Dental Survey of Kindergarten-Aged Children 2009-2010 A Provincial and First Nations School Analysis Ministry of Health Services Healthy Women, Children and Youth Secretariat Population and Public Health January 13, 2011 1
Contents Executive Summary... 3 Introduction... 5 Screening Criteria and Definitions... 7 Target Population... 7 Participating First Nations Schools... 8 Kindergarten Dental Survey... 10 First Nations Schools Kindergarten Dental Survey... 16 Conclusion... 23 Appendix 1: Parental Consent Form for Screening in First Nations Schools... 24 Appendix 2: Dental Survey Data by Health Authority... 26 Appendix 3: First Nations Schools Dental Survey Data by Health Authority... 27 2
Executive Summary In 2009-2010, a provincial dental survey was conducted by health authority dental staff to measure the dental health of kindergarten age children. A total of 35,420 children participated in the provincial dental survey. The provincial dental survey included 2219 children attending public and independent schools and 226 First Nations children attending 33 First Nations schools. It has always been thought that children have higher rates of early childhood caries. The results of this survey confirm that children have poorer dental health than non- children, and that children in First Nations schools have even poorer dental health than children in public or independent schools. When reviewing the results of this report, it is important to recognize the context of how health services are offered and delivered. First Nations people on reserve receive a mix of dental health prevention services and programs funded through Health Canada s First Nation Inuit Health program and the regional health authorities. Some First Nations communities have contracts with other organizations or provide services directly. Not all communities receive the same level of services or programs. In addition, some First Nations communities and schools follow specific protocols or processes that provide direction on how health authority staff engage with First Nations communities. In 2009-10, a new parental consent form was introduced for children participating in dental screening in First Nations schools. Results (Includes public, independent and First Nations Schools) Caries Immune: 39.3% of children in BC were caries immune, compared to 65.1% of non- children. No Visible Decay: 32.2% of children in BC had no evidence of visible decay but had restorations present, compared to 18.8% of non- children; Visible Decay: 28.5% of children in BC had evidence of visible decay, compared to 16.2% of non- children. Visible Decay in Three or Four Quadrants: 8.8% of kindergarten-aged children had evidence of decay in 3 or 4 quadrants, compared to 3.7% of non- children. Urgent Referrals: 5.0% of children in BC received urgent referrals for dental treatment, compared to 1.8% of non- children. urgent Referrals: 24.4% of children in BC received non-urgent referrals for dental treatment, compared to 14.6% of non- children. First Nations Schools Results (on reserve) Caries Immune: 18.1% of First Nations children attending First Nations schools were caries immune, compared to 41.5% of children attending public or independent schools. No Visible Decay: 47.3% of First Nations children attending First Nations schools had no visible decay but restorations present, compared to 30.7% of children attending public or independent schools. 3
Visible Decay: 34.5% of First Nations children attending First Nations schools had evidence of visible decay, compared to 27.9% of children attending public or independent schools. Visible Decay in Three or Four Quadrants: 9.3% of First Nations children attending First Nations schools had evidence of decay in three or four quadrants, compared to 8.8% of children attending public or independent schools. Percentage Screened: In 2006-07, 84.9% of First Nations children enrolled in participating First Nations schools were screened. In 2009-10 the percentage of children screened in participating schools dropped to 71.3%, following the introduction of a parental consent-based process. Reasons for not screening included parental refusal, parents not returning consent forms, parents returning blank consent forms, and child absenteeism. Also, at least four schools who agreed to participate could not be screened because either the consent process was not put into place in time or no consent forms were returned. 4
