The influence of social deprivation on dental caries in Swedish children and adolescents, as measured by an index for primary health care: The Care Need Index

Area-Level Factors of Dental Caries in Children and Adolescents in European Neighborhoods - a Systematic Review

The WHO emphasizes the importance of taking area-level factors into account when formulating public health interventions. The aim of this systematic review was to identify which area-level factors are associated with children's dental caries in Europe and might therefore be a suitable starting point for public health interventions. We conducted a systematic review based on a search in PubMed, Web of Science, and Cochrane Library including all European studies on caries in children and their area-level factors published since the year 2000 in English or German. We included 39 studies and identified 13 area-level factors investigated in the literature: degree of urbanization, deprivation, mean housing price, gross-national product, mean level of education, unemployment proportion and income, density of supermarkets, snack bars and dental offices, health, diet, and crime. Rural residency and higher unemployment were weakly associated with poorer oral health regarding dental caries. Deprivation showed a stronger (inverse) association. For income, findings were ambiguous; studies showed associations in both directions. For the other determinants, the included studies found no association. Many studies reported associations between place of residence and children's dental caries, but the mediators on this causal path are still not clearly established. The area-level factors analyzed in this review seem to play a role, but more studies with designs that allow causal interpretation of findings are needed to establish solid robust evidence that can be used in the formulation of future health policies.

Persistent oral health inequality in children-repeated cross-sectional studies in 2010 and 2019

BACKGROUND AND AIM

Children growing up in vulnerable circumstances have a higher risk of caries experience. Tracking the development of caries in relation to socioeconomic variables over time is essential for fair resource distribution to groups with higher caries risk and to even out inequalities in oral health. The aim was therefore to analyse the association between 6-year-olds´ caries prevalence and socioeconomic variables at family and residential area levels in 2010 and 2019 as well as potential differences in the association between 2010 and 2019.

METHODS

The study design is an epidemiological registry-based, repeated cross-sectional study based on caries data (grouped as 0, 1-3 and > 3 dmft) for the population of 6-year-olds in 2010 (n = 4,408, 95% coverage) and 2019 (n = 5,199, 94% coverage) in a Swedish region. Multiple socioeconomic variables for the children's families and residential areas were retrieved from official registries. Multinomial logistic regression was performed at both levels to produce models for each level and studied year.

RESULTS

The variables that explained most of the association between caries and socioeconomic variables were mainly the same over the years at both levels. At the family level, these were: maternal age when having their first child (explained most of the association in both years, at 30 and 35%, respectively); maternal age when having the child in the study group; parental employment; parental and child's migration background; maternal educational level; form of housing; and financial assistance (only 2010). At the residential area level, these were: migration background (explained most of the association both years; 82 and 52%, respectively), educational level and number of persons per household. The association between socioeconomic variables and caries was consistently stronger for severe caries (dmft > 3) than moderate (dmft 1-3). Multiple socioeconomic risk variables meant an even greater likelihood of caries.

CONCLUSION

Over the studied years, variables related to socioeconomic vulnerability continued to be associated with caries in young children growing up under socially disadvantaged circumstances. Effective efforts for families living in socially vulnerable contexts are needed to achieve good and equal oral health, as is continued follow-up to evaluate whether the goal is reached.

Dental caries spectrum profile in Brazilian public school children and adolescents

Dental caries remains a major public health problem, with a higher prevalence among in adolescence. The present study aimed to assess the dental caries spectrum profile in children and adolescents in Brazilian public schools. A cross-sectional study was performed in two public schools in Brazil to examine the permanent teeth of children and adolescents. The dental caries were assessed by applying the Caries Assessment Spectrum and Treatment (CAST) instrument, and the results were distributed as per disease status (healthy/codes 0-2; pre-morbidity/code 3; morbidity/code 4-5; severe morbidity/codes 6-7; mortality/code 8) and by severity as per the CAST-F1 formula (no severity, mild, moderate, and severe). The CAST data were described by age groups (8-9 y, 10-11 y, 12-13 y, 14-15 y, 16-17 y, and 18-19 y). The Kruskal-Wallis test was used to investigate differences in CAST prevalence and severity among the groups (p < 0.05). Total 598 students were enrolled. Most of the subjects were male (53.34%) and belonged to the age group of 12-13 y (34.95%). The variables CAST 0/1 (p = 0.024), CAST (p = 0.024), and CAST-F1 (p = 0.029) showed significant differences among age groups, and the post hoc test showed the differences in these variables as per the age groups of 14-15 y and 16-17 y (CAST 0/1, p = 0.047; CAST, p = 0.047; CAST-F1, p = 0.033). The dental caries spectrum increased from 8 to 19 y with a peak in the prevalence and severity in the middle of adolescence.

