Indigenous Mothers' Oral Health Literacy and Early Childhood Caries in Canada

Objectives: To investigate the relationship between Early Childhood Caries (ECC) incidence and Oral Health Literacy (OHL) and Knowledge among mothers of First Nations children in Canada.
Methods: As part of the “Baby Teeth Talk” Study, a community-based ECC-preventive randomized controlled trial, this research used data from its 2-year follow-up with a sample of 347 mother-child dyads from Indigenous communities in Manitoba and Ontario. The ECC definition followed the American Academy of Pediatric Dentistry. OHL was measured by a modified version of the Health Literacy in Dentistry scale (HeLD) with 16 questions. The outcome variable was ‘no’ ECC incidence from birth to age 2 (dmft=0). Independent variables included mother’s age, employment, education, area of residence, and self-rated oral health, and child’s feeding habits, caregiver’s perceptions of child oral health, oral hygiene practices, and visit to a dental professional.
Results: Multivariate analysis of modifiable risk factors showed a significant relationship between ECC incidence in the first two years of life and mothers’ OHL. First Nations mothers with higher OHL (OR=2.85), as well as those who never put their child to sleep with a bottle (2.45) and whose children consume fruits and vegetables (OR=2.21), have had no experience with ECC (23.0%). Otherwise, visiting a dental professional (OR=2.77) and the belief that “there is nothing wrong with putting the child to sleep with a bottle” (OR=1.97) predicted the incidence of ECC.
Conclusions:
Results confirm that the mother’s OHL is an important determinant for the oral health of her child, in addition to her knowledge and attitude regarding the proper use of the bottle at sleep time. Visiting a dental professional most often occurred when ECC was already present. Improving mothers’ OHL, changing child-feeding behaviors and greater emphasis on early preventive dental visits for children are important steps to reducing ECC in Indigenous communities.