Introduction Dental health has been shown to have a significant impact on general health and well-being. Research has found associations between dental disease and a variety of other diseases, including diabetes, heart disease and respiratory disease. 1 The two primary dental diseases are caries and periodontal disease. Caries is an infectious and transmissible disease which young children often acquire through a primary caregiver before age three. 2 Childhood prevention is important to ensuring long-term reductions in dental caries. Public health dental services in BC provide a variety of programs focusing on the early years including education initiatives, fluoride varnish application for children at risk of dental decay, caries risk assessment, and support for families in accessing dental treatment. Broad, multi-component strategies have been used to provide education on preventing oral disease, particularly early childhood caries. In 2005, the Ministry of Health Services (MOHS) provided funding to the BC Dental Association for a three-year media awareness and education program about early childhood caries. MOHS also worked with the BC Dental Association to raise professional and parent awareness and education through resource development. Two dental health DVDs were developed: one for parents and care providers focusing on dental caries prevention, and one for dentists and dental offices that provides strategies for working with young children in their dental practices. A DVD for parents and communities about prevention of dental decay and oral health care is currently being developed by the First Nations Health Council. First Nations people on reserve receive a mix of dental health prevention services and programs funded through Health Canada s First Nation Inuit Health program and the regional health authorities. Some First Nations communities have contracts with other organizations or provide services directly. Not all communities receive the same level of services or programs. Some First Nations communities receive services through Health Canada s Children s Oral Health initiative (COHI). COHI was developed as a means to address the disparity between the oral health of First Nations and Inuit and that of the general Canadian population. COHI was launched on a test basis in Fall 2004 and has expanded to sixty one communities in BC. The program focuses on the prevention of dental disease and promotion of good oral health practices. In order to measure the dental health status of kindergarten children and the success of early childhood dental health promotion activities, a provincial kindergarten dental survey was conducted by health authority dental staff in 2009-10. The full report of the provincial survey can be accessed at http://www.health.gov.bc.ca/women-andchildren/pdf/kindergarten-dental-survey.pdf. A total of 35,420 children participated in the provincial dental survey (91.1% of all those enrolled). 3 The provincial dental survey 1 Model Core Program paper for Dental Public Health, October 2006. 2 Model Core Program paper for Dental Public Health, October 2006. 3 2009-10 provincial dental graphs 5
included 2425 children attending either a public school, independent school, or one of 33 participating First Nations schools (83.5% of those enrolled and identified as in participating schools). Dental screening is a key action item in the Transformative Change Accord, First Nations Health Plan. In order to report progress on this action item, health authorities were asked to collect identifiers for all children surveyed both in public and on-reserve First Nations schools and report survey data. In public school settings, teachers and school enrolment information was used to elicit identity for kindergarten children surveyed. The School Act provides the authority for public health staff to access student demographic information for public health programs delivered in school settings. Health authorities use a practice of parent notification with an opt out process for the dental survey. Parents are notified by letter about the dental health survey, and are informed when the survey will occur and provided with the health authority contact phone number if further information is needed or to decline participation in the survey. The opt out process allows parents to decline services with no consequences to future service provision or care of their child. If the parent does not contact public health, the child is screened. The process of parent notification and opt out was also