Identifying associations between dental arch relationship scores, relative deprivation and other cleft audit outcomes. Part 2

Identify associations between dental arch relationship scores, oral health status and deprivation index in patients with complete unilateral cleft lip and palate (UCLP) and bilateral cleft lip and palate (BCLP). Ninety-two 5-year-old children with non-syndromic complete UCLP and thirty-nine 5-year-old children with non-syndromic complete BCLP from the United Kingdom. Data were collected from the 5-year audit outcomes submitted to the Cleft Registry and Audit Network (CRANE). The index of multiple deprivation (IMD) and Welsh index of deprivation were used to assess a relative measure of deprivation. Comparisons of 5-year-old index/BCLP Deciduous Dentition Yardstick outcome against IMD and dmft are performed using multivariable linear regression models. Both UCLP and BCLP had a high percentage of children with dmft >0 (47% and 49%, respectively). The mean dmft for the UCLP cohort was 2.8 and 2.6 for the BCLP cohort. In the UCLP group, a poorer 5-year-old index was associated with an increased dmft score (P = .023) and higher level of deprivation (P = .010). In the BCLP group, there was no significant associations between BCLP Deciduous Dentition Yardstick, dmft and IMD. A poorer dental arch relationship outcome may be associated with higher level of area deprivation and oral health status, in children with UCLP. Those with a poor outcome for the 5-year-old Index are more likely to have increased caries experience.

Neighbourhood characteristics and children's oral health: a multilevel population-based cohort study

Background

To understand determinants of oral health inequalities, multilevel modelling is a useful manner to study contextual factors in relation to individual oral health. Several studies outside Europe have been performed so far, however, contextual variables used are diverse and results conflicting. Therefore, this study investigated whether neighbourhood level differences in oral health exist, and whether any of the neighbourhood characteristics used were associated with oral health.

Methods

This study is embedded in The Generation R Study, a prospective cohort study conducted in The Netherlands. In total, 5 960 6-year-old children, representing 158 neighbourhoods in the area of Rotterdam, were included. Data on individual and neighbourhood characteristics were derived from questionnaires, and via open data resources. Caries was assessed via intraoral photographs, and defined as decayed, missing and filled teeth (dmft).

Results

Differences between neighbourhoods explained 13.3% of the risk of getting severe caries, and 2% of the chance of visiting the dentist yearly. After adjustments for neighbourhood and individual characteristics, neighbourhood deprivation was significantly associated with severe dental caries (OR: 1.48, 95% CI: 1.02–2.15), and suggestive of a low odds of visiting the dentist yearly (OR: 0.81, 95% CI: 0.56–1.18).

Conclusions

Childhood caries and use of dental services differs between neighbourhoods and living in a deprived neighbourhood is associated with increased dental caries and decreased yearly use of dental services. This highlights the importance of neighbourhoods for understanding differences in children’s oral health, and for targeted policies and interventions to improve the oral health of children living in deprived neighbourhoods.

A longitudinal study of the impact of change in socioeconomic status on dental caries in the permanent dentition of Swedish children and adolescents

OBJECTIVES

The overall aim was to analyse longitudinally the development of dental caries in the permanent dentition of children and adolescents in a Swedish region, in relation to possible change in socioeconomic status (SES).

METHODS

A total of 259 448 individuals in western Sweden were followed over a 3-year period, through dental journal records at baseline (3-19-year-olds) and 1-3 dental check-ups during the follow-up period. Official socioeconomic register information (ethnicity, wealth, parental education and employment) was available at both baseline and follow-up. Data were used both as independent single variables and combined in an index. Gender, age and caries status at baseline and the examination years were included as covariates in the regression models.

RESULTS

Associations over time were found between SES and dental caries in young people. A persistently low SES was associated with the greatest risk of both new and accumulated (decayed plus filled teeth/approximal surfaces) caries; however, any change in SES, whether improved or worsened, led to a greater risk. An increased risk of new caries events was identified for those who were older at baseline and by examination year. On average, the increase per year in decayed and/or filled teeth and in approximal surfaces was 0.23 and 0.12, respectively.

CONCLUSION

SES was shown to be an important risk factor for dental caries over time in young Swedish people. Prevention programmes should pay particular attention to the needs of socioeconomically vulnerable individuals and groups.

