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

Objectives: This study aimed to identify strategies for implementing and integrating the Canadian Caries Risk Assessment (CRA) tool for preschoolers into the primary care of First Nations and Métis children in Manitoba, Canada, based on the perspectives of nondental primary care providers (NDPCPs). Methods: An exploratory qualitative design was employed to gather insights from NDPCPs who provide care to Indigenous children aged <6 y. Fifty participants were purposefully recruited from 10 urban, rural, and remote communities across Manitoba. Data were collected through 8 focus groups and 12 in-depth key informant interviews conducted between April 2023 and September 2024. Interviews were transcribed verbatim and analyzed thematically via an inductive approach informed by a social constructivist framework. Results: Four interrelated themes were identified by participants as central to CRA implementation and integration. Strengthening primary care systems involved training in fluoride varnish application, management endorsement, electronic medical record integration, standardized documentation, and incentives such as fee-for-service models. Building trust and culturally safe connections with Indigenous communities included establishing respectful relationships, embedding CRA into trusted programs, and addressing access barriers such as transportation and oral health supplies. Educating and engaging families focused on developing accessible educational materials and using trusted communication channels such as Facebook and local radio to improve oral health literacy. Advocating for policy changes involved calls for billing codes, sugar reduction policies, and CRA integration into existing well-child programs. Conclusion: NDPCPs in Manitoba are supportive of integrating the CRA tool into Indigenous pediatric primary care. Their recommendations offer a practical road map for CRA implementation, emphasizing systemic support, culturally responsive care, education, and policy alignment. These findings contribute to broader efforts to reduce oral health disparities and improve early childhood caries prevention in underserved populations. Knowledge Transfer Statement: Nondental primary care providers recommend integrating Caries Risk Assessment tools into Indigenous children’s care through enhanced training, culturally safe engagement, and supportive policy development to address persistent oral health inequities.