used in First Nations school on reserve in 2006-2007. In 2009-2010, new protocols were developed by First Nations Health Council in collaboration with the former Ministry of Healthy Living and Sport and the First Nations School Association. Public health staff were asked to follow protocols for First Nations Schools on reserve if existing relationships were not established. These new First Nation protocols included a parental consent process, whereby signed parental consent was required prior to providing screening services. During the screening program, kindergarten children were assessed for: evidence of no visible dental decay (caries immune), evidence of no visible decay but evidence of existing restorations, evidence of pain or infection at the time of screening, evidence of visible dental decay in one or more teeth, and number of quadrants with decay. The following are suggested benchmarks for prevention of dental disease: 60% of school-entry children are caries free (no decay and no fillings), less than 20% of school entry children have unmet dental treatment needs 4. This report compares the dental screening results of kindergarten children in BC to that of non- kindergarten children in BC. It also compares the dental screening results of children in public schools to that of First Nations children in First Nations schools. Finally, it directly compares dental screening results in twelve First Nations schools that were screened in both 2009-2010 and 2006-2007. 4 Model Core Program paper for Dental Public Health, October 2006 6
Screening Criteria and Definitions Caries Immune No Visible Decay Visible Decay No evidence of visible decay and no existing restorations No evidence of visible decay but evidence of existing restorations Evidence of obvious decay in one or more teeth Decay in Quadrants Evidence of decay in one or more teeth in 1, 2, 3, or 4 quadrants Urgent referrals urgent referrals Children who were referred for further treatment due to the urgency of their conditions Children who did not have urgent conditions but were referred for further treatment Target Population The population for this program is school children (kindergarten) between the ages of 4 and 6 across the province. 7
Participating First Nations Schools Participating schools include schools where at least one child was screened and the results were recorded and available for analysis. This list does not include schools that agreed to participate but did not get the consent process in place in time to complete the screening. Health Authority School Name 2009-10 2006-07 COHI Program 5 Interior A'q'Amnik Nagwantloo Neqweyqwelsten Nlapapamux Nta mtqen Snm alm ayatn Outma Squilxw Sensisyusten Sen Pok Chin Skeetchestn Sk'elep Sxoxmic Tl'etinqox School Tsi Del Del Yaqan Nukiy Yunesit'in 12 schools 6 schools Fraser 0 schools 0 schools Vancouver Coastal Acwsalcta Band Xit'Olacw Xwemelch'stn 6 Head of the Lake 7 4 schools 2 schools Vancouver Island Gwasala Kingcome Inlet Kuper Island LauWelnew Nutsmaat Lelum Quam Quam Quatsino T'Lisalagi"Lak Wagalus 9 schools 6 schools 5 Some First Nations communities receive services through Health Canada s Children s Oral Health initiative (COHI). This list indicates schools were it is known that there are COHI programs in place. 6 The name of this school has changed to Capilano Little Ones. This school was not included in the analysis because it was not identified as a First Nations school prior to conducting the analysis. 7 This school was not included in the analysis because it was not identified as a First Nations school prior to conducting the analysis. 8
Health Authority School Name 2009-10 2006-07 COHI Program 5 Northern Chalo Chief Matthews School Eugene Joseph Gitnayow Gitsegulka Haisla Elementary Kisopiox Klappen Lach Klan Elementary Morris Williams Nak'albun Nisga s Elementary Prophet Saulteau 10 schools 6 schools TOTAL 33 schools 20 schools 9
