Tooth decay is a disease, however with good oral hygiene and practice, it is preventable. Steps to prevent it ideally should begin prenatally with pregnant women and continue with the mother and young child.Early risk assessment should be carried out to screen for parent-infant groups who are at risk of early childhood dental caries and who would arguably benefit from early intervention. Timely delivery of educational information to populations at high risk of caries helps to avoid the need for later surgical intervention.The problem is exacerbated by inappropriate feeding practices, poor oral hygiene and lack of fluoride, which together create the ideal conditions for bacteria to produce acids that demineralise tooth enamel and cause cavities (MOH, 2006).

Improving oral health is one of the 13 health improvement priorities outlined in the New Zealand Health Strategy (2000), is a strategic priority for the Counties Manukau District Health Board (CMDHB) (2005),  and is one of the 12 priorities for Maori health (Ministry of Health 2006). In the Counties Manukau Oral Health Plan (2005),  Maori, preschoolers and an increase in oral health promotion and prevention are all identified as priority areas of focus. This is in response to the inequalities evident in child oral health outcome data where Maori children have the worst oral health status at age five when compared with non-Maori in New Zealand (Ministry of Health, 2006) and more children under five years of age are hospitalised for dental conditions in the CMDHB district than anywhere else in New Zealand (CMDHB, 2005). Within this district Otara is shown to have the lowest rate of preschool children attending and keeping their dental appointments (CMDHB, 2007). Compared with other community clusters in the CMDHB area, Otara preschoolers have the highest rates of tooth decay. On average, this amounts to around 32% of the preschool population (CMDHB, 2005).

The vision is for high quality oral health services that promote, improve, maintain and restore good oral health,with proactive measures in place to address the needs of those at greatest risk of poor oral health (MOH 2006). To improve oral health, initiatives should include increasing preschool and adolescent attendance at dental services, and increased health promotion and clinical prevention for lower socioeconomic groups, including Maori and Pacific peoples (MOH 2000). Young children cannot intervene by themselves. Parents have an important role in making decisions about their childrens' oral health. Thus assistance is required from 1) parents and caregivers 2) health professionals and 3) the community. With this in mind this project aims to collaborate with and coordinate these three groups towards promotion of oral health amongst Maori parents and their 0-5 year old children within early childhood settings in Otara, i.e. Te Kohanga Reo (TKR) / preschools, Marae, Maori whanau and events.

This project identifies 'by Maori for Maori' approaches within Maori communities to identify and provide for their own health needs, and to foster and support Maori oral health knowledge, skills and development. Providing training and assistance for a Maori community group (Otara Maori Forum) along with employment, resources and clinical support will enable a service model that best meets the needs of communities such as TKRs, ensuring under 5yr old children have access to all the elements of primary oral health care.

Maori health promotion literature (He Korowai Oranga: Maori Health Strategy) supports the following types of initiatives:

• "by Maori for Maori" approaches where Maori who are fluent in Te Reo can appropriately promote oral health within TKR settings
• community ownership and control
• Consideration of Marae as a setting
• culturally appropriate
• dissemination of information in Te Reo
• a 'whole whanau' approach