Effect of acculturation on objective measures of oral health in Haitian immigrants in New York City

Sociocultural determinants of children's oral health among immigrants in Canada

OBJECTIVE

A conceptual model was designed and tested to predict immigrant children's oral health in Canada by examining parental acculturation and perceived social support (PSS) using structural equation modelling.

METHODS

A convenience sample of first-generation immigrant parents and their children aged 2-12 years were recruited by multilingual community workers in Edmonton, Canada. Parents completed a validated questionnaire on demographics, child's oral health (OH) behaviours, parental acculturation and PSS. Dental examinations determined children's dental caries rate using DMFT/dmft index. Structural equation modelling (SEM) was used to analyse the data.

RESULTS

A total of 336 families participated in this study. The average parental acculturation level was 10.46 with a maximum of 15, and the average PSS was 63.27 with a maximum of 75. SEM showed that 77% of the variance of DMFT/dmft scores in children was explained by parental PSS, acculturation level, immigration-related variables, socioeconomic variables and children's OH behaviours. The direct effect of parental PSS was associated with a significantly reduced rate of dental caries (β = -.076, p-value = .008) and lower sugar consumption (β = -.17, p-value = .04). While the mediation effect of parental acculturation on PSS was associated with positive OH behaviours of children (e.g., toothbrushing frequency and dental care utilization), the indirect effect was negatively associated with caries rate (β = .77, p-value = .00).

CONCLUSIONS

The direct effect of Parental Perceived Stress Scale (PSS) was associated with more favourable oral health behaviours and a lower prevalence of dental caries, while the mediation effect of acculturation was linked to a higher prevalence of dental caries.

Immigrant Parents' Perceived Social Support and Their Children's Oral Health Behaviors and Caries Experience

This study examined the associations between immigrant parents’ perceived social support (PSS) and their children’s oral health behaviors (OHB) and caries experience. We recruited immigrant parents and children aged 2−12 years. Data were collected on the sociodemographic and OHB information of the children. The parents’ total PSS score and its dimensions were measured using the validated Personal Resource Questionnaire (PRQ2000). Dental examinations determined the children’s caries experience using the DMFT/dmft index. A total of 336 parents and children were included in the study. Household income predicted the parents’ PSS (B = −5.69; 95% CI −9.077, −2.32). Children of parents with higher PSS reported ≥2 toothbrushing/day (p ≤ 0.05). Among the PSS domains, parental education level predicted their social integration (B = −0.16; 95% CI −0.30, −0.02) and nurturance (B = −0.24; 95% CI −0.43, −0.06). Family income predicted social integration (B = −0.17; 95% CI −0.33 −0.01), worth (B = −0.23; 95% CI −0.39 −0.06), and assistance (B = −0.22; 95% CI −0.42 −0.01). Parents with higher scores of intimacy and social integration were more aware of their children’s oral health (p = 0.01). The parental social integration mean scores were significantly higher among parents whose children consumed ≥1 sugary snack/day (p = 0.02). All five domain scores were significantly higher among parents of children who reported ≥2 toothbrushing/day compared with children who brushed <2/day (p < 0.05). The results demonstrated that parents’ PSS only improved their children’s toothbrushing frequency. Compared to other domains, social integration was significantly associated with children’s OHB. Neither parental PSS total score nor domains were associated with DMFT/dmft.

Acculturation and 4-year caries increment among children of foreign-born mothers in Sweden: a register-based cohort study

Background

To study the association of maternal age upon arrival and length of residence in Sweden with the 4-year caries increment in their children between ages 3 and 7 years in relation to the human development index (HDI) of the maternal country of origin.

Method

This registry-based cohort study included all children born in 2000–2003 who resided in Stockholm County, Sweden, at age 3 years and who were followed up at age 7 (n = 63,931). Negative binomial regressions were used to analyze different models adjusted for sociodemographic factors.

Results

Children of foreign-born mothers, regardless of the HDI of the maternal country of origin, had a higher risk of caries increment between ages 3 and 7 years than children of Swedish-born mothers. Furthermore, children of mothers who had arrived from a low or medium HDI country had a lower caries increment if their mothers arrived before age 7 compared with after age 7. Nearly half (44%) of the children whose mothers arrived in Sweden at age ≥ 20 years from a low HDI country had a caries increment compared to 22% of the children whose mothers had arrived in Sweden before 7 years of age. Furthermore, children whose mothers were born in a low HDI country and had resided in Sweden ≤ 19 years had approximately 1.5 times higher risk of caries increment compared to children of mothers who had resided in Sweden for more than 20 years.

Conclusions

Caries increment in the children of foreign-born mothers was associated with the age of their mother when she arrived in Sweden and was lower when the mother had arrived before age 7 years. This indicates an intergenerational effect that carries over to the children and is greater the longer the mother has participated in Swedish dental healthcare.