Kindergarten Dental Survey In 2009-10, 2425 children had their teeth screened in public, independent and First Nations schools in BC (83.5% of those enrolled and identified as in participating schools). Not all First Nations schools were screened, and it is possible that some children in public or independent schools were not identified as. No First Nations schools were screened in the Fraser Health Authority. Figure 1: Percent caries immune, restorations present and visible decay for and, Provincial Dental Survey, 2009/10 (95% confidence intervals displayed) 8 0% 20% 40% 60% 80% 100% % Caries Immune 65.1% 39.3% % Restorations Present 18.8% 32.2% % Visible Decay 16.2% 28.5% Figure 1 shows the percentage of and non- children in BC who were caries immune, had no evidence of visible decay but restorations present, or had evidence of visible decay in 2009-10: 39.3% of children were caries immune, compared to 65.1% of non- children. 32.2% of children had no evidence of visible decay but had restorations present, compared to 18.8% of non- children. 28.5% of children had evidence of visible decay, compared to 16.2% of non- children. 8 2009-10 Dental Survey Analysis 10
NHA VIHA VCHA FHA IHA Figure 2: Percent caries immune, restorations present and visible decay for and by Health Authority, Provincial Dental Survey, 2009/10 (95% confidence intervals displayed) 0% 20% 40% 60% 80% 100% NHA VIHA VCHA FHA IHA % Caries Immune 61.7% 34.1% 68.9% 35.2% 66.0% 39.2% 63.1% 47.0% 66.7% 38.0% % Restorations Present 19.8% 32.7% 18.5% 40.2% 17.7% 35.5% 20.0% 26.6% 17.1% 29.1% % Visible Decay 18.5% 33.2% 12.6% 24.5% 16.3% 25.3% 16.9% 26.4% 16.2% 32.9% 9 9 2009-10 Dental Survey Analysis 11
Figure 2 shows the percentage of and non- children in each health authority who were caries immune, had no evidence of visible decay but restorations present, or had evidence of visible decay in 2009-10: Fraser, followed by Vancouver Coastal, had the highest percentage of children who were caries immune (47.0% and 39.2%). Fraser s higher result should be interpreted with caution because no First Nations schools were screened in this Health Authority. Vancouver Island and Vancouver Coastal had the highest percentage of children with no visible decay and restorations present (40.2% and 35.5%, respectively). Northern and Interior had the highest percentage of children with evidence of visible decay (33.2% and 32.9%, respectively). Figure 3: Percent decay for and by quadrant, Provincial Dental Survey, 2009/10 (95% confidence intervals displayed) 10 0% 10% 20% 30% 40% % 1 Quadrant 6.2% 9.5% % 2 Quadrants 6.2% 10.2% % 3 Quadrants 1.7% 3.7% % 4 Quadrants 2.0% 5.1% Total Visible Decay 16.2% 28.5% Figure 3 shows the percentage of and non- children in BC who had evidence of visible decay in 1, 2, 3, or 4 quadrants in 2009-10: 19.7% of children had evidence of decay in 1 or 2 quadrants, compared to 12.4% of non- children. 8.8% of kindergarten-aged children had evidence of decay in 3 or 4 quadrants, compared to 3.7% of non- children. 10 2009-10 Dental Survey Analysis 12
NHA VIHA VCHA FHA IHA Figure 4: Percent decay for and by quadrant and Health Authority, Provincial Dental Survey, 2009/10 (95% confidence intervals displayed) 0% 10% 20% 30% 40% NHA VIHA VCHA FHA IHA % 1 Quadrant 8.2% 9.6% 6.5% 9.8% 4.7% 7.5% 5.9% 7.8% 7.7% 12.1% % 2 Quadrants 6.6% 13.7% 4.1% 7.7% 7.4% 10.9% 6.6% 9.9% 5.3% 10.1% % 3 Quadrants 1.9% 4.8% 1.2% 2.4% 2.0% 2.6% 1.9% 3.1% 1.5% 5.3% % 4 Quadrants 1.7% 5.0% 0.9% 4.6% 2.2% 4.2% 2.5% 5.6% 1.7% 5.5% Total Visible Decay 18.5% 33.2% 12.6% 24.5% 16.3% 25.3% 16.9% 26.4% 16.2% 32.9% 11 11 2009-10 Dental Survey Analysis 13
Figure 4 shows the percentage of and non- children in each health authority who had evidence of visible decay in 1, 2, 3, or 4 quadrants in 2009-10: Interior, followed by Vancouver Island, had the highest percentage of children with evidence of visible decay in one quadrant (12.1% and 9.8%, respectively). Northern, followed by Vancouver Coastal, had the highest percentage of children with evidence of visible decay in two quadrants (13.7% and 10.9% respectively). Interior and Northern had the highest percentage of children with evidence of visible decay in three quadrants (5.3% and 4.8% respectively). Fraser and Interior, had the highest percentage of children with evidence of visible decay in four quadrants (5.6% and 5.5%, respectively). Figure 5: Percent requiring referrals for and, Provincial Dental Survey, 2009/10 (95% confidence intervals displayed) 0% 10% 20% 30% 40% % Urgent referrals 1.8% 5.0% % urgent referrals 14.6% 24.4% Total Referrals 16.4% 29.4% 12 Figure 5 shows the percentage of and non- children in BC who were referred for dental treatment in 2009-10: 5.0% of children received urgent referrals, compared to 1.8% of non- children 24.4% of children received non-urgent referrals, compared to 14.6% of non- children 12 2009-10 Dental Survey Analysis 14
