Socioeconomic inequalities in oral health in childhood and adulthood in a birth cohort

Predictors and correlates of edentulism in the healthy old people in Edinburgh (HOPE) study

OBJECTIVES

To determine the extent to which correlates of edentulism are explained by an association between tooth loss and cognitive ability.

METHODS

Participants in the Healthy Old People in Edinburgh (HOPE) study aged 70 or more at baseline were assessed and health, cognitive, socio-economic and socio-environmental data collected on four consecutive occasions. It was noted whether the participant had any retained teeth and if not, the age when the last tooth was lost. Prior determinants of edentulism were investigated with binary logistic regression models. At the 9-year follow-up, associations with edentulism were examined using general linear models with edentulism as an independent factor.

RESULTS

201 participants were adequately tested, of whom 104 (51.7%) were edentulous. A logistic regression model that considered age, sex, education, social class, deprivation index of residence, objective distance from dentist, participant's estimate of distance from dentist and NART-estimated IQ (NARTIQ) found age (p = 0.032), occupational class (p = 0.019) and NARTIQ (p = 0.027) as significant predictors of edentulism. Cox's proportional hazards modelling found only NARTIQ (p = 0.050) to be correlated. Being edentulous was associated with poorer respiratory function but not hand grip strength (p = 0.23). Edentulous participants had lower self esteem scores (p = 0.020) and poorer dietary assessment scores (p = 0.028). Being edentulous was also associated with significantly lower mean scores on all cognitive testing, although these associations became non-significant after adjustment for NARTIQ and age.

CONCLUSIONS

In healthy older people, edentulism is associated with relative impairment of cognitive ability, although this association is explained by the fact that lower original intelligence predisposes to edentulism and poorer performance on cognitive tests in old age. Once original intelligence is adjusted for, tooth loss is not related to cognitive ability. Tooth loss is, however, associated with poorer status across a wide range of health measures: physical health, nutrition, disability and self-esteem. Establishing the degree to which these health outcomes are causally related to edentulism could usefully be factored into cost-benefit analyses of programmes designed to prevent tooth loss.

Oral health disparities in the United States

Oral health disparities refers to the existence of differences in the incidence, prevalence, mortality, and burden of oral diseases and other adverse health conditions, as well as the use of health care services, among specific population groups in the United States. Existence of disparities in oral health status, accessing and using the oral health care delivery system, and receiving treatment depending on gender, race or ethnicity, education, income, disability, geographic location, and sexual orientation have been documented. Different states have initiated a series of steps as tools to document, assess, develop strategies, and monitor progress in efforts to eliminate or reduce oral health disparities in the United States.

Should we brush twice a day? Determinants of dental health among young adults in Finland

We explore the determinants of dental ill-health as measured by the occurrence of caries. A recursive bivariate probit model that was derived from health production and demand theory is employed to model caries, while taking account of dental care use. The data are from a follow-up questionnaire used in a longitudinal study of the Northern Finland 1966 Birth Cohort, with respondents aged 31 (n = 5020). The factors controlled for relate to family background and health behavior during their youth, current socioecononomic variables and dental health stock. The total effects on the occurrence of caries of the explanatory variables are computed. Among females, factors increasing caries are body mass index and intake of alcohol, sugar and soft drinks, and those reducing caries are birth weight and adolescent school achievement. Among males, caries is positively related to the metropolitan residence and negatively related to education and healthy diet. Smoking increases caries, whereas dental care use, regular dental attendance and brushing teeth at least twice a day decrease caries. To promote oral health, attention should focus on policies to improve dental health education and to reduce the impacts of common risk factors.

Determinação social da odontalgia em estudos epidemiológicos: revisão teórica e proposta de um modelo conceitual

A literatura epidemiológica se caracteriza por limitada abordagem teórica acerca dos mecanismos complexos de determinação das doenças e condições de saúde. No campo da epidemiologia da saúde bucal, isto não tem sido diferente, uma vez que a cárie dentária a doença bucal mais investigada no mundo é comumente vista sob um ponto de vista biologicista/reducionista. Uma das mais importantes conseqüências da cárie é a dor de origem dentária ou odontalgia, a qual tem recebido pouca atenção em investigações com refinamento teórico e delineamento de maior capacidade para inferência causal. O objetivo deste trabalho foi rever a literatura científica sobre os determinantes da odontalgia e colocar em debate teorias pertinentes à explicação do fenômeno. São revistos modelos de determinação e correntes de pensamento emergentes no estudo de morbidades bucais, estabelecendo-se interface com o modelo biopsicossocial da dor e almejando-se a elaboração de um modelo conceitual abrangente da odontalgia. Sugere-se que a ligação entre estrutura social e saúde bucal se dá por meio de vias materiais, comportamentais e psicossociais. Aspectos da estrutura social são levantados na tentativa de relacioná-los com o desfecho de interesse, destacando sua importância nas discussões acerca da causalidade dos fenômenos de saúde bucal.

