AAP Voices Blog

Raymond, a single dad raising three young children, offers a good example of the challenges facing Indigenous children’s oral health. He and his family also ably demonstrate how we can work together to help prevent caries in Indigenous children.

Since his first child developed early childhood caries and required dental surgery in the hospital, he has been diligent in ensuring his children receive regular dental visits and is deeply motivated to keep serious problems from happening to his two youngest children.

We know that American Indian and Alaska Native children in the United States and First Nations, Metis, and Inuit children in Canada do not enjoy the same measure of health as other North Americans.

Demonstrated gaps in health outcomes exist throughout the lifespan -- from infant mortality, maternal health, mental health, and addiction to chronic diseases -- just to name a few.

“Rates of dental caries among Indigenous children are dismally high. This is especially poignant because dental disease is almost completely preventable.”

One health outcome where disparities are particularly egregious is children’s oral health. Rates of dental caries among Indigenous children are dismally high. This is especially poignant because dental disease is almost completely preventable.

We see many children under the age of 6 who suffer from early childhood caries, or tooth decay. It is particularly common in children from families with low incomes and those residing in rural and remote regions.

Early childhood caries is a tremendous concern because it increases the risk for tooth decay throughout childhood and adolescence and has a negative impact on a child’s ability to eat, sleep, and learn and on overall health and well-being. Hospital-based dental surgery to treat severe disease is costly, traumatic, and yet far too common in the U.S. and Canada.

However, Indigenous children haven’t always had a high burden of tooth decay. A century ago, Indigenous peoples were known to have excellent oral health. So, what happened?

Disruptions in traditions and diet, poverty, residential schools, loss of cultural practices, and deleterious government policies have contributed to the increase in dental disease, exacerbating poor access to nutritious foods, low oral health literacy, limited access to dental care, and the lack of fluoridated drinking water.

As a society, it is important that we work to address these issues, but doing so is much more complicated than one might expect. Think about this for a moment. Living in an urban area usually means your child has better access to a dentist as well as drinking water that contains cavity-fighting fluoride. But what if you are living in a community that has no running water – let alone water with fluoride – or one that is located several hours away from the nearest dentist?

Earlier this year, the American Academy of Pediatrics and the Canadian Paediatric Society published their joint policy statement on “Early Childhood Caries in Indigenous Communities”. This resource provides important recommendations to help close the gap in children’s oral health disparities. It includes guidance on preventive and clinical oral health care for infants, toddlers, preschool children, and pregnant women, many of which can be delivered by primary health care providers. The policy also addresses community-based health promotion initiatives, including referral to dental professionals, fluoride varnish application, placement of sealants, and non-invasive dental procedures such as interim therapeutic restorations, including silver diamine fluoride.

Research on the microbiology, epidemiology, prevention, and management of caries in Indigenous communities needs to be community-based and take into account the root causes of systemic disenfranchisement.

November is Native American Heritage Month, so it’s a good time to start oral health promotion in primary care practice, including referral to a dental professional. Encourage parents to take their child for a first dental visit by the time they are 12 months old. Not only does this visit give the dental professional an opportunity to check the child’s teeth, but it also gives parents a chance to learn more about the importance of early oral health from dental professionals.

Collaboration is crucial to address oral health disparities. Listening to the voices of Indigenous parents, elders, and communities is essential if we are to help improve oral health outcomes and delivery of care. Communities possess valuable insight into traditional teachings that can be used to inform oral health messaging and information, ensuring that it is culturally appropriate and impactful.

Early childhood caries is preventable. Working together we can develop new approaches that will ultimately improve the oral health of young Indigenous children.

Please share these AAP resources with the families you see:

• Ways to prevent tooth decay in babies, toddlers, and preschoolers
• Ways to protect teeth and prevent decay in school-age kids and teens
• Protecting your teeth for a lifetime
• Protecting your teeth later in life