NHA VIHA VCHA FHA IHA Figure 6: Percent requiring referrals for and by Health Authority, Provincial Dental Survey, 2009/10 (95% confidence intervals displayed) 0% 10% 20% 30% 40% NHA VIHA VCHA FHA IHA % Urgent referrals 2.6% 7.0% 0.5% 4.1% 1.2% 2.3% 2.1% 5.0% 2.8% 5.7% % urgent referrals 16.2% 28.4% 12.0% 21.4% 15.4% 23.0% 14.9% 22.0% 13.9% 27.8% Total Referrals 18.8% 35.3% 12.5% 25.5% 16.6% 25.3% 17.0% 27.0% 16.7% 33.5% 13 13 2009-10 Dental Survey Analysis 15
Figure 5 shows the percentage of and non- children in each health authority who were referred for dental treatment in 2009-10: Northern and Interior had the highest percentage of children who received urgent referrals (7.0% and 5.7%, respectively). Northern and Interior had the highest percentage of children who received non-urgent referrals (28.4% and 27.8%, respectively). First Nations Schools Kindergarten Dental Survey The following section of the report focuses on dental survey results for First Nations schools on reserve. In 2009-10, 33 First Nations schools participated in the dental survey. These schools represent 39.8% 14 of all First Nations schools offering kindergarten in BC. It is not known whether these 33 schools were chosen due to enrolment size, location, history of prior service delivery or other factors. Of the 33 schools screened, 11 were located in communities that receive services through Health Canada s Children's Oral Health Initiative. A total of 226 children were screened, or 34.9% 15 of all kindergarten children enrolled in First Nations schools in BC. At least eight schools that were offered screening declined participation. No First Nations schools were screened in the Fraser Health Authority; this health authority identified time constraints as a barrier to screening. In 2006-07, 20 First Nations schools participated in the dental survey. In 2009-10, 13 more schools participated; however, fewer children within these schools were screened. This drop in the screening rate reflects a new parental consent process that was introduced in 2009-10. In 2006-07, parents received a letter notifying them of the upcoming dental survey and were given the option of opting out of the survey. In 2009-10, parents were asked to return a written consent form. This consent process introduced two barriers to screening: 1. Some First Nations schools who agreed to participate did not put the consent process into place; public health staff were therefore unable to survey children in these schools. 2. In many First Nations schools that agreed to participate and introduced the consent process, obtaining consent was a challenge. Reasons for not screening included parental refusal, parents returning blank consent forms, and parents not returning consent forms. Table 1 shows the number of participating First Nations schools and the number of children screened in each health authority. 14 2009-10 First Nations schools K enrolment 15 2009-10 First Nations schools K enrolment 16
Table 1: Health Authority and First Nation School Participation Health Authority Number of participating schools (at least one child screened and data available) Number of schools that declined participation Number of schools who could not participate because they did not obtain parental consent Number of children enrolled in participating schools Number of children screened in participating schools Interior 12 4 1 72 41 Fraser 0 n/a n/a n/a n/a Vancouver Coastal 2 16 Unknown Unknown 29 29 Vancouver 9 2 0 123 95 Island Northern 10 2 At least 3 93 61 TOTAL 33 Unknown Unknown 317 226 Source: 2006-2009 First Nations Dental Survey Analysis and communication with health authority program leads. 16 Two additional First Nations schools were screened in the Vancouver Coastal Health Authority; however, these schools were not included in the analysis because they were not identified as First Nations schools prior to conducting the analysis. 17
Figure 7: Percent of children screened among participating First Nations schools with a minimum of one child screened, 2006/07 and 2009/10 100% 80% 60% 40% 20% 0% IHA NHA VCHA VIHA Overall BC 2006 80.6% 91.8% 89.5% 82.0% 84.9% 2009 56.9% 65.6% 100.0% 77.2% 71.3% Schools which agreed to participate, but at which there were no children screened have been removed from this analysis. 17 Figure 7 shows the percentage of children screened in participating First Nations schools in 2006-07 and 2009-10. In 2006-07, 84.9% of First Nations children enrolled in participating schools were screened. In 2009-10, the parental consent form was introduced for First Nations schools, and only 71.3% of children in participating schools were screened. This 13.6% decline in the screening rate may be the result of parents not consenting to screening or not returning consent forms. 17 2006-2009 First Nations Dental Survey Analysis 18