Inequalities in oral health practices and social space: an exploratory qualitative study

This study analyzed the oral health practices and access to dental care of individuals according to their position in social space. The rationale was based on the hypothesis that different positions in social space may imply different habitus, in the sense conferred by Bourdieu. Such dispositions would influence practical behavior, choices and preferences in general and in this context, dental care. Twenty-two semi-structured interviews were carried out with individuals, as part of a multiple case study carried out in two municipalities in the state of Bahia, Brazil. Differences were found between the two study groups both with respect to actions of personal care and in seeking and using dental services. This, in addition to poor material and living conditions, and difficult access to restorative dental work in the public sector, may explain part of the pattern of tooth loss found in the adult Brazilian population. The adoption of effective communicative and educational actions by health professionals should be stimulated. However, the structural dimension of the social determinants requires transformations in the structures that generate the perceptions and practices of agents. The study discusses the implications of these data to public dental policies that are focused on reducing these inequalities.

A life-course approach to assess psychosocial factors and periodontal disease

BACKGROUND

Several models have been used to suggest the role of psychosocial factors in periodontal disease. None have adopted the life-course approach, which emphasizes the importance of exposures over time and at critical points of a person's life.

OBJECTIVE

To investigate the relationship between psychosocial factors at two periods of life and periodontal diseases in Brazilian adult females.

MATERIAL AND METHODS

The study design was a cross-sectional survey of 330 women randomly selected from a larger sample of mothers whose children participated in a study on chronic oral disease using a life-course framework. Each woman was clinically assessed for the presence of periodontal disease. An interview collected information on socioeconomic, behavioural and family-related factors at two periods of the participant's life (childhood and adulthood). The main outcome variable was loss of periodontal attachment. Data analysis used logistic regression.

RESULTS

High levels of periodontal disease were predicted by <4 years of education, past and present smoking, high levels of paternal discipline in childhood and low levels of emotional support in adulthood. The influence of childhood factors was not attenuated by adulthood circumstances.

CONCLUSION

Psychosocial factors in childhood and adulthood were associated with high levels of periodontal disease in adulthood.

Gradients in periodontal status in Japanese employed males

AIM

The objective was to assess whether there was a social gradient in periodontal status by job classification in Japanese male workers.

MATERIAL AND METHODS

Study participants were 15,803 Japanese male workers aged 20-69 years. There were seven groups classified by jobs. Oral examinations were conducted using community periodontal index (CPI).

RESULTS

The percentages of sextants with a CPI score of 3 or 4 of professionals were significantly lower than for other job classes. The gradient also existed for the percentage of sextants with CPI score 4. After adjusting for age, a history of diabetes mellitus and smoking status, those lower on the gradient, namely, drivers, service occupations, salespersons and managers were 2.0, 1.5, 1.4 and 1.4, times, respectively more likely to have one or more sextants with CPI score 3 or 4 compared with professionals. Odds ratios of having more than one or more sextants with CPI score 4 after adjusting for age, clinical history of diabetes mellitus and smoking status for drivers, service occupations, salespersons and managers were 2.1, 1.5, 1.5 and 1.2, respectively, compared with professionals.

CONCLUSIONS

There was a gradient in periodontal status by job classification. Professional and office workers had better periodontal status than salespersons, service occupations and drivers.

Influences on children's oral health: a conceptual model

OBJECTIVES

Despite marked improvements over the past century, oral health in America is a significant problem: caries is the most common chronic disease of childhood. Much oral health research examines influences primarily in the oral cavity or focuses on a limited number of individual-level factors. The purpose of this article was to present a more encompassing conceptual model of the influences on children's oral health.

METHODS

The conceptual model presented here was derived from the population health and social epidemiology fields, which have moved toward multilevel, holistic approaches to analyze the complex and interactive causes of children's health problems. It is based on a comprehensive review of major population and oral health literatures.

