Community Dentistry Discipline, Department of Biological and Diagnostic Sciences, Faculty of Dentistry, University of Toronto, Toronto, ON, Canada.
Community Dent Oral Epidemiol. 2009 Dec;37(6):495-508. doi: 10.1111/j.1600-0528.2009.00497.x. Epub 2009 Sep 22.
To investigate (i) oral health inequalities between off-reserve Aboriginal and non-Aboriginal children entering junior kindergarten (JK) in the Thunder Bay District, Northwest Ontario, Canada, (ii) oral health inequalities between kindergarten-aged (4 years old) Aboriginal children living on reserves in the Sioux Lookout Zone (SLZ), Northwest Ontario and those living off-reserve in the Thunder Bay District and (iii) early childhood caries (ECC) trends among SLZ children between 2001 and 2005.
Cross-sectional oral health data (dmft/s Indices) for 416 (2003/2004), 687 (2004/2005) and 544 (2005/2006) 3- to 5-year olds attending JK in the Thunder Bay District were collected by calibrated dental hygienists with the District's Health Unit. Secondary analysis of oral health status data from two studies conducted in the SLZ between 2001 and 2005 provided the dmft of random samples of children younger than 6 years of age living in 16-20 First Nations communities.
When compared with non-Aboriginal children aged 3-5 years attending the same schools in the Thunder Bay District between 2003 and 2006, off-reserve Aboriginal children had 1.9 to 2.3 times the risk of having ECC (dmft > 0), 2.9 to 3.5 times the risk of a dmft > 3 and 1.8 to 2.5 times the risk of untreated decayed teeth after adjusting the prevalence ratios for child's age and sex, school's risk level and clustered-correlated data. The mean dmft of on-reserve Aboriginal 4-year olds in 2005 was 11.2 and 5.9 for their off-reserve Aboriginal counterparts. In 2001, the mean dmft scores (95% confidence interval) of 2-, 3- and 4-year-old Aboriginal children in the SLZ were: 9.1 (8.3-9.9), 12.4 (11.8-13.1), 13.1 (12.1-14.2). In 2005, similarly aged SLZ children had a mean dmft of: 6.2 (5.2-7.1), 8.9 (8.2-9.6), 11.2 (10.5-11.9), representing significant reductions in caries severity (32%, 28% and 14.5%, respectively).
Significant disparities in caries experience exist between off-reserve Aboriginal and non-Aboriginal children living in the same locales and between Aboriginal children living on- and off-reserve in northwestern Ontario. The study showed decreased trends in the severity of ECC for children in the SLZ occurring over the 5-year period. Despite this progress, the oral health of young Aboriginal children in Ontario continues to lag far behind that of non-Aboriginal children, demanding further programs and policies to tackle the social determinants of oral health and resolve these inequalities.
调查(i)在加拿大安大略省西北部 Thunder Bay 区进入初级幼儿园（JK）的保留地外的土著和非土著儿童之间的口腔健康不平等现象，(ii)在安大略省西北部 Sioux Lookout 区（SLZ）居住在保留地的和居住在 Thunder Bay 区的同年龄段（4 岁）的土著儿童之间的口腔健康不平等现象，以及 (iii)SLZ 儿童在 2001 年至 2005 年之间的早期儿童龋（ECC）趋势。
对 416 名（2003/2004 年）、687 名（2004/2005 年）和 544 名（2005/2006 年）3 至 5 岁的在 Thunder Bay 区上 JK 的儿童进行了横断面口腔健康数据（dmft/s 指数）收集，由经过校准的牙科保健员与该地区的卫生局一起进行。对 2001 年至 2005 年在 SLZ 进行的两项研究中的口腔健康状况数据进行二次分析，为居住在 16-20 个第一民族社区的 6 岁以下儿童的随机样本提供了 dmft。
与 2003 年至 2006 年在 Thunder Bay 区就读相同学校的非土著 3-5 岁儿童相比，保留地外的土著儿童发生 ECC（dmft>0）的风险高 1.9 至 2.3 倍，dmft>3 的风险高 2.9 至 3.5 倍，未经治疗的龋齿风险高 1.8 至 2.5 倍，在调整儿童年龄和性别、学校风险水平和聚类相关数据的流行率比后。2005 年，居住在保留地的 4 岁土著儿童的平均 dmft 为 11.2，而居住在保留地外的土著儿童的平均 dmft 为 5.9。2001 年，SLZ 2 岁、3 岁和 4 岁的土著儿童的平均 dmft（95%置信区间）分别为：9.1（8.3-9.9）、12.4（11.8-13.1）、13.1（12.1-14.2）。2005 年，同样年龄的 SLZ 儿童的平均 dmft 为：6.2（5.2-7.1）、8.9（8.2-9.6）、11.2（10.5-11.9），分别表示龋病严重程度降低了 32%、28%和 14.5%。
在安大略省西北部，居住在同一地点的保留地外的土著和非土著儿童之间以及居住在保留地内外的土著儿童之间，在龋齿经历方面存在显著差异。该研究显示，在过去的 5 年中，SLZ 儿童的 ECC 严重程度呈下降趋势。尽管取得了这一进展，但安大略省的年轻土著儿童的口腔健康状况仍远远落后于非土著儿童，需要进一步制定方案和政策，以解决口腔健康的社会决定因素问题，并解决这些不平等问题。