Figure 8: Percent caries immune, restorations present and visible decay for children attending First Nations Schools and those attending public or independent schools, Provincial Dental Survey, 2009/10 (95% confidence intervals displayed) First Nations Public/Independent 0% 20% 40% 60% 80% 100% Public/Independent First Nations % Caries Immune 41.5% 18.1% % Restorations Present 30.7% 47.3% % Visible Decay 27.9% 34.5% 18 Figure 8 shows the percentage of children in First Nations schools and children in public or independent schools who were caries immune, had no evidence of visible decay but restorations present, or had evidence of visible decay in 2009-10: 18.1% of First Nations children attending First Nations schools were caries immune, compared to 41.5% of children attending public or independent schools. 47.3% of First Nations children attending First Nations schools had no visible decay but restorations present, compared to 30.7% of children attending public or independent schools. 34.5% of First Nations children attending First Nations schools had evidence of visible decay, compared to 27.9% of children attending public or independent schools. 18 2006-2009 First Nations Dental Survey Analysis 19
NHA VIHA VCHA IHA Figure 9: Percent caries immune, restorations present and visible decay for children attending First Nations Schools and those attending public or independent schools by Health Authority, Provincial Dental Survey, 2009/10 (95% confidence interv First Nations Public/Indep First Nations Public/Indep First Nations Public/Indep First Nations Public/Indep 0% 20% 40% 60% 80% 100% NHA VIHA VCHA IHA Public/Indep First Nations Public/Indep First Nations Public/Indep First Nations Public/Indep First Nations % Caries Immune 36.6% 19.7% 39.8% 13.7% 40.7% 27.6% 39.5% 19.5% % Restorations Present 31.0% 42.6% 37.1% 54.7% 34.3% 44.8% 28.3% 39.0% % Visible Decay 32.4% 37.7% 23.0% 31.6% 25.0% 27.6% 32.2% 41.5% 19 19 2006-2009 First Nations Dental Survey Analysis 20
Figure 9 shows the percentage of First Nations children in First Nations schools and children in public or independent schools in each health authority who were caries immune, had no evidence of visible decay but restorations present, or had evidence of visible decay in 2009-10. The survey results in the First Nations schools should be interpreted with caution because of varying sample sizes among the health authorities. Figure 10: Percent decay by quadrant for children attending First Nations Schools and those attending public or independent schools, Provincial Dental Survey, 2009/10 (95% confidence intervals displayed) First Nations Schools Public/Independent Schools 20 0% 10% 20% 30% 40% Public/Independent Schools First Nations Schools % 1 Quadrant 9.2% 12.4% % 2 Quadrants 10.0% 12.8% % 3 Quadrants 3.8% 2.7% % 4 Quadrants 5.0% 6.6% Total Visible Decay 27.9% 34.5% Figure 10 shows the percentage of First Nations children in First Nations schools and children in public or independent schools who had evidence of visible decay in 1, 2, 3, or 4 quadrants in 2009-10: 12.4% of First Nations children attending First Nations schools had evidence of decay in one quadrant, compared to 9.2% of children attending public or independent schools. 12.8% of First Nations children attending First Nations schools had evidence of decay in two quadrants, compared to 10.0% of children attending public schools. 2.7% of First Nations children attending First Nations schools had evidence of decay in three quadrants, compared to 3.8% of children attending public schools. 6.6% of First Nations children attending First Nations schools had evidence of decay in four quadrants, compared to 5.0% of children attending public schools. 20 2006-2009 First Nations Dental Survey Analysis 21
Figure 11: Percent caries immune, restorations present and visible decay for children attending First Nations Schools, Comparing Provincial Dental Survey 2006/07 with 2009/10 (95% confidence intervals displayed) 2009 2006 0% 20% 40% 60% 80% 100% 2006 2009 % Caries Immune 16.8% 18.9% % Restorations Present 49.0% 41.7% % Visible Decay 34.2% 39.4% 21 Only schools with children screened in both 2006/07 and 2009/10 have been included in this comparison. There were twelve First Nations schools that were screened in both 2006-07 and 2009-2010. Figure 11 compares the dental survey results of these twelve First Nations schools from 2006-07 to 2009-10: The percentage of caries immune children increased by 2.1%. The percentage of children with no visible decay and restorations present decreased by 7.3%. The percentage of children with evidence of visible decay increased by 5.2%. Because these results are limited to twelve schools, they should be interpreted with caution. 21 2006-2009 First Nations Dental Survey Analysis 22
