TREATING EARLY CHILDHOOD CARIES UNDER GENERAL ANESTHESIA: A NATIONAL REVIEW OF CANADIAN DATA.

INTRODUCTION: Many Canadian children are affected by early childhood caries (ECC) and require treatment under general anesthesia. The purpose of this study was to determine the burden of day surgery for children with ECC in Canada. METHODS: Day surgery abstracts for children 6 years of age with ECC were extracted from the Canadian Institute for Health Information Discharge Abstract Database and National Ambulatory Care Reporting System for 4 years, 2010/11 to 2013/14. All provinces and territories participated except Quebec. Variables considered included sex, age, proportion of immigrants in the neighbourhood, Aboriginal concentration, material deprivation index and rurality. Rates were calculated for the pooled 4-year cohort. RESULTS: The overall rate of dental surgery to treat ECC was 12.1 per 1000 children 12-59 months of age, accounting for 31.0% of all day surgeries performed on this age group in Canada. Rates of dental surgery for children from neighbourhoods with a high proportion of Aboriginal people were 7.8 times those for children living in areas with a low proportion (84.5 vs. 10.9 per 1000). For children from rural regions of Canada, rates were 3.2 times those of urban dwelling children (31.2 vs. 9.8 per 1000). Children from the least-affluent regions had dental surgery rates 3.7 times higher than those from the most-affluent communities (25.7 vs. 6.9 per 1000). Total hospital-associated costs of treating ECC under general anesthesia averaged $21184545 annually. CONCLUSION: Dental surgery for ECC is far too common and occurs more often among children from the least-affluent households, rural regions and communities with a high proportion of Aboriginal people. Dental surgery rates can serve as an important population health indicator.

Measuring the short-term impact of fluoridation cessation on dental caries in Grade 2 children using tooth surface indices.

OBJECTIVES: To examine the short-term impact of fluoridation cessation on children's caries experience measured by tooth surfaces. If there is an adverse short-term effect of cessation, it should be apparent when we focus on smooth tooth surfaces, where fluoride is most likely to have an impact for the age group and time frame considered in this study. METHODS: We examined data from population-based samples of school children (Grade 2) in two similar cities in the province of Alberta, Canada: Calgary, where cessation occurred in May 2011 and Edmonton where fluoridation remains in place. We analysed change over time (2004/2005 to 2013/2014) in summary data for primary (defs) and permanent (DMFS) teeth for Calgary and Edmonton, for all tooth surfaces and smooth surfaces only. We also considered, for 2013/2014 only, the exposed subsample defined as lifelong residents who reported usually drinking tap water. RESULTS: We observed, across the full sample, an increase in primary tooth decay (mean defs - all surfaces and smooth surfaces) in both cities, but the magnitude of the increase was greater in Calgary (F-cessation) than in Edmonton (F-continued). For permanent tooth decay, when focusing on smooth surfaces among those affected (those with DMFS>0), we observed a non-significant trend towards an increase in Calgary (F-cessation) that was not apparent in Edmonton (F-continued). CONCLUSIONS: Trends observed for primary teeth were consistent with an adverse effect of fluoridation cessation on children's tooth decay, 2.5-3 years post-cessation. Trends for permanent teeth hinted at early indication of an adverse effect. It is important that future data collection efforts in the two cities be undertaken, to permit continued monitoring of these trends.

Equity in children's dental caries before and after cessation of community water fluoridation: differential impact by dental insurance status and geographic material deprivation.

BACKGROUND: One of the main arguments made in favor of community water fluoridation is that it is equitable in its impact on dental caries (i.e., helps to offset inequities in dental caries). Although an equitable effect of fluoridation has been demonstrated in cross-sectional studies, it has not been studied in the context of cessation of community water fluoridation (CWF). The objective of this study was to compare the socio-economic patterns of children's dental caries (tooth decay) in Calgary, Canada, in 2009/10 when CWF was in place, and in 2013/14, after it had been discontinued. METHODS: We analyzed data from population-based samples of schoolchildren (grade 2) in 2009/10 and 2013/14. Data on dental caries (decayed, missing, and filled primary and permanent teeth) were gathered via open mouth exams conducted in schools by registered dental hygienists. We examined the association between dental caries and 1) presence/absence of dental insurance and 2) small area index of material deprivation, using Poisson (zero-inflated) and logistic regression, for both time points separately. For small-area material deprivation at each time point, we also computed the concentration index of inequality for each outcome variable. RESULTS: Statistically significant inequities by dental insurance status and by small area material deprivation were more apparent in 2013/14 than in 2009/10. CONCLUSIONS: Results are consistent with increasing inequities in dental caries following cessation of CWF. However, further research is needed to 1) confirm the effects in a study that includes a comparison community, and 2) explore possible alternative reasons for the findings, including changes in treatment and preventive programming.