A combined quantitative and qualitative study of severe early childhood caries among three and five year-old Aboriginal children in the District of Manitoulin, Ontario.

摘要

Objective. To determine the prevalence of Severe Early Childhood Caries (S-ECC), the risk factors for S-ECC and the social factors influencing infant/child feeding/rearing practices among primary caregivers. Methods. The following combined quantitative and qualitative methods were used: (1) all 3 and 5 year-olds enrolled in elementary schools and daycare centres in seven Aboriginal communities of M'Chigeeng, Sheshegwaning, Sheguiandah, Aundeck Omni Kaning, Zhiibaahaasing, Birch Island and Wikwemikong in the District of Manitoulin, Ontario, and all of the 3 year-olds at home and 5 year-olds attending school off-reserve in all communities except Wikwemikong were eligible for the epidemiological survey examination; (2) using a case-control study design risk factors were identified using a standardized interview questionnaire given to 72 primary caregivers; and (3) grounded theory research methodology guided sampling, data collection and analysis with 12 primary caregivers. Results. Eighty-seven children (59% 5 year-olds, 54% females) were included in the study. Forty-five cases of S-ECC were found, a prevalence of 52%. The mean dmft score for cases was 7.5 (95 CI 6.51--8.42) and 0.8 (95 CI 0.47--1.11) for non-cases; the difference was statistically different (P 0.001). Risk factors associated with the development of S-ECC ( P ≤ 0.1) were: father's education level, child using a bedtime bottle containing sweet liquids after the child began walking; mother's education level, primary caregiver initiating child's brushing of teeth after the age of 24 months; and the child eating four or more between-meal snacks per day. Managing short-term family circumstances determined parenting choices more than correct knowledge. The factors influencing this phenomenon included: (1) primary caregiver's experiences with alcohol misuse within the family, and (2) the educational or employment activities of mothers with preschool aged children. Conclusions. The results of this study demonstrate a prevalence of S-ECC higher than in the general population of children in Ontario (10%). The determinants of Severe Early Childhood Caries in these communities are the product of both individual choices and social, political and historical factors. These results will help identify children and families at risk of S-ECC and assist the local health authorities in planning appropriate oral health programs.