Modifiable Factors Explain Socioeconomic Inequalities in Children’s Dental Caries

The aim of this article was to quantify socioeconomic inequalities in dental caries experience among Australian children and to identify factors that explain area-level socioeconomic inequalities in children’s dental caries. We used data from the National Child Oral Health Survey conducted in Australia between 2012 and 2014 ( n = 24,664). Absolute and relative indices of socioeconomic inequalities in the dental caries experience in primary and permanent dentition (decayed, missing, and filled surfaces [dmfs] and DMFS, respectively) were estimated. In the first stage, we conducted multilevel negative binomial regressions to test the association between area-level Index of Relative Socioeconomic Advantage and Disadvantage (IRSAD) and dental caries experience (dmfs for 5- to 8-y-olds and DMFS for 9- to 14-y-olds) after adjustment for water fluoridation status, sociodemographics, oral health behaviors, pattern of dental visits, and sugar consumption. In the second stage, we performed Blinder-Oaxaca and Neumark decomposition analyses to identify factors that explain most of the area-level socioeconomic inequalities in dental caries. Children had a mean dmfs of 3.14 and a mean DMFS of 0.98 surfaces. Children living in the most disadvantaged and intermediately disadvantaged areas had 1.96 (95% confidence interval, 1.69–2.27) and 1.45 (1.26–1.68) times higher mean dmfs and 1.53 (1.36–1.72) and 1.43 (1.27–1.60) times higher mean DMFS than those living in the most advantaged areas, respectively. Water fluoridation status (33.6%), sugar consumption (22.1%), parental educational level (14.2%), and dental visit patterns (12.7%) were the main factors explaining area-level socioeconomic inequalities in dental caries in permanent dentition. Among all the factors considered, the factors that contributed most in explaining inequalities in primary dental caries were dental visits (30.3%), sugar consumption (20.7%), household income (20.0%), and water fluoridation status (15.9%). The inverse area-level socioeconomic inequality in dental caries was mainly explained by modifiable risk factors, such as lack of fluoridated water, high sugar consumption, and an unfavorable pattern of dental visits.

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Caregiver's Education Level and Child's Dental Caries in African Americans: A Path Analytic Study

Caries Research ◽

10.1159/000368560 ◽

2015 ◽

Vol 49 (2) ◽

pp. 177-183 ◽

Cited By ~ 13

Author(s):

Masahiro Heima ◽

Wonik Lee ◽

Peter Milgrom ◽

Suchita Nelson

Keyword(s):

High School ◽

Oral Health ◽

Dental Caries ◽

Low Income ◽

Routine Care ◽

Education Level ◽

Caries Experience ◽

Dental Visits ◽

Caregiver Education ◽

Child Oral Health

The objective of this study was to investigate the influence of caregiver education level on children's dental caries mediated by both caregiver and child oral health behaviors. Participants were 423 low-income African American kindergarteners and their caregivers who were part of a school-based randomized clinical trial. Path analysis tested the hypothesis that caregiver education level affected untreated dental caries and cumulative overall caries experience (decayed or filled teeth) through the mediating influence of frequency of dental visits, use of routine care, and frequency of toothbrushing for both the caregiver and the child. The results supported the hypothesis: caregivers who completed high school were 1.76 times more likely to visit dentists compared with those who did not complete high school (e0.56 = 1.76, 95% CI: 1.03-2.99), which in turn was associated with 5.78 times greater odds of dental visits among their children (e1.76 = 5.78, 95% CI: 3.53-9.48). Children's dental visits, subsequently, were associated with 26% fewer untreated decayed teeth compared with children without dental visits (e-0.31 = 0.74, 95% CI: 0.60-0.91). However, this path was not present in the model with overall caries experience. Additionally, caregiver education level was directly associated with 34% less untreated decayed teeth (e-0.42 = 0.66, 95% CI: 0.54-0.79) and 28% less decayed or filled teeth (e-0.32 = 0.72, 95% CI: 0.60-0.88) among the children. This study overcomes important conceptual and analytic limitations in the existing literature. The findings confirm the role of caregiver education in child dental caries and indicate that caregiver's behavioral factors are important mediators of child oral health.