Parental acculturation and oral health of children among immigrants

OBJECTIVES

This cross-sectional study aimed to examine the associations between parental acculturation level and strategies and children's caries experience and oral health (OH) behaviors.

METHODS

Participants were immigrant parents of children aged 2-12 years. Data were collected by validated questionnaires gathering information on socio-demographics, child's OH behaviors, and parents'; acculturation and dental examinations determining child's caries experience using DMFT/dmft index. Univariate and multivariate regression analyses were used.

RESULTS

Three hundred and thirty-six parent/child dyads completed the study. Length of residency (B = 0.103; 95% CI: 0.064, 0.141) parents' education (B = 1.691; 95% CI: 1.228, 2.155), and household income (B = -0.959; 95% CI: -1.566, -0.352) significantly predicted acculturation level. Parents with high Canadian cultural knowledge reported higher frequency of children's toothbrushing (p-value = 0.015). Parents of children who consumed sugar >1/day had higher mean scores of acculturation to Canadian culture (p-value = 0.016), English language proficiency (p-value = 0.024), and Canadian food adoption (p-value = 0.046). Parents of children who visited the dentist within last 12 months had significantly higher assimilation and lower separation mean scores. Parents of children who visited dentist because of dental problems had higher marginalization mean score than those who went for check-ups (p-value = 0.046). Parental acculturation was not significantly correlated with their children's dmft/DMFT level.

CONCLUSIONS

Children of highly acculturated parents reported higher toothbrushing frequency and were more likely to consume sugar than children of less acculturated parents. Assimilated parents reported more and marginalized parents reported less favorable OH behaviors than other categories. Parental acculturation level or strategy was not associated with children's caries experience.

Risk indicators of dental caries among refugee patients attending a public dental service in Victoria

BACKGROUND

Little is known about the relationship between dental caries prevalence and the social risk factors of asylum seekers and refugees in Australia.

METHODS

An oral health interview and a clinical oral examination were carried out on 201 asylum seekers and refugees patients, aged 18-68, attending Monash Health Dental Services, Melbourne, Victoria.

RESULTS

Data illustrated that 82% of participants had at least one tooth with untreated decay. Tooth level analysis revealed that white spot lesions were most prevalent in age groups 18-29 and 30-39, with respective mean values of 4.45 ± 4.95 and 3.49 ± 4.74. Binary logistic regression models identified multiple social factors as a barrier to receiving dental care. These included, but were not limited to; medication intake, consumption of soft drinks and long waiting lists. These social factors in addition to oral health factors, such as white spot and hypomineralization lesions, were significant predisposing factors to the presence of cavitated carious lesions.

CONCLUSIONS

Multiple social and oral health risk factors were identified and significantly associated with dental caries among refugee and asylum seeker patients. Addressing these underlying risks is an integral component to reducing the prevalence of dental caries among this population group and improving their overall general and oral health.

Adaptation and Validation of a Short Acculturation Scale in a Multi-Ethnic Asian Population

The Short Acculturation Scale (SAS) has been widely used for assessing the level of the acculturation of migrants in Western countries. However, the validity of SAS for use in cosmopolitan settings without a single prevailing culture is unclear. We examined the validity and reliability of a version of the SAS adapted to a multi-ethnic Asian society. We used cross-sectional data from 12,610 Singaporean citizens and permanent residents, aged 21–75 years, of Chinese, Malay, and Indian ethnicity. Our version used 11 items, with 5 questions on language use, 3 on media use, and 3 on ethnic social relations, to measure acculturation. Our version of the SAS had good internal consistency. The three-factor CFA model had a good fit to our data. The results from the multiple group CFA supported metric invariance and partial scalar invariance across the three ethnic groups. The total score was positively correlated with generation in Singapore and the number of languages spoken. Among first generation immigrants, country of origin, but not the duration of residence was significantly associated with the acculturation score. Our three-factor version of the SAS is a reliable and valid tool for measuring acculturation in Singapore residents. These findings indicate that adapted SAS can be used to assess acculturation in multicultural settings.

Prevalence of Dental Caries and Treatment Needs in Tibetan Monks and Nuns in Karnataka

Aim

The aim of this study was to assess the prevalence of dental caries and treatment needs among Tibetan monks and nuns in Bylakuppe.

Materials and Methods

In this cross-sectional study, stratified random sampling was used to obtain desired sample for the study. The clinical examination was carried out to obtain data regarding dental caries status and treatment needs using World Health Organization (WHO) Oral Health Assessment Pro forma 1997. Statistical analysis was carried out using Statistical Package for the Social Sciences (SPSS) software program, version 20.0. The data were statistically analyzed by using descriptive statistics and chi-square test.

