title: Dental self-care and dietary characteristics of remote-living Indigenous children.
abstract: BACKGROUND
  Indigenous children in remote communities carry a disproportionate amount of the dental disease burden among Australian 4-12 year-olds. However, there have been no reports of dental service use, dental self-care or dietary characteristics among remote-living Indigenous children. This information may provide insight into behaviours linked with the high levels of dental disease observed. The purpose of this study was to examine such behaviours among Indigenous children in three remote communities in the Top End of the Northern Territory of Australia. The study is part of a wider investigation involving the implementation and monitoring of water fluoridation plants in two of the communities, and the collection of clinical dental data from children in these three and other remote communities.
  
  
  METHODS
  In 2003, small-scale fluoridation plants were installed in two remote communities (Communities A and B) in the Top End of the Northern Territory with naturally low fluoride levels in the water and with a high prevalence of child dental disease. Another community (Community C) was selected as a comparison site (natural levels of water fluoride low). A convenience sample of carers of children from all communities completed a questionnaire that sought information on carer education and their children's age, sex, use of dental services, dental self-care behaviours, dietary characteristics, household water source and water consumption. The questionnaires were administered by a project worker and community residents once consent had been obtained. Data were analysed using SPSS version vers.13.0 (SPSS Inc; Chicago, IL, USA).
  
  
  RESULTS
  Some 214 carers completed the questionnaire for 409 children aged 4-12 years; 131 (32.0%) from Community A, 158 (38.6%) from Community B and 120 (29.3%) from Community C. The response rates for the child survey based on Census data (generally regarded as an undercount) was 55% across the three communities. Approximately one-third of carers had had no secondary schooling or could not recall their level of educational attainment. Child age was reasonably spread over the target age-range and there were no significant differences between communities by sex. Approximately one-third of children were reported to have had their teeth checked every year by a dental therapist and most children were reported to use a toothbrush. While most children were also reported to use toothpaste, only 20% of such children reportedly used it every day. Time of toothpaste use was evenly distributed between morning and evening, with a small proportion of children reportedly using it twice a day. The most common age that toothpaste use began was 4 years and most children had never taken fluoride supplements. Over three-quarters of children who reportedly consumed softdrinks, cordial, milk or flavoured milk in the evenings drank such beverages at least a few evenings each week. Over 90% of children across the three communities who reportedly drank tea, and approximately three-quarters of those who consumed sweet snacks, did so at least a few evenings each week. Almost all houses were connected to the community water supply. Most children sourced their drinking water from a tap and approximately two-thirds were reported to drink more than 4 cups of water a day.
  
  
  CONCLUSIONS
  Our study showed there were low levels of preventive dental care, irregular use of dentrifices, negligible implementation of alternative fluoride sources, high consumption of sweetened snacks and drinks in the evenings, and almost universal connection of houses to the public water supply among remote-dwelling Indigenous children. The findings provide some insights into factors contributing to the poor and declining state of such children's dental health, and should aid in the planning and implementation of oral health promotion initiatives.
authors.affiliation: Australian Research Centre for Population Oral Health, The University of Adelaide, Adelaide, South Australia, Australia. lisa.jamieson@adelaide.edu.au
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Jamieson
authors.forename: Ross S
authors.initials: RS
authors.lastname: Bailie
authors.forename: Mary
authors.initials: M
authors.lastname: Beneforti
authors.forename: Carmen R
authors.initials: CR
authors.lastname: Koster
authors.forename: Andrew John
authors.initials: AJ
authors.lastname: Spencer
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D019140:Dental Care for Children / Q000706:statistics & numerical data*; D004032:Diet; D005260:Female; D005457:Fluoridation; D006801:Humans; D008297:Male; D015876:Northern Territory; D009910:Oral Hygiene / Q000706:statistics & numerical data*; D044382:Population Groups; D012424:Rural Population; D011795:Surveys and Questionnaires