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Ethnic Disparities in Dental Caries among Adolescents in China

Journal of Dental Research ◽

10.1177/0022034520976541 ◽

2020 ◽

pp. 002203452097654

Author(s):

S.C. Wu ◽

X.X. Ma ◽

Z.Y. Zhang ◽

E.C.M. Lo ◽

X. Wang ◽

...

Keyword(s):

Oral Health ◽

Dental Caries ◽

Ethnic Minority ◽

Minority Groups ◽

Negative Binomial ◽

Economic Status ◽

Ethnic Disparities ◽

Caries Experience ◽

Ethnic Minority Groups ◽

Sugary Beverages

Comprehensive research on ethnic disparities in dental caries in China is limited. The aims of this cross-sectional study were to compare the levels of dental caries in adolescents between the Han ethnic group and ethnic minority groups in China and to explore the risk indicators for dental caries within ethnic subgroups. Data from the Fourth National Oral Health Survey in 2015, which covered all 31 province-level administrative divisions in mainland China, were used. The dental caries status in the permanent dentition of adolescents aged 12, 13, 14, and 15 y was measured using the decayed, missing, and filled teeth (DFMT) score, and sociodemographic characteristics and oral health–related behaviors were also collected. A total of 118,601 adolescents were included, with ethnic minority groups accounting for 13.15%. Of the Han and minority groups, the standardized prevalence of dental caries experience was 40.58% and 47.67%, and the mean DMFT scores were 0.97 and 1.28, respectively. According to the multivariate zero-inflated negative binomial regression analysis, the caries status of minorities was more severe than Han adolescents (adjusted prevalence rate ratio [PRR], 1.14; 95% confidence interval [CI], 1.10–1.18). This disparity was greater among adolescents who lived in rural areas, had mid-level economic status, and frequently consumed sugary beverages. After propensity score matchings, Uygur (PRR, 1.44; 95% CI, 1.25–1.67), Tibetan (PRR, 1.39; 95% CI, 1.3–1.48), and Yi (PRR, 1.24; 95% CI, 1.04–1.48) adolescents were significantly more likely to have caries than Han adolescents. Subgroup analyses revealed that gender, age, location of residence, economic status, region, consumption of sweet snacks and sugary beverages, and dental visit pattern were significantly associated with dental caries within ethnic minorities.

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Prevalence of Dental Caries and its Association with Risk Factors amongst Preschool Children of Bharakahu, Islamabad

Journal of Islamabad Medical & Dental College ◽

10.35787/jimdc.v9i2.463 ◽

2020 ◽

Vol 9 (2) ◽

pp. 88-94

Author(s):

Saba Masoud ◽

Sheze Haroon Qazi ◽

Rubina Mumtaz

Keyword(s):

Preschool Children ◽

Dental Caries ◽

Screening Method ◽

Caries Experience ◽

Base Line ◽

Caries Prevalence ◽

Sugar Consumption ◽

Treatment Needs ◽

Dental Visits ◽

Significant Difference

Background: It is necessary to understand the prevalence and pattern of distribution of dental caries for better planning and execution of preventive activities in the right dimension. This study provided the base line data about prevalence of dental caries in pre-school children of Bharakahu, Islamabad, and its association with brushing, sugar consumption and previous dental visits. Material and Methods: A total of 384 preschool children aged 3-5-year-old were screened from periurban area of Bharakahu, Islamabad, using type IV screening method. Data about decayed, missing and filled teeth was recorded using decayed-missing-filled teeth (DMFT) index. Socio-demographics, brushing, sugar consumption and previous dental visits were also recorded and analyzed and their association with dental caries was assessed using Chi square and Odds ratio. Results: The overall caries prevalence among the sample was 49%. The mean DMFT score with 1 SD was 2.07±3.215. There was no significant difference in caries prevalence in relation to gender of the children. The most significant association was for brushing and low DMFT. Children who brushed their teeth were 4 times more likely to have a low DMFT score of <1 than those who did not brush at all (P<0.001). Likewise, those who had visited a dentist in the past were twice more likely to have a low DMFT (P=0.003). The association of low sugar consumption and a low DMFT score was statistically insignificant (OR 1.4; P=0.878). Hence, brushing turned out to be the most significant factor in determining the caries experience for a child. Conclusions: This study provided us with the baseline data regarding the prevalence of caries in primary school going children of Bharakahu. The prevalence of unmet dental treatment needs was reflected through a high number of ‘decayed teeth’ as compared to missing and filled ones highlighting the need for restorative care in these children.