Results

The study population consisted of 345 Tibetan monks (men) and 35 Tibetan nuns (women). Prevalence of dental caries was 88.68% with mean decayed, missing, and filled teeth (DMFT) value of 6.06 ± 5.37. Assessment of dental treatment needs showed 82.3% of participants needed one surface filling, 11.9% of participants needed pulp care and restoration, and 9.3% of participants required extraction of teeth.

Conclusion

The study population is characterized by high prevalence of dental caries and lack of awareness about treatment needs.

Neighborhood Cohesion and Oral Health Problems Among Older Chinese American Immigrants: Does Acculturation Make a Difference?

BACKGROUND AND OBJECTIVES

Despite an increasing, yet still limited amount of research on social determinants of oral health, the influences of neighborhood characteristics remain understudied, especially within the context of immigration. Acculturation is multidimensional, and its influences on the oral health of immigrants vary across age and ethnic groups. This study investigated the relationship between neighborhood cohesion and oral health problems among older Chinese American immigrants, and whether and to what extent acculturation indicators moderate the relationship between such cohesion and oral health.

METHODS

The research design and working sample included 3,157 older Chinese American immigrants aged 60 years or older from the baseline of the Population Study of Chinese Elderly in Chicago. Neighborhood cohesion was measured by a six-item scale. Oral health problems were measured by the presence or absence of such problems. Acculturation included residence in ethnic enclaves, length of stay, and behavioral acculturation. Stepwise logistic regression models with interaction terms (Neighborhood cohesion × Acculturation) were conducted to examine the association between neighborhood cohesion and oral health problems, accounting for sociodemographics, health conditions, and health behaviors.

RESULTS

Individuals experiencing higher levels of neighborhood cohesion reported a lower likelihood of having oral health problems. The protective effect of neighborhood cohesion against having oral health problems was stronger when individuals resided in ethnic enclaves such as Chinatown.

DISCUSSION AND IMPLICATIONS

To promote optimal oral health, interventions need to account for individuals' perceptions and levels of integration into their neighborhoods and communities.

Impact of social support on oral health among immigrants and ethnic minorities: A systematic review

Objective

Adaptation to social life changes after migration may be beneficial or detrimental to migrants’ oral health outcomes and related behaviors. This systematic review aims to synthesize the scientific literature on the impact of social support on immigrants’ and ethnic minorities’ oral health status and/or behaviors.

Methods

A comprehensive electronic search, up to November 2018, was conducted using five electronic databases. We included cross-sectional and longitudinal quantitative studies that examine associations between social support and oral health outcomes among immigrants and ethnic minorities. Study selection, data extraction, and risk of bias assessment were completed in duplicate and the Newcastle-Ottawa checklist was used to appraise the methodological quality of the quantitative studies.

Results

A total of 26 studies met the eligibility criteria. Included studies examined multiple oral health outcomes such as dental care utilization, oral health behaviors, oral health problems, self-rated oral health, oral health knowledge, and oral health-related quality of life among immigrants and ethnic minorities. The social support level is assessed either by social support indicators or by adapting certain scales. Overall, social support was found to be positively associated with dental care utilization, number of carious teeth, periodontal disease, oral health behaviors, oral health knowledge, oral health-related quality of life, and self-rated oral health.

Conclusion

Although immigrants and ethnic minorities encounter several challenges after migration to a new country that could affect their oral health, social support from their surrounding environment in the form of structural or functional support plays an important role in improving their oral health outcomes.

Impact of acculturation on oral health among immigrants and ethnic minorities: A systematic review

OBJECTIVE

Cultural changes faced by immigrants and ethnic minorities after moving to a host country may have a detrimental or beneficial influence on their oral health and oral health-related behaviors. Therefore, this paper reviews the literature to see the impact of acculturation on immigrants and ethnic minorities' oral health outcomes.

METHODS

We searched seven electronic databases up to January 2018. All cross-sectional and longitudinal quantitative studies that examined associations between acculturation and oral health status and/or oral health behaviors among ethnic minority and immigrant population[s] were included. Study selection, data extraction, and risk of bias assessment were completed in duplicate. The Newcastle-Ottawa checklist was used to appraise the methodological quality of the quantitative studies. A meta-analytic approach was not feasible.

RESULTS

A total of 42 quantitative studies were identified. The studies showed a positive association between acculturation and oral health status/behaviors. The most frequently used acculturation indicators were language spoken by immigrant and ethnic minorities and length of stay at the host country. High-acculturated immigrant and ethnic minority groups demonstrated better oral health outcomes, oral health behaviors, dental care utilization, and dental knowledge.

CONCLUSIONS

According to existing evidence, a positive effect of acculturation on oral health status and behaviors was found.

PRACTICAL IMPLICATIONS

Dental practitioners should be culturally competent to provide the appropriate services and treatments to immigrant and ethnic minorities. Policymakers should also be sensitive to cultural diversities and properly address the unique needs of each group in order to maintain oral health equity.

Associations Between Acculturation and Oral Health Among Older Chinese