RESULTS

A multilevel conceptual model is described, with the individual, family, and community levels of influence on oral health outcomes. This model incorporates the 5 key domains of determinants of health as identified in the population health literature: genetic and biological factors, the social environment, the physical environment, health behaviors, and dental and medical care. The model recognizes the presence of a complex interplay of causal factors. Last, the model incorporates the aspect of time, recognizing the evolution of oral health diseases (eg, caries) and influences on the child-host over time.

CONCLUSIONS

This conceptual model represents a starting point for thinking about children's oral health. The model incorporates many of the important breakthroughs by social epidemiologists over the past 25 years by including a broad range of genetic, social, and environmental risk factors; multiple pathways by which they operate; a time dimension; the notion of differential susceptibility and resilience; and a multilevel approach. The study of children's oral health from a global perspective remains largely in its infancy and is poised for additional development. This work can help inform how best to approach and improve children's oral health.

Life-course epidemiology: concepts and theoretical models and its relevance to chronic oral conditions

Etiological models that predominantly emphasize current adult life styles, such as smoking, diet and lack of exercise have recently been seriously challenged by a growing body of evidence that disturbed early growth and development, childhood infection, poor nutrition, and social and psychosocial disadvantage across the life-course affect chronic disease risk, including chronic oral disease. This relatively new area of research is called life-course epidemiology. The life-course framework for investigating the aetiology and natural history of chronic disease proposes that advantages and disadvantages are accumulated throughout life generating differentials in health along the life-course, but most importantly later in life. Furthermore, its dynamic framework brings together the effects of intrinsic factors (individual resources) with extrinsic factors (environmental factors). The aim of this paper is to give an overview of this new epidemiological approach and to discuss how the life-course framework has been applied to chronic oral conditions.

Dentes da desigualdade: marcas bucais da experiência vivida na pobreza pela comunidade do Dendê, Fortaleza, Ceará, Brasil

Este estudo antropológico investiga a experiência vivida das doenças bucais no contexto da pobreza no Nordeste brasileiro. Durante seis meses em 2004, foram conduzidas entrevistas etnográficas, narrativas e observação participante com 31 moradores do Dendê, comunidade de baixa renda em Fortaleza, Ceará, analisadas pelo método hermenêutico-dialético. Revelou-se que as precárias condições de vida dificultam priorizar o cuidado em saúde. Embora sofram da dor dentária, ir ao dentista é percebido com um luxo, não um direto do cidadão. O difícil acesso ao serviço e restauração de má qualidade, favorecem a extração dentária como mais resolutiva. A deterioração da saúde bucal é lamentada pelos moradores que buscam ajuda de clínicas populares, políticos e curandeiros. A experiência da doença dentária diferencia de acordo com a classe, deixa marcas bucais da iniqüidade e prejudica a auto-estima e inclusão social. "Tratar" os dentes da desigualdade nesse contexto exige aprofundar a compreensão dos determinantes sociais da saúde, reduzir injustiças no acesso aos serviços de qualidade, remover estigmas que desmoralizam e fortalecer a viva voz da comunidade frente às forças estruturais que afetam sua vida.

Theoretical explanations for social inequalities in oral health

Social inequalities in health and oral health continue to present a major challenge to public health. Progress towards the development of interventions to reduce health inequalities is currently being hampered by an incomplete understanding of the causes of inequalities in health. This paper aims to provide oral health researchers with an overview of four current explanations for inequalities in oral health and to suggest further areas of research needed to advance our understanding of the causes of social inequalities in oral health.

From victim blaming to upstream action: tackling the social determinants of oral health inequalities

The persistent and universal nature of oral health inequalities presents a significant challenge to oral health policy makers. Inequalities in oral health mirror those in general health. The universal social gradient in both general and oral health highlights the underlying influence of psychosocial, economic, environmental and political determinants. The dominant preventive approach in dentistry, i.e. narrowly focusing on changing the behaviours of high-risk individuals, has failed to effectively reduce oral health inequalities, and may indeed have increased the oral health equity gap. A conceptual shift is needed away from this biomedical/behavioural 'downstream' approach, to one addressing the 'upstream' underlying social determinants of population oral health. Failure to change our preventive approach is a dereliction of ethical and scientific integrity. A range of complementary public health actions may be implemented at local, national and international levels to promote sustainable oral health improvements and reduce inequalities. The aim of this article is to stimulate discussion and debate on the future development of oral health improvement strategies.

