The effect of an oral health education program for mothers and fluoride treatment on oral health in Indigenous Maori children

Early Childhood Caries (ECC) causes profound suffering, frequently requiring expensive treatment under a general anaesthetic. It is the strongest predictor of poor oral health in adulthood. Despite ECC being entirely preventable, marked ECC disparities exist between Maori and non-Maori children in New Zealand. If the burden of ECC and associated oral health inequalities experienced by Maori children is to be reduced, more needs to be done to ensure that appropriate preventive measures, together with support for maintaining optimal oral health, are provided to carers of such children in the early life stages. This will be an interventional study, with all the participants receiving the intervention benefits. Pregnant Maori women and their families will be included. The intervention will be implemented from birth and continue for the first three years of a participating child’s life. It will involve four components: dental care provided to the mother, application of a topical fluoride to the teeth of children, anticipatory guidance and motivational interviewing. Following a kaupapa Maori research framework and methodology, the intervention will be tailored at the individual- or whanau-level, with each carer or whanau progressing to the next level only when they are ready. Developing a culturally-appropriate ECC intervention that aims to improve child oral health, in full partnership with the Maori communities involved, will provide much needed evidence for policy makers to address the challenge of improved oral health and related outcomes for Maori children. The goal of this study is to determine whether implementation of a culturally-appropriate Early Childhood Caries (ECC) intervention utilising a kaupapa Maori methodology reduces dental disease burden and oral health inequalities among young Maori children living wthin the Waikato-Tainui tribal area. More specifically, the aim is: Aim: To determine whether implementation of a culturally-appropriate ECC intervention, that employs a tailored approach and draws on a range of kaupapa Maori relevant contexts including oral health knowledge, oral self-care, dental service utilisation, and oral health-related self-efficacy, reduces dental disease burden and oral health inequalities among young Maori children living within the Waikato-Tainui tribal area. Hypothesis: Exposure to a culturally-appropriate (kaupapa Maori) ECC intervention will reduce dental disease burden and oral health inequalities among young Maori children who reside within the Waikato-Tainui tribal area. It is anticipated that implementation of a culturally-appropriate ECC intervention that aims to improve levels of oral health among tamariki Maori will, in turn, lead to improved general health outcomes. This is through (1) Maramatanga – increased understanding of the processes that lead to dental diseases and in turn, other health conditions; (2) Te Taha Tinana – a greater appreciation of the role of prevention in reducing ECC; the dietary component of which may, in turn, have benefits for other preventable, dietary-related conditions such as obesity and diabetes; (3) Te Taha Whanau – improved knowledge of lifestyle habits that are not conducive to optimim oral health; (4) Te Ara Tika – increased understanding of how to access oral health care for the whanau.