Abstract
BackgroundMaaori are the Indigenous people of New Zealand and do not enjoy the same oral health status as the non-Indigenous majority. To overcome oral health disparities, the life course approach affords a valid foundation on which to develop a process that will contribute to the protection of the oral health of young infants. The key to this process is the support that could be provided to the parents or care givers of Maaori infants during the pregnancy of the mother and the early years of the child. This study seeks to determine whether implementing a kaupapa Maaori (Maaori philosophical viewpoint) in an early childhood caries (ECC) intervention reduces dental disease burden among Maaori children. The intervention consists of four approaches to prevent early childhood caries: dental care provided during pregnancy, fluoride varnish application to the teeth of children, motivational interviewing, and anticipatory guidance.Methods/designThe participants are Maaori women who are expecting a child and who reside within the Maaori tribal area of Waikato-Tainui.This randomised-control trial will be undertaken utilising the principles of kaupapa Maaori research, which encompasses Maaori leadership, Maaori relationships, Maaori customary practices, etiquette and protocol. Participants will be monitored through clinical and self-reported information collected throughout the ECC intervention. Self-report information will be collected in a baseline questionnaire during pregnancy and when children are aged 24 and 36 months. Clinical oral health data will be collected during standardised examinations at ages 24 and 36 months by calibrated dental professionals. All participants receive the ECC intervention benefits, with the intervention delayed by 24 months for participants who are randomised to the control-delayed arm.DiscussionThe development and evaluation of oral health interventions may produce evidence that supports the application of the principles of kaupapa Maaori research in the research processes. This study will assess an ECC intervention which could provide a meaningful approach for Maaori for the protection and maintenance of oral health for Maaori children and their family, thus reducing oral health disparities.Trial registrationAustralia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12611000111976.
Highlights
Maaori are the Indigenous people of New Zealand and do not enjoy the same oral health status as the non-Indigenous majority
This study will assess an early childhood caries (ECC) intervention which could provide a meaningful approach for Maaori for the protection and maintenance of oral health for Maaori children and their family, reducing oral health disparities
Provision of comprehensive dental care to mothers during pregnancy reduces their levels of Streptococcus mutans, a micro-organism associated with ECC that can be transferred to the infant at birth. (2)Fluoride varnish application to children’s teeth
Summary
Childhood caries remains a major health issue in New Zealand, even though dental treatment for all New Zealanders is free until their 18th birthday. ECC can be successfully prevented by fluoride varnish application to the teeth of children, and the engagement of the mother through the provision of dental care during pregnancy together with anticipatory guidance and motivational interviewing. The World Health Organization view is that ‘health research involving Indigenous Peoples, whether initiated by the community itself or by a research institute, needs to be organised, designed and carried out in a manner that takes account of cultural differences, is based on mutual respect, and is beneficial and acceptable to both parties’ (Sims et al [22]). This study is being carried out according to the practices and principles of kaupapa Maaori research It is only by engaging in this approach that the outcomes will have validity, credibility and acceptability to Maaori and will have the potential to make a significant contribution to the improvement of Maaori health status and overall Maaori health. All authors were involved in revising the manuscript for important intellectual content and read and approved the final manuscript
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