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Prevalence and determinants of dental caries experience among adolescents in Kazakhstan: a cross-sectional study

10.21203/rs.3.rs-25373/v1 ◽

2020 ◽

Author(s):

Anara Zhumadilova ◽

Turgan Supiyev ◽

Sholpan Abralina ◽

Ardak Yeslyamgaliyeva ◽

Aizhan Kulmirzayeva ◽

...

Keyword(s):

Oral Health ◽

Dental Caries ◽

Parent Education ◽

Negative Binomial ◽

Dietary Habits ◽

Material Deprivation ◽

Caries Experience ◽

Dental Attendance ◽

Attendance Pattern ◽

The Mean

Abstract Background The information on dental caries experience and its determinants in Central Asia is limited. The aim of the present study was to provide estimates of the mean levels, prevalence and severity of dental caries, and to identify the factors associated with these characteristics in the population of school-aged children from four regions in Kazakhstan.Methods We examined 2149 schoolchildren aged 11–15 years from 4 regions of Kazakhstan. The overall response rate was 68%. Dental caries experience was assessed clinically, and standardized questionnaire was used to gather sociodemographic and oral health behavior information. Caries experience was measured by using DMFT (decayed, missing, and filled teeth) index. Negative binomial hurdle regression model was used to assess the relationship between the caries experience and covariates.Results The overall prevalence of dental caries was 74%, obvious decayed teeth was found in 44% of subjects, while only 6% had missing teeth and 24% had their teeth treated. The mean DMFT index was 2.48 among 12-year-olds and 3.9 among 15-year-olds. There were large differences of dental caries experience between the regions, with all indicators (decayed, missed and filled teeth) being less favourable in Semey region. The caries prevalence experience in the studied population was associated with higher age, geographic region, ethnicity, mother’s education, material deprivation, frequent consumption of sugar-added drinks, age of start brushing the teeth and dental attendance pattern. Age, region, ethnicity, dietary habits and dental attendance pattern were found to be significantly associated with the predicted degree of caries experience among those with caries experience.Conclusions The high prevalence of dental caries and large differences in caries indices between the regions in Kazakhstan might be related to rapid westernization in the Central Asian region and associated nutrition transition. Also, the increasing burden of untreated caries in less advantaged populations was observed. Parent education and material deprivation may be a very important determinants of the oral health among adolescents in Kazakhstan.

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Water Fluoridation and Dental Caries in U.S. Children and Adolescents

Journal of Dental Research ◽

10.1177/0022034518774331 ◽

2018 ◽

Vol 97 (10) ◽

pp. 1122-1128 ◽

Cited By ~ 21

Author(s):

G.D. Slade ◽

W.B. Grider ◽

W.R. Maas ◽

A.E. Sanders

Keyword(s):