Conclusion Good dental health has a significant impact on overall health and wellness. The 2009-2010 kindergarten dental survey provides an indication of the dental health of children in BC. The results indicate that 39.3% of children surveyed were caries immune and 32.2% had no visible decay but restorations present. In total, 71.5% of children surveyed had no evidence of visible decay. The dental survey results also indicate that 28.5% of kindergartenaged children had evidence of visible decay. 8.8% of these children had evidence of decay in three or four quadrants, compared to 3.7% of non- children. First Nations children attending First Nations schools had evidence of worse dental health than children attending public or independent schools. 41.5% of children attending public or independent schools were caries immune, while only 18.1% of First Nations children attending First Nations schools were caries immune. First Nations schools had a higher percentage of children with no visible decay and restorations present and a higher percentage of children with evidence of visible decay. In First Nations schools, 9.3% of children showed evidence of decay in three or four quadrants compared to 8.8% of children in public or independent schools. The percentage of First Nations children screened in participating First Nations schools dropped significantly from 2006-07 to 2009-10 (from 84.9% to 71.3%). In 2009-10, a parental consent requirement was introduced. Previously parents were given the option of opting out of the screening, but if they did not indicate otherwise, consent was implied. The introduction of required consent may have created a barrier to screening. Additional work is needed to address the disparities in early childhood dental health and to close the gap between and non- children. This includes increasing the number of children who are caries free and reducing rates of early childhood dental decay. Continued collaboration and program planning is needed between Tripartite partners to address early childhood dental health for children both on and off reserve. This includes ensuring preventative services are available and that dental health messages are integrated within public health prevention programs, improving coordination of service delivery and program monitoring, and making available culturally appropriate educational resources for families and care providers about prevention of early childhood caries. The provincial dental survey is an important tool for monitoring trends between regions and within communities as well as for evaluating the effectiveness of multiple prevention strategies in an effort to decrease the rate of dental caries in young children. The survey results inform public health program planning and allocation of resources to those areas with identified need, where those needs can be addressed through preventative programs. Subsequent kindergarten surveys will be important for monitoring trends and identifying changes in the dental health status of children. 23
Appendix 1: Sample - Parental Consent Form for Screening in First Nations Schools Consent for Kindergarten Dental, Hearing and Vision Screening Dear Parent or Guardian; Public Health staff will be working with your community to offer dental, hearing and vision screening for kindergarten students at your child s school on. The goal is to find children who may need extra help with their teeth, hearing and vision. What do you need to know? It s free, fast and easy for the children Children do not need to be able to read - staff will check their eyes with a special machine The public health dental staff will look into children s mouths using a flashlight Children will listen to sounds through headphones to check their hearing We will let you know in writing what we find and suggest any follow-up needed Screening does not replace regular check-ups by your family doctor, dentist, eye doctor or ear specialist Children seen by an eye doctor or ear specialist in the last 6 months