The relation between family socioeconomic trajectories from childhood to adolescence and dental caries and associated oral behaviours

OBJECTIVES

To investigate the influence of family socioeconomic trajectories from childhood to adolescence on dental caries and associated behaviours.

DESIGN

Population-based birth cohort.

SETTING

Representative sample of the population of subjects born in 1982 in Pelotas, Brazil.

PARTICIPANTS

Adolescents (n = 888) aged 15 years old were dentally examined and interviewed.

MAIN OUTCOME MEASURES

Dental caries index (DMFT), care index (F/DMFT), tooth brushing, flossing and pattern of dental services use.

MAIN RESULTS

Adolescents who were always poor showed, in general, a worse pattern of dental caries, whereas adolescents who never were poor had a better pattern of dental caries. Adolescents who had moved from poverty in childhood to non-poverty in adolescence and those who had moved from non-poverty in childhood to poverty in adolescence had similar dental pattern to those who were always poor except for the pattern of dental services use, which was higher in the first group. In all groups girls had fewer carious teeth, better oral hygiene habits and higher dental services use than boys.

CONCLUSION

Poverty in at least one stage of the lifespan has a harmful effect on dental caries, oral behaviours and dental services use. Belonging to upwardly mobile families between childhood and adolescence only contributed to improved dental care.

A life-course approach to measuring socioeconomic position in population health surveillance systems

Measuring socioeconomic position (SEP) in population chronic disease and risk factor surveillance systems is essential for monitoring socioeconomic inequalities in health over time. Life-course measures are an innovative way to supplement other SEP indicators in surveillance systems. A literature review examined the indicators of early-life SEP that could potentially be used in population health surveillance systems. The criteria of validity, relevance, reliability and deconstruction were used to determine the value of potential indicators. Early-life SEP indicators used in cross-sectional and longitudinal studies included education level, income, occupation, living conditions, family structure and residential mobility. Indicators of early-life SEP should be used in routine population health surveillance to monitor trends in the health and SEP of populations over time, and to analyse long-term effects of policies on the changing health of populations. However, these indicators need to be feasible to measure retrospectively, and relevant to the historical, geographical and sociocultural context in which the surveillance system is operating.

Dental caries risk in the U.S. Air Force

BACKGROUND

This study describes the dental caries risk in the active duty U.S. Air Force population from October 2000 through September 2004.

METHODS

The authors used data collected from two Air Force databases (personnel and dental files) by cross-referencing Social Security numbers from both databases with date.

RESULTS

During the study period, the percentages of people at high and moderate risk of developing caries decreased by 31 percent and 12 percent, respectively, while the percentage of people at low risk of developing caries increased by 9 percent. Among Air Force members who were enrolled continuously during the study period, the percentages at high and moderate risk of developing caries decreased by 57 percent and 18 percent, respectively, while the percentage at low risk of developing caries increased by 14 percent. The authors observed improvement in caries risk in 83 percent and 73 percent of the people at high and moderate caries risk, respectively, for those continuously enrolled. High caries risk was related inversely to age, rank, education and years in service. Also, tobacco users had an elevated risk of developing caries.

CONCLUSIONS

The Air Force Dental Service has made great strides in improving the oral health of the Air Force population. The results of this study suggest that caries risk is decreasing in the Air Force population, but oral health disparities still exist and require further evaluation.

CLINICAL IMPLICATIONS

This investigation suggests that a caries risk assessment can be conducted successfully, and caries risk can be reduced by using a comprehensive population-based prevention program. This caries risk assessment also can identify factors associated with dental caries disparities in a large-scale population.

Oral health inequalities among indigenous and nonindigenous children in the Northern Territory of Australia

OBJECTIVE

To describe oral health inequalities among indigenous and nonindigenous children in the Northern Territory of Australia using an area-based measure of socioeconomic status (SES).

METHODS

Data were obtained from indigenous and nonindigenous 4-13-year-old children enrolled in the Northern Territory School Dental Service in 2002-2003. The Socio-Economic Indices For Areas (SEIFA) were used to determine socioeconomic relationships with dental disease experience.