Sensitivity Analysis ◽

Dental Caries ◽

Children And Adolescents ◽

Permanent Dentition ◽

Primary Dentition ◽

Caries Experience ◽

Linear Regression Models ◽

Water Fluoridation ◽

Tooth Surfaces ◽

The U.S

Fluoridation of America’s drinking water was among the great public health achievements of the 20th century. Yet there is a paucity of studies from the past 3 decades investigating its dental health benefits in the U.S. population. This cross-sectional study sought to evaluate associations between availability of community water fluoridation (CWF) and dental caries experience in the U.S. child and adolescent population. County-level estimates of the percentage of population served by CWF (% CWF) from the Centers for Disease Control and Prevention’s Water Fluoridation Reporting System were merged with dental examination data from 10 y of National Health and Nutrition Examination Surveys (1999 to 2004 and 2011 to 2014). Dental caries experience in the primary dentition (decayed and filled tooth surfaces [dfs]) was calculated for 7,000 children aged 2 to 8 y and in the permanent dentition (decayed, missing, and filled tooth surfaces [DMFS]) for 12,604 children and adolescents aged 6 to 17 y. Linear regression models estimated associations between % CWF and dental caries experience with adjustment for sociodemographic characteristics: age, sex, race/ethnicity, rural-urban location, head-of-household education, and period since last dental visit. Sensitivity analysis excluded counties fluoridated after 1998. In unadjusted analysis, caries experience in the primary dentition was lower in counties with ≥75% CWF (mean dfs = 3.3; 95% confidence limit [CL] = 2.8, 3.7) than in counties with <75% CWF (mean dfs = 4.6; 95% CL = 3.9, 5.4), a prevented fraction of 30% (95% CL = 11, 48). The difference was also statistically significant, although less pronounced, in the permanent dentition: mean DMFS (95% CL) was 2.2 (2.0, 2.4) and 1.9 (1.8, 2.1), respectively, representing a prevented fraction of 12% (95% CL = 1, 23). Statistically significant associations likewise were seen when % CWF was modeled as a continuum, and differences tended to increase in covariate-adjusted analysis and in sensitivity analysis. These findings confirm a substantial caries-preventive benefit of CWF for U.S. children and that the benefit is most pronounced in primary teeth.

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Experiencing Financial Strain and Clinically Assessed Caries Experience in Dentate Adults Aged 25–44 Years: An Exploration of Potential Pathways

Caries Research ◽

10.1159/000511466 ◽

2020 ◽

pp. 1-10

Author(s):

Mariëlle A. Beenackers ◽

Jan H. Vermaire ◽

Paula van Dommelen ◽

Annemarie A. Schuller

Keyword(s):

Oral Health ◽

Oral Hygiene ◽

Negative Binomial ◽

Dietary Habits ◽

Financial Strain ◽

Caries Experience ◽

Socioeconomic Indicators ◽

Dental Visits ◽

Health Related ◽

Preventive Dental

Large socioeconomic inequalities still exist in oral health. It is already known that oral health-related behaviour may contribute to these inequalities, but why people with a lower socioeconomic position behave less healthily is not easily understood. A possible explanation that integrates insights on health behaviour, stress, and financial resources is the pathway of behavioural responses to financial strain. The aim of this study was to assess to what extent financial strain is associated with clinically assessed caries experience in a population-based study of dentate adults, independently of other socioeconomic indicators. Furthermore, the potential mediating pathways of oral health-related behaviours (oral hygiene, dietary habits, preventive dental visits) were explored. Dentate participants, aged 25–44 years, taking part in a survey on oral health and preventive behaviour in the Netherlands in 2013 were clinically examined on – among others – caries experience (DMFS index) and level of oral hygiene (OHI-s index). Financial strain, frequency of tooth brushing, dietary habits, attendance of (preventive) dental visits in the past year, and demographic variables were assessed via questionnaires. Negative binomial hurdle models were used to study the association between financial strain and DMFS and between oral health behavioural indicators and DMFS. Although it was observed that experiencing financial strain did not seem to affect whether there is any caries experience or not, among those having any caries (DMFS >0) suffering from financial strain was associated with a higher caries prevalence, independent of educational level and income. None of the studied potential mediators could explain this association.

