3-Year Results of a Collaborative School-based Oral Health Program in a Remote First Nations Community

"Programs that incorporate ongoing enthusiastic support, education, and follow up from visiting multidisciplinary health professionals may have a positive impact on behaviours that affect oral health among children living in remote Aboriginal communities."

This 7-page evaluation examines an oral health initiative - "Brighter Smiles" - designed to improve the knowledge and behaviour of school-aged children in a small, remote First Nations community in Canada. As the authors explain, surveys of dental health among Aboriginal children in Canada, using scales such as the Decayed, Missing, and Filled Teeth (DMFT) score, indicate that Aboriginal children have 2 to 3 times poorer oral health compared with other populations.

The community- and university-supported, school-based, collaborative oral health programme grew out of a partnership between the Pediatric Residency Program at the University of British Columbia and the people of Hartley Bay, a remote First Nations community with a population of 200-300. In consultation with school principal, teachers, and the entire community, an intervention was developed that consisted of daily brush-ins, fluoride application, educational presentations, and a recognition/incentive scheme. To expand upon the latter, teachers award prizes weekly, monthly, and annually for participation, and the school maintains a wall of photographs of children who are caries-free as a measure of their success.

In order to understand whether active participation actually led to measurable results, evaluators undertook a cross-sectional study of all school-aged children. Pre- and post-intervention evaluation of oral health was conducted by a dentist not involved in the study. Twenty-six children were assessed prior to the intervention, representing 45% of the 58 children then in the community. All 40 children in the community were assessed following the intervention. As detailed here, prior to the intervention, 8% of children were cavity-free. Interim assessments showed that at the end of the first year, 41% of the children had no new cavities. Following 3 years of the intervention, 32% were cavity-free. Among the 13 children assessed both pre- and post-intervention, dmfs/DMFS (primary teeth/permanent teeth score) improved significantly (p 0.005).

Two years into the programme, the government dental hygienist reported that the majority of the children had visibly better oral hygiene and that the "time required to treat" for restoration had decreased significantly from 117.6 minutes for 58 children in 2002 to 68.4 minutes for 49 children in 2004. The "time required to treat" for preventative therapy had decreased from 421 minutes (n = 55) to 301 minutes (n = 49). There was no difference in the "time required to treat" for extraction of teeth.

Evaluators provide the following qualitative data: "The response of the community was consistently positive, and resulted in requests for additional interventions, including immunization and screening for type 2 diabetes. The pediatric trainees reported significant increase in insight and understanding of the issues and obstacles faced by their aboriginal patients in remote communities." Perhaps for these reasons, the programme is still in progress as of 2008; 100% of the children remain enrolled, and "pride in their success and motivation of each other is very evident". Furthermore, in partnership with Makarere University in Kampala, organisers have since taken the Brighter Smiles programme to Uganda, where over 1,100 children were enrolled in 4 remote communities.