Association between severe unaddressed dental needs and developmental health at school entry in Canada: a cross-sectional study

Background

Dental problems are the most prevalent chronic disease worldwide, with up to half of all kindergarten children having tooth decay. However, there is a lack of evidence of whether unaddressed dental needs (UDNs) are associated with children’s developmental health, a concept reflecting holistic child development - encompassing physical, emotional, and cognitive development. The objective of the current study was to evaluate the relationship between UDNs and developmental health among kindergarten children using the Early Development Instrument (EDI).

Methods

We examined associations between teacher reported UDNs and developmental vulnerability on the EDI. Children were included in the study if they were enrolled in kindergarten in publicly-funded schools in Canada between 2010 and 2015, had been in the classroom for at least one month, and had no more than 25% of missing items on the questionnaire.

Results

Among 576,264 children who met inclusion criteria (95.4% of eligible children), 2465 (0.4%) were identified as having UDNs by their teachers. Children with UDNs had 4.58 to 8.27 times higher odds of being vulnerable on any of the five developmental domains (physical health and well-being, social competence, emotional maturity, language and cognitive development, communication skills and general knowledge), compared to children without UDNs.

Conclusion

In this study, teacher-reported UDNs were associated with developmental vulnerability in kindergarten children. Teacher reported unmet dental needs in kindergarten children may be a proxy for poor developmental health at school entry, and thus a marker for supporting both children’s oral health and early developmental needs.

The Swedish dental health register - validation study of remaining and intact teeth

BACKGROUND

Sweden has a long tradition of nationwide registers enabling population-based research of high quality and validity. We aimed to describe the content and validity of reported number of remaining and intact teeth in the Swedish Dental Health Register and report some descriptive data on dental health care utilization.

METHODS

The Swedish Dental Health Register was initiated in July 1st 2008 and contains individual data on dental health care to the whole adult population of Sweden. The dental care given freely to children and young adults is not included. Descriptive data on remaining, intact teeth and dental health care utilization is presented by proportion of the population stratified by sex and age. We conducted a validation study, by manual review of randomly sampled 1500 dental health visits records, to assess reported number of teeth to the register with what was actually recorded in the dental health care record (gold standard), analyzed by positive predictive value (PPV) and Bland-Altman plots.

RESULTS

Of the Swedish adult population 2014, 2.6 million (69%) men and 2.9 million (76%) women had at least one visit to a dentist during a two-year period 2013 to 2014. More than half of the population up to age 64 have all remaining teeth (28 teeth or more). Of the 1500 requested dental records 1131 (75%) were received. The positive predictive value for patients reported to the register as having at least 1 tooth up to 31 intact teeth was 91.5% (95% confidence interval 89.0-93.5, 567 manually reviewed to be correct out of 620 reported).

CONCLUSIONS

For patients coded as having less than 32 intact teeth but not being edentulous the reported number of remaining and intact teeth is to a very high degree correct. However, the correctness for those coded as edentulous or having 32 remaining intact teeth is low and varies substantially by age.

Multiple Socioeconomic Factors and Dental Caries in Swedish Children and Adolescents

The study aimed to explore associations between multiple socioeconomic factors and dental caries experience in Swedish children and adolescents (3-19 years old). Electronic dental records from 300,988, in a Swedish region (97.3% coverage) were collected using the DMFT indices (decayed, missing, filled teeth: dependent variables). Socioeconomic status (SES) data (ethnicity, wealth, parental education, and employment) for individuals, parents, and families were obtained from official registers. Principal component analysis was used to explore SES data. Scores based on the first factor were used as an independent aggregated socioeconomic variable in logistic regression analyses. Dental caries experience was low in the participants: 16% in 3- to 6-year-olds (deft index: decayed, extracted, filled teeth) and 47% in 7- to 19-year-olds (DFT index). Both separate and aggregated socioeconomic variables were consistently associated with the dental caries experience irrespective of the caries index used: the crude odds ratio (OR) for having at least 1 caries lesion in 3- to 6-year-olds (deft index) in the lowest SES quintile was 3.26 (95% confidence interval [CI] 3.09-3.43) and in ≥7-year-olds (DFT index) OR 1.80 (95% CI 1.75-1.84) compared with children in the 4 higher SES quintiles. Overall, associations were stronger in the primary dentition than in the permanent dentition. Large SES models contributed more to explaining the caries experience than slim models including fewer SES indicators. In conclusion, socioeconomic factors were consistently associated with dental caries experience in the children and adolescents both as single factors and as multiple factors combined in an index. Socioeconomic inequalities had stronger associations to caries experience in young children than in older children and adolescents.