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Root caries experience among older adults in a country with long term systemic water fluoridation

10.21203/rs.3.rs-89918/v1 ◽

2020 ◽

Author(s):

Rakhi Mittal ◽

Mun Loke Wong ◽

Patrick Finbarr Allen

Keyword(s):

Risk Factors ◽

Older Adults ◽

Oral Health ◽

Gingival Recession ◽

Community Dwelling ◽

Caries Experience ◽

Root Caries ◽

Water Fluoridation ◽

Attachment Loss ◽

Dental Visits

Abstract ObjectiveThe objective of this study was to explore dental caries experience in older Singaporeans (60-90 years old), a country with over 60 years of water fluoridation, and to examine what risk factors contribute to prevalence of oral disease, in particular root caries, and to assess the impact of service utilisation on treatment of root caries.Methodology500 community dwelling older adults, aged 60 years and above were invited to participate in this cross-sectional study. Participants completed a survey which included questions related to demographics (e.g. age, gender, ethnicity, education level) self-rated oral health, oral health attitudes and frequency of dental visits. A clinical examination recorded details of decayed, missing and filled teeth; stimulated saliva flow was also measured. The main outcome of this study was prevalence of decayed and filled root surfaces (DFRS) of older adults, categorised as “low” [DFRS ≤3] and “high” [DFRS >3]. The regression models were controlled for age, gender, ethnicity, education, marital status, housing type, oral health related factors and salivary parameters. Results84.2% of the participants ethnicity was Chinese and 15.2% were Non-Chinese. The mean DFRS score was [Mean (SD), 3(3.5)], decayed [Total (Mean), 68(13.6)] and filled [Total (Mean), 287 (57.4)]. In bivariate analysis, age, ethnicity, education, dental visits, recession, restored coronal surfaces and oral health attitude were found to be significantly associated with DFRS. In final multivariate model it was found that age, ethnicity, education, pattern of dental visits, gingival recession/periodontal attachment loss and number of restored coronal surfaces are independent predictors of root caries experience in older adults. The selected risk factors in the final model explained about 20% of the variation.ConclusionHigher education and awareness increase dental care utilization which corresponds to a high filled (F) component of DFRS. Previous coronal caries experience and gingival recession/attachment loss are risk indicators of higher root caries experience.

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The Impact of Policy Modifiable Factors on Inequalities in Rates of Child Dental Caries in Australia

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16111970 ◽

2019 ◽

Vol 16 (11) ◽

pp. 1970 ◽

Cited By ~ 4

Author(s):

Sharon Goldfeld ◽

Kate Louise Francis ◽

Monsurul Hoq ◽

Loc Do ◽

Elodie O’Connor ◽

...

Keyword(s):

Oral Health ◽

Dental Caries ◽

Service Use ◽

Population Distribution ◽

Caries Experience ◽

Period 2 ◽

Modifiable Factors ◽

Nationally Representative ◽

The Impact

Background: Poor oral health in childhood can lead to adverse impacts later in life. We aimed to estimate the prevalence and population distribution of childhood dental caries in Australia and investigate factors that might ameliorate inequalities. Methods: Data from the nationally representative birth cohort Longitudinal Study of Australian Children (N = 5107), using questions assessing: The experience of dental caries during each biennial follow-up period (2–3 years to 10–11 years), socioeconomic position (SEP), and policy modifiable oral health factors. Results: The odds of dental caries were higher for children with lowest vs. highest SEP (adjusted OR (adjOR) 1.92, 95% CI 1.49–2.46), and lower where water was fluoridated to recommended levels (adjOR 0.53, 95% CI 0.43–0.64). There was no evidence of an association between caries experience and either reported sugary diet or tooth brushing. When SEP and fluoridation were considered in conjunction, compared to the highest SEP group with water fluoridation children in the lowest SEP with fluoridation had adjOR 1.54 for caries, (95% CI 1.14–2.07), and children in the lowest SEP without fluoridation had adjOR 4.06 (95% CI 2.88–5.42). For patterns of service use: The highest SEP group reported a greater percentage of service use in the absence of caries. Conclusions: Dental caries appears prevalent and is socially distributed in Australia. Policy efforts should consider how to ensure that children with dental caries receive adequate prevention and early care with equitable uptake.