RESULTS

Some 12,584 children were examined, 35.1% of whom were indigenous. Across all age-groups, socially disadvantaged indigenous children experienced higher mean dmft and DMFT levels than their similarly aged, similarly disadvantaged nonindigenous counterparts. Indigenous children aged 5 years had almost four times the dmft of their nonindigenous counterparts in the same disadvantage category (P < 0.05), while indigenous children aged 10 years had almost five times the DMFT of similarly disadvantaged nonindigenous children (P < 0.05). A distinct social gradient was apparent among indigenous and nonindigenous children, respectively, whereby those with the highest dmft/DMFT levels were in the most disadvantaged SES category and those least disadvantaged had the lowest dmft/DMFT levels. In most age-groups, indigenous children who were least disadvantaged had worse oral health than the most disadvantaged nonindigenous children.

CONCLUSIONS

The findings suggest that indigenous status and SES have strong oral health outcome correlations but are not mutually dependent, that is, indigenous status influences oral health outcomes irrespective of social disadvantage. From a health policy perspective, greater oral health gains may be possible by concentrating public health and clinical effort among all indigenous children irrespective of SES status.

Dental caries experience and use of dental services among preschool children in Ajman, UAE

OBJECTIVE

The aim of this study was to estimate the prevalence and severity of dental caries in the primary dentition of young children in Ajman, UAE, and investigate its association with sociodemographic characteristics and use of dental services.

METHODS

A cluster-sampling approach was used to randomly select children aged 5 or 6 years who were enrolled in public or private schools. Clinical examinations for caries were conducted by a single examiner using World Health Organization criteria. Parents completed questionnaires seeking information on socioeconomic background and dental service utilization. Zero-inflated negative binomial (ZINB) regression modelling was used to identify risk markers and risk indicators for caries experience.

RESULTS

The prevalence of dental caries in the sample was high 76.1%. The average dmfs score 10.2. Caries severity was greater among older children and among male children of less educated mothers. Emirati (local) children had higher caries severity than others. Children who had higher level of caries visited the dentist more frequently than other children whose visits were for check-up only.

CONCLUSIONS

Dental caries prevalence and severity in young children in Ajman are high, and socioeconomic characteristics and dental utilization are important determinants of their dental caries experience. There is an urgent need for oral health programmes targeted at the treatment and underlying causes of dental caries in these children.

Disparities in early childhood caries

Despite remarkable reduction in the prevalence of dental caries in the United States, dental caries is still a highly prevalent disease among children who are socially disadvantaged (racial/ethnic minority, poor, rural, immigrants). Consequently, caries sequelae such as dental pain, need for dental treatment under general anesthesia, and future orthodontic treatment, are also concentrated among the most socially disadvantaged children. To make the situation more appalling, those children who need treatment the most are the ones least likely to visit the dentist. Low income children are less likely to visit the dentist in part because of family's competing needs for limited resources, shortage of pediatric dentists, and dentists not taking uninsured or publicly insured patients. In the same vein, if these children do not have access to dental care, they are deprived from effective caries preventive measures that are dentist-dependent such as sealants and professionally applied fluoride. Dentistry has done well at devising caries preventive and treatment strategies; but these strategies have missed the most needed segment of society: disadvantaged children. The challenge now is to develop innovative strategies to reach these children.

Reducing oral health disparities: a focus on social and cultural determinants

Oral health is essential to the general health and well-being of individuals and the population. Yet significant oral health disparities persist in the U.S. population because of a web of influences that include complex cultural and social processes that affect both oral health and access to effective dental health care.

This paper introduces an organizing framework for addressing oral health disparities. We present and discuss how the multiple influences on oral health and oral health disparities operate using this framework. Interventions targeted at different causal pathways bring new directions and implications for research and policy in reducing oral health disparities.

Dental health in rural Victoria: the Crossroads Household Survey

BACKGROUND

The aims of this study were to describe dental health and perceived barriers to dental care in a regional centre and surrounding smaller towns in rural Victoria.

METHODS

A stratified, randomized, face-to-face household survey was undertaken to assess levels of edentulism and access to oral health services. A study response rate of 70.3 per cent (6316/9260) was achieved.

RESULTS

When compared with those in the regional centre, people living in the shire capitals were more likely to travel greater distances to see a dentist and were less likely to have seen a dentist within the past 12 months. While there was little difference in the edentulous proportion living in shire capitals compared with the regional centre, the level of edentulousness over the entire region was greater than overall Australian estimates. Differences in perceived barriers to care within the region were less than expected. Existing perceived barriers were lack of need, time until available appointments, attitudes of dentists and lack of public dental facilities. Differences in these barriers existed between socio-economic groups.

