902Effect modification by homeownership in the relationship between household income and child oral health

Background Poor oral health among children is socially patterned and poorly understood. To optimise interventions aimed at reducing the persistent socioeconomic gap in health, we need to understand its shaping mechanisms. We examined if homeownership modifies the widely recognised association between household income and child oral health. Methods Data were analysed on 3,344 children from the Longitudinal Study of Australian Children. Multivariable regression models tested associations between tertiles of household income and dental decay and tooth loss. Effect modification by homeownership was tested on both additive and multiplicative scales. Models were adjusted for demographic variables, area of residence and family characteristics. Results For dental decay and tooth loss, children in households in the lower tertiles of income had worse oral health than children in the highest. Additive interaction was weakly supported in our models. The relative effect of income on oral health was greater for homeowners than renters for dental decay (medium household income 0.65 (95%CI: 0.44; 0.98) and low household income 0.82 (95%CI: 0.58; 1.15)) and tooth loss (medium household income 0.25 (95%CI: 0.09; 0.68) and low household income 0.41 (95%CI: 0.17; 0.97)). Conclusions Low-income children have poorer oral health outcomes. Although children of homeowners have better oral health than children of renters, income inequality is higher among the homeowner’s group. Current rent assistance programs for low-income families in Australia may minimise income-related inequalities on a relative scale. Key messages Our findings shed light on the potential of equalising policies in reducing income-related oral health inequalities.

Protocol for A randomised feasibility trial comparing fluoride interventions to prevent dental decay in older people in care homes (FInCH trial)

Background The number and proportion of older people globally is growing faster than that of any other age group. At the same time the number of people retaining some of their own teeth is rising. There significant differences between those living in care and their community dwelling peers, with evidence showing those in care having fewer teeth and significantly higher levels of dental decay. There are numerous Cochrane reviews linking the use of fluoride to a reduction in dental decay, however, the majority of research on effectiveness has been conducted on children and consequently, children and adolescents tend to be the main recipients of fluoride interventions. There are to date no studies comparing the effectiveness of fluoride interventions in older people in care homes in the UK. However, prior to developing an appropriate protocol for full-scale trial comparing clinical effectiveness of fluoride interventions, there are a number of trial feasibility and statistical parameters that need to be clarified. Methods This trial is a single centre, multi-site randomised controlled assessor blind parallel group (three groups) trial, with the primary objective of establishing the feasibility, practicability and compliance of fluoride interventions to prevent dental decay in care homes. Secondary and tertiary objectives will aim to explore the acceptability of the interventions from resident, care home and dental services perspectives, and estimate the efficacy of the three different fluoride treatments. Discussion This feasibility trial will produce new knowledge and add value to a landscape that is under researched. Although the efficacy of fluoride interventions is proven, the feasibility of dental research and prevention in this vulnerable group and in the complex care home setting is novel. This work will not only add to our understanding of the interface of dental care and social care but will also contribute to our broader understanding on undertaking research in care home settings. Dental care for older people has been a longstanding issue, and the events of this past year has shone a light on the vulnerabilities of those residing in care homes and so this research is landing at a pivotal time. Trial registration EudraCT Registration 2017-002248-34. Registered 20th February 2018 https://www.clinicaltrialsregister.eu/ctr-search/search?query=2017-002248-34.

Fluoride Content in Drinking Water and the Health Implications of Fluoride-Rich Water Consumption: An Overview of the Situation in Canada and Nigeria

Fluoride is an inorganic monatomic anion of fluorine and forms part of essential reagents used by the chemical industry. It occurs naturally in several minerals and in trace quantities in water. Fluoride has been used to prevent tooth decay and in the treatment of osteoporosis. Extensive research has consistently demonstrated the safety and effectiveness of fluorides in the prevention of dental caries following the practice of water fluoridation. Despite these benefits, fluorides pose danger as an endocrine disruptor thus, affecting bones, brain, thyroid gland, pineal gland and blood sugar levels. In Canada, water fluoridation remains a contentious issue although dental decay constitutes the most common chronic disease. However, several Canadians are receiving the benefits of water fluoridation and about 1% have access to naturally fluoridated water. In Nigeria, the prevalence of dental caries has been documented to be greatly reduced following fluoridation of public water supplies in areas where the condition was endemic. Fluoride is therefore the only medicine added to public water, and at the recommended level, fluoride is safe and effective in the reduction of dental decay and poses no risk for health problems. Hence, this article highlighted fluoride content in drinking water and the health implications of consuming fluoride-rich water with a focus on the situation in Canada and Nigeria.

Prevalence of Dental Caries Among Costa Rican Male Students Aged 12-22 Years Using ICDAS-II

Objective: Dental decay is a public health challenge in Low- and Middle-Income Countries, particularly for young people, often confronted to healthcare access barriers. The aim of this study was to determine the prevalence and severity of dental caries among young male students in Costa Rica. Study design: A cross-sectional study was performed in 428 Costa Rican male students aged 12-22 years, who attended a nonprofit social welfare boarding school in 2019. A clinical examination was ran by three calibrated examiners following the International Caries Detection and Assessment System (ICDAS-II). Results: Caries prevalence was estimated at 83%, 15% have lost a tooth due to dental decay, 61% have at least one filled tooth, 36% have at least one filled and decayed tooth. The most frequent caries lesions were codes 2-Inactive (46.7%), and code 1-Inactive (23.8%). DMFT indicated a mean index using ICDAS-II 1-6>0 codes of 7.89. Using ICDAS-II 3-6>0 as threshold, the index decreases to 3.94. Finally, the lower and upper first permanent molars were found to be the most affected teeth. Conclusions: Dental caries experience represents a significant public health burden in young people, requiring better access to public dental healthcare.