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Does non-institutionalized elders have a better oral health status compared to institutionalized ones? A systematic review and meta-analysis

Ciência & Saúde Coletiva ◽

10.1590/1413-81232020256.18252018 ◽

2020 ◽

Vol 25 (6) ◽

pp. 2177-2192 ◽

Cited By ~ 3

Author(s):

Ilky Pollansky Silva e Farias ◽

Simone Alves de Sousa ◽

Leopoldina de Fátima Dantas de Almeida ◽

Bianca Marques Santiago ◽

Antonio Carlos Pereira ◽

...

Keyword(s):

Systematic Review ◽

Health Status ◽

Oral Health ◽

Dental Caries ◽

Meta Analysis ◽

Oral Health Status ◽

Cochrane Library ◽

Caries Experience ◽

Institutionalized Elderly ◽

Periodontal Status

Abstract This systematic review compared the oral health status between institutionalized and non-institutionalized elders. The following electronic databases were searched: PubMed (Medline), Scopus, Web of Science, Lilacs and Cochrane Library, in a comprehensive and unrestricted manner. Electronic searches retrieved 1687 articles, which were analyzed with regards to respective eligibility criteria. After reading titles and abstracts, five studies were included and analyzed with respect their methodological quality. Oral status of institutionalized and non-institutionalized elderly was compared through meta-analysis. Included articles involved a cross-sectional design, which investigated 1936 individuals aged 60 years and over, being 999 Institutionalized and 937 non-institutionalized elders. Studies have investigated the prevalence of edentulous individuals, the dental caries experience and the periodontal status. Meta-analysis revealed that institutionalized elderly have greater prevalence of edentulous (OR = 2.28, 95%CI = 1.68-3.07) and higher number of decayed teeth (MD = 0.88, 95%CI = 0.71-1.05) and missed teeth (MD = 4.58, 95%CI = 1.89-7.27). Poor periodontal status did not differ significantly between groups. Compared to non-institutionalized, institutionalized elders have worse dental caries experience.

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Free Sugars Intake among Chinese Adolescents and Its Association with Dental Caries: A Cross-Sectional Study

Nutrients ◽

10.3390/nu13030765 ◽

2021 ◽

Vol 13 (3) ◽

pp. 765

Author(s):

Qiping Yang ◽

Yue Xi ◽

Hanmei Liu ◽

Jing Luo ◽

Yufeng Ouyang ◽

...

Keyword(s):

Oral Health ◽

Dental Caries ◽

Cross Sectional Study ◽

Chinese Adolescents ◽

Food Sources ◽

Caries Experience ◽

Sectional Study ◽

Cross Sectional ◽

Free Sugars ◽

Targeted Interventions

This study aims to estimate the free sugars intake, identify the primary food sources of free sugars, and explore the relationship between free sugars intake and dental caries among Chinese adolescents. This cross-sectional study included 1517 middle-school students aged 12–14 years in Changsha city, China. Adolescents completed a 12-item Food Frequency Questionnaire (FFQ) and oral health assessment. The students’ dental caries experience was available as DMFT score (number of decayed, missing, and filled permanent teeth). Statistical analyses included the Mann–Whitney test, Kruskal–Wallis test, Chi-square test, and binary logistic regression model. The average intake of free sugars was 53.1 g/d in adolescents, and 43.2% of the students consumed more than 50 g of free sugars daily. The primary contributor to free sugars was sugar-sweetened beverages (SSBs). Age, boarders, and high family income were risk factors for excessive free sugars intake (p < 0.05), and increased free sugars intake was a risk factor for dental caries (odds ratio, OR = 1.446, 95% confidence interval: 1.138–1.839). Both the free sugars intake and dental caries prevalence in Chinese adolescents were high. Targeted interventions are urgently needed to address the excessive consumption of free sugars and improve Chinese adolescents’ oral health.

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