HERENIA LAWRENCE IS A SCIENTIST WITH A SOCIAL MISSION. THE ASSISTANT professor of community dentistry at U of T’s Faculty of Dentistry is mapping out strategies to curb early childhood tooth decay in remote First Nations communities.

Early childhood tooth decay – officially called “early childhood caries” or ECC – affects far more Aboriginal children than other Canadian children. “About five per cent of children in Toronto experience ECC, compared to over 90 per cent of young Aboriginal children,” says Lawrence.

With funding from the Hospital for Sick Children Foundation and Health Canada’s First Nations & Inuit Health branch, Lawrence launched an oral health survey in 2000 to study the problem more closely.

She and her team examined almost 1,000 pre-school-age children in Sioux Lookout Zone, a vast area in northwestern Ontario that is home to 28 remote First Nations communities. “We also assessed parents’ and caregivers’ knowledge, feeding practices and other risk factors for early childhood tooth decay,” recalls Lawrence. Two surveys were conducted one year apart to determine the effects of the treatment and prevention programs.

One of the main factors Lawrence identified was access to care. “Aboriginal groups are in isolated communities where access to health care, appropriate oral health information and a good diet are problems.” Another factor is the high prevalence of prolonged bottle-feeding with sugary drinks, which greatly increases the incidence of ECC.

Lawrence discovered that, on average, children in these communities have 12 cavities before the age of five. “Often, soon after the first teeth erupt, they have abscesses, which cause dental pain and chewing impairments as well as other forms of bacterial infection, like ear infections, tonsillitis and pneumonia,” says Lawrence.

Treatment for young children, particularly when several teeth are affected, is difficult in the dentist’s chair, she says. Consequently, these patients are often flown to a hospital and treated under general anaesthetic. “It’s very expensive, but it’s the only viable alternative when the disease reaches this stage.”

Lawrence insists that prevention is the key to solving the problem.

To that end, her team is testing a new fluoride varnish that is safe and easy to apply. “It can be applied every six months by a health care professional who isn’t necessarily a dentist,” says Lawrence. “A dental assistant, a nurse or a nurse practitioner can apply the varnish while they’re seeing patients for other reasons.” Obvious venues, she says, are immunization clinics.

Lawrence is also spearheading an initiative to add an oral health component to pre- and post-natal visits. “Community health workers, like pre- and post-natal nutrition educators, act as the first line of defence against ECC,” says Lawrence. “They can help mothers establish good routines like tooth brushing and healthy food choices right from the start.”

Raising awareness among paediatricians is currently on Lawrence’s agenda. One of her students is conducting a survey to determine the willingness and ability of this group to address oral health care. “The role of physicians and nurses during well-baby visits is key – we need to promote oral health care to these professionals so they can pass the message on to their patients.” — Althea Blackburn-Evans