may not need screening, so contact the health unit if you have questions about this. The school will be asked to assist public health staff by providing a copy of the enrolment list. Information about your child s screening will be recorded in your child s health record at the Health Unit and is used to help with your child s referral and follow up. As well, some information is used for evaluation of the programs by the Vancouver Island Health Authority and at a provincial level. To support your child s learning we will also notify your child s school principal of the screening results. We collect, use and share this information only as allowed by law the Freedom of Information and Protection of Privacy Act. Parents or guardians need to sign and return this consent before screening can be provided. Please complete the information section below. Check either agree or do not agree, sign, date and return the form to the school. Choosing not to participate will not affect your child s eligibility for other services or quality of care provided. 24
Appendix 1: Parental Consent for Screening in First Nations Schools (continued) Please fill in the sections below and return this form to your child s school. Child s Last Name First Name Birthdate (Day/month/year) Carecard # School Name of Parent/Guardian Relationship to Child Address Day Phone /Cell Phone Evening Phone/Cell Phone I have read the above information and want my child to receive the following screening services: Dental Screening I agree I do not agree Hearing Screening I agree I do not agree Vision Screening I agree I do not agree Share Screening results with principal I agree I do not agree Signature Date * This consent is valid for a period of 1 year from the date of your signature, but can be withdrawn at anytime. If you have any questions about these programs, or about your child s vision, dental health or hearing, please contact us. Sincerely, Kindergarten Screening Program Child, Youth and Family Community Health Saanich Health Unit 3995 Quadra Street, Victoria BC V8X 1J8 Tel: 250-519-5100 Fax: 250-744-1042 25
Appendix 2: Dental Survey Data by Health Authority 2009-2010 (includes public, independent, and participating First Nations schools) HA Screened Enrolled Caries Immune No Visible Decay Visible Decay 1 Quad 2 Quad 3 Quad 4 Quad Urgent referrals urgent referrals IHA 547 666 208 159 180 66 55 29 30 31 152 FHA 655 748 308 174 173 51 65 20 37 33 144 VCHA 265 310 104 94 67 20 29 7 11 6 61 VIHA 542 647 191 218 133 53 42 13 25 22 116 NHA 416 532 142 136 138 40 57 20 21 29 118 BC 2425 2903 953 781 691 230 248 89 124 121 591 Source: 2009-10 Dental Survey Analysis Definitions a) Caries Immune - No evidence of visible decay and no existing restorations b) No Visible Decay No evidence of visible decay but evidence of existing restorations c) Visible Decay Evidence of obvious decay in one or more teeth d) Decay in Quadrants Evidence of decay in one of more teeth in 1, 2, 3 or 4 quadrants. e) Urgent Referrals Children who were referred for further treatment due to the urgency of their condition f) urgent Referrals Children who did not have urgent conditions but were referred for further treatment Statistics are based on data received from health authorities as of Oct. 12, 2010. Any data received after Oct. 12, 2010 date was not included in the analysis. 26
Appendix 3: First Nations Schools Dental Survey Data by Health Authority 2009-2010 (includes participating First Nations schools) HA Screened Enrolled Caries Immune No Visible Decay Visible Decay 1 Quad 2 Quad 3 Quad 4 Quad IHA 41 72 8 16 17 5 7 3 2 FHA 0 0 0 0 0 0 0 0 0 VCHA 29 29 8 13 8 1 4 0 3 VIHA 95 123 13 52 30 14 4 2 10 NHA 61 93 12 26 23 8 14 1 0 TOTAL 226 317 41 107 78 28 29 6 15 Source: 2006-2009 First Nations Dental Survey Analysis Definitions g) Caries Immune - No evidence of visible decay and no existing restorations h) No Visible Decay No evidence of visible decay but evidence of existing restorations i) Visible Decay Evidence of obvious decay in one or more teeth j) Decay in Quadrants Evidence of decay in one of more teeth in 1, 2, 3 or 4 quadrants. k) Urgent Referrals Children who were referred for further treatment due to the urgency of their condition l) urgent Referrals Children who did not have urgent conditions but were referred for further treatment Statistics are based on data received from health authorities as of Oct. 12, 2010. Any data received after Oct. 12, 2010 date was not included in the analysis. 27