorable trend.

• Children in Non-Low Income Neighborhoods had better health compared to Low Income Neighborhoods.

• Oral health in both Urban and Rural children has improved.

• Rural children had better oral health compared to Urban children

Discussion

Improvements of oral health in Rural areas

• Involvement of Nurse Practitioners/Public Health Nurses in rural areas

• Possible confounders (Aboriginal status, dental insurance) wasn’t assessed

• Role of water fluoridation wasn’t assessed

Fluoride water content has not improved over the years.

No significant differences in oral health in Fluoridated vs non- Fluoridated areas (SHR Dental Screening Program Report 2013-2014)

• Fluoride Varnish Program wasn’t evaluated

• Changes in lifestyle and habits in urban areas

Recommendations

• Involve Nurse Practitioners/Public Health Nurses in Fluoride Varnish Programs in Urban areas (Low Income Neighborhoods)

• Conduct data entry the same day (web-based in real time)

• Conduct a national dental survey for children younger than 6 year old. • Canadian Health Measure Survey 2007-2009 ( 6-11 year old children)

• Provide free consultation/checkup for the children 1 year old (Canadian Dental Association)

• Incorporate oral preventive health care in the universal health care system

• Incorporate oral exam as a part of routine prenatal care

• Improve training in pediatric dental care and pregnant women dental care in dental school

Acknowledgments

Dental Health Screening Advisors • Leslie Topola • Julie Laberge-Lalonde • Cynthia Ostafie

Examiners and Data Collection Nurse Practitioners and Public Health Nurses Oral Health Professional • Leah Abrook • Julie Laberge-Lalonde • Linda O’Keefe • Cynthia Ostafie • Gwen Sawicki • Diane Schitka • Chris Vandale • Leanne Ziolkowski

Office Administration • Barbara Anderson • Joyce Birchfield • Terry Dunlop • Josh Marko • Bob Toso

References:

King A. Oral health – more than just cavities: a report by Ontario’s Chief Medical Officer of Health. Ontario: Queen’s Printer for Ontario; 2012. Available from: http://www.health.gov.on.ca/en/common/ministry/publications/reports/oral_health/oral_health.pdf

Oral health during pregnancy and early childhood: evidence-based guidelines for health professionals. J Calif Dent Assoc. 2010; 38(6):391. Available from: www.cdafoundation.org/Portals/0/pdfs/poh_guidelines.pdf

Saskatoon Health Region. Oral Health Program Population and Public Health. Dental Health Screening Program Report 2013-2014. Saskatoon, Saskatchewan: Saskatoon Health Region; 2014. Available from: https://www.saskatoonhealthregion.ca/locations_services/Services/OralHealth/Documents/SHR%20FINAL%20Dental%20Screening%20Report%202013-2014.pdf

Saskatoon Health Region. Saskatchewan Dental Health Screening Program report 2013-2014; 2014. Available from: https://www.saskatoonhealthregion.ca/locations_services/Services/Oral-Health/Documents/Saskatchewan%202013 14%20Dental%20Screening%20Report.pdf