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Recommendations for Integrating Caries Risk Assessment into Primary Care for Indigenous Children.

O O Olatosi1,2,3, R J Schroth1,2,3,4,5, D DeMaré1,3

  • 1Department of Preventive Dental Science, Dr. Gerald Niznick College of Dentistry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.

JDR Clinical and Translational Research
|September 19, 2025
PubMed
Summary

Nondental primary care providers in Manitoba support integrating the Canadian Caries Risk Assessment (CRA) tool for Indigenous children. Recommendations focus on system support, cultural safety, family education, and policy changes to improve pediatric oral health.

Keywords:
Indigenousaccess to carechildhealthhealth promotionhealth servicesoral healthpreschoolprimary health care

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Area of Science:

  • Public Health
  • Pediatric Dentistry
  • Indigenous Health

Background:

  • Early childhood caries (ECC) is a significant public health issue, particularly among Indigenous populations.
  • Integrating oral health screening into primary care settings offers a promising avenue for early intervention and prevention.
  • The Canadian Caries Risk Assessment (CRA) tool has the potential to enhance early detection and management of caries risk in young children.

Purpose of the Study:

  • To explore strategies for implementing and integrating the Canadian Caries Risk Assessment (CRA) tool into primary care for First Nations and Métis children in Manitoba.
  • To gather perspectives from nondental primary care providers (NDPCPs) on facilitators and barriers to CRA tool adoption.
  • To inform the development of culturally safe and effective approaches for pediatric oral health promotion in Indigenous communities.

Main Methods:

  • An exploratory qualitative study design was utilized.
  • Fifty NDPCPs providing care to Indigenous children under 6 years old were recruited from diverse communities across Manitoba.
  • Data were collected through focus groups and key informant interviews, followed by thematic analysis using an inductive approach.

Main Results:

  • Four key themes emerged: strengthening primary care systems (training, EMR integration, incentives), building trust and culturally safe connections (respectful relationships, addressing access barriers), educating and engaging families (accessible materials, trusted channels), and advocating for policy changes (billing codes, sugar reduction).
  • NDPCPs expressed support for CRA tool integration, highlighting the need for systemic support, culturally responsive practices, and policy alignment.
  • Participants emphasized the importance of addressing practical barriers such as transportation and the availability of oral health supplies.

Conclusions:

  • NDPCPs in Manitoba are amenable to integrating the CRA tool into pediatric primary care for Indigenous children.
  • The study provides a practical roadmap for CRA implementation, emphasizing the need for enhanced training, culturally safe engagement, and supportive policy development.
  • These findings are crucial for reducing oral health disparities and improving early childhood caries prevention in underserved populations.