CONCLUSIONS

This study shows that the prevalence of edentulism was higher in the areas studied relative to the Australian population. Significant patient perceived barriers to care exist which may contribute to the problem.

Risk factors for dental caries in the five-year-old South Australian population

BACKGROUND

This study tested the hypothesis that risk behaviours in disadvantaged groups would explain socio-economic inequality in dental caries prevalence among preschool children.

METHODS

Using a case-control study, children with caries experience (one or more decayed, missing or filled primary tooth surfaces) and with no caries experience were sampled with known probabilities from among five year olds attending the South Australian Dental Service (SADS). Dental caries experience of primary teeth was recorded by SADS clinicians. Social and behavioural information was collected using a questionnaire mailed to parents. Prevalence rates, prevalence ratios (PR) and 95 per cent confidence intervals (95% CI) were computed, taking into account sampling probabilities.

RESULTS

Questionnaires were obtained for 64.6 per cent of sampled children (n = 1398) and 40.2 per cent (95% CI = 37.8-42.6) of them had caries experience. Five statistically significant risk factors were identified relating to previous feeding, current oral hygiene and parent's own oral health perceptions. The prevalence of four risk factors was greater in low-income households compared with high-income households (P < or = 0.01). In multivariate analysis, after adjusting for age of tooth cleaning onset, age at which toothpaste was introduced was not significantly associated with caries prevalence. Behavioural risk factors did not explain income-related gradients in caries prevalence but modified the level of risk associated with delayed onset of tooth cleaning. Children who delayed tooth cleaning until the age of 24 months or more and who were from low-income households had a 2.7-fold increase in caries prevalence (95% CI = 2.1-3.4).

CONCLUSIONS

Caries prevention efforts need to target behaviours in infancy and non-behavioural risk factors among preschoolers in low-income households.

Socio-economic risk indicators for apical periodontitis

OBJECTIVE

The aim of this study was to reveal possible socio-economic risk indicators for apical periodontitis.

MATERIAL AND METHODS

In 1992-93 a representative sample of women in Göteborg, Sweden, aged 38-84 years, participated in a medical and dental survey (n=981) which included dental and medical examinations and dental radiographic examination (OP). The dependent variable was apical periodontitis (AP=0, AP>0). The independent variables were age, number of teeth, number of restored teeth, number of root-filled teeth, number of teeth with carious lesions, satisfactory masticatory function, and dental esthetics as crude measures of self-reported dental health, dental anxiety, time elapsed since last visit to a dental office, regular dental visiting habits, smoking, alcohol habits, and marital status. A subjective evaluation of economy, health and life situation (acceptable or poor) was accounted for as socio-economic variables. The oldest age group, women born 1908, and edentulous individuals were omitted, leaving 844 subjects for analysis. Statistical analysis included multivariate logistic regression, chi-squared test, and independent t-test for comparison of group characteristics (AP=0 vs AP>0).

RESULTS

For socio-economic variables there was a significant association between acceptable health and apical periodontitis (OR=1.72 (CI=1.09-2.70)). For oral-related variables, root-filled teeth (OR=1.17 (CI=1.10-1.23)) and teeth with carious lesions (OR=1.48 (CI=1.19-1.85)) were predictive of apical periodontitis.

CONCLUSIONS

In the present study, socio-economic variables and dental visiting habits did not appear to have obvious implications for periapical health, whereas root-filled teeth and carious lesions were associated with apical periodontitis.

Dental caries experience: a two-generation study

The life-course framework stresses the importance of social, psychosocial, and biological factors in early life on the development of later disease. From this perspective, the association between edentulousness of mothers and their children's caries risk has not been studied. Therefore, a sample of 6303 mother-child pairs was randomly selected in Quebec (Canada). Mothers (6039 dentate and 264 edentulous) completed a self-administered questionnaire, and their children, aged 5 to 9 years, were clinically examined. Bivariate analyses and multiple logistic regressions showed that edentulous mothers' children are more likely to experience caries on both primary [OR=1.7 (1.3-2.3)] and permanent [OR=1.4 (1.0-2.0)] dentitions when compared with dentate mothers' children. These results are independent of socio-economic status, age, gender, and children's oral-health-related behaviors. Our study is the first to show that edentulous mothers' children constitute a group at risk of caries. It also highlights the need for a better understanding of the mother-child transmission of risk.