Prevalence and risk factors for parental-reported oral health of Inuit preschoolers: Nunavut Inuit Child Health Survey, 2007-2008

Abstract

Studies from the early 20th Century suggest that Inuit had a low prevalence of dental caries. However, Inuit children now experience a high prevalence of tooth decay and dental caries. The main objectives of this study were to provide an estimate of the prevalence and correlates of parental-reported oral health among Inuit preschool-aged children in Nunavut. Inuit preschool-aged children aged 3 to 5 years from 16 of Nunavut's 25 communities were randomly selected to participate in the Nunavut Inuit Child Health Survey conducted in 2007 and 2008. The parent/primary caregiver was asked to give written informed consent for their child's participation. Caregivers were asked to rate their child's oral and dental health and if their child had any 'decayed, extracted or filled baby teeth': an affirmative response designated a child as having reported-caries experience (RCE). Interviewer administered questionnaires included household characteristics, nutritional supplements, past-month qualitative food frequency questionnaire (FFQ), and a 24 hour dietary recall with repeat 24 hour recalls on a 20% sub-sample. The overall participation rate was 72.3% (388 children). Among the participating children, 53% percent were female and the mean age was 4.4 +/- 0.9 years. The weighted prevalence of RCE was 69.1% (95% CI: 63.7-74.4%). Caregivers rated their child's oral and dental health as: 'very good' (9.5%), 'good' (44.5%), 'fair' (29.5%) and 'poor' (16.6%). Very few children were taking a fluoride supplement (4.6%, 95% CI: 2.3-6.9%) or a vitamin D supplement (4.9%, 95% CI: 2.4-7.4%). Sixteen percent of children (95% CI: 12.3.-20.1) were taking a multivitamin and multimineral supplement containing vitamin D and calcium but not fluoride. In univariate analyses using data from the qualitative FFQ, children with RCE drank milk less often than children without RCE (1.6 +/- 0.1 vs 2.2 +/- 0.2 times per day, respectively, t-test p <or=0.01). Also, children with RCE drank more soda pop compared with children without RCE (0.8 +/- 0.1 vs 0.5 +/- 0.1 times per day, respectively, t-test p <or=0.05). Consistent with findings from the FFQ, children with RCE drank less milk in the previous day than children without RCE (225.9 +/- 17.0 vs 325.6 +/- 44.8 g/day respectively, p <or=.01). Reported-caries experience was also more common among children who did not take any nutritional supplements containing vitamin D, calcium or fluoride than among those who did (75.5% vs 60.0% respectively, chi(2) p <or=0.01). Multivariable logistic regression revealed that a higher frequency of milk intake was independently protective against having RCE (OR = 0.84, 95% CI: 0.73-0.97). A higher frequency of high-sugar food intake was independently associated with having RCE (OR = 1.11, 95% CI: 1.02-1.12). A high prevalence of RCE was found among Inuit preschool-aged children in Nunavut Territory, Canada. In this cross-sectional health survey, milk intake showed protective associations while sugar intake showed deleterious associations with RCE, which is compatible with emerging literature on milk in animal- and population-based research, and with existing literature on the deleterious effects of acidic sugary drinks on dental health. This study emphasizes the likely importance of nutritional health education and better access to nutritious foods for promoting oral health. It also demonstrates the continued importance of oral health initiatives that are currently in place in Nunavut.