Background: Early childhood caries (ECC) is a devastating form of dental decay affecting many Canadian children, especially those from northern First Nations communities. ECC is multifactorial in origin, and the notion that the principal etiology is inappropriate feeding modalities is no longer tenable.
Methods: This study was conducted in the community of Garden Hill First Nation, Manitoba, to assess the prevalence of dental decay in young children, to assess risk factors for ECC and to determine the influence of vitamin D supplementation (a modified form of stosstherapy using 100,000 IU vitamin D), both prenatally and at 6 weeks of age, on the oral health of children. The study involved a cross-sectional dental examination of children, an interview with mothers and a maternal chart review.
Results: A total of 98 children participated: their mean age was 46.4 +/- 6.3 months. The mean number of decayed, extracted and filled teeth (deft) was 13.7 +/- 3.2. Caries rates were significantly greater among children who had had sugar added to the feeding bottle. Behaviours typically associated with ECC and caries activity, such as poor oral hygiene and late weaning from the bottle, were also exhibited among residents. Although 50% of children had enamel hypoplasia, no statistically significant differences in the amount of enamel hypoplasia and caries were found between those who received modified stosstherapy and those who did not. Not receiving stosstherapy was associated with later eruption time of the first primary tooth (7.2 vs. 5.0 months). Interviews revealed that, during pregnancy, many of the mothers only infrequently consumed foods rich in calcium and vitamin D, elements that are essential to the development of strong bones and teeth.
Conclusions: The mean deft for these First Nations preschoolers was high and 50% had enamel defects. Although daily vitamin D supplementation of 400 IU during pregnancy has been known to reduce primary tooth enamel defects, the supplementation previously administered to participants in this study was not found to result in reduced enamel defects or caries. The high caries burden among children from this community reveals the need for effective prevention methods. It is important for pediatricians, family physicians and other health service providers encountering very young children and expectant mothers to be cognizant of ECC and its ramifications, as their education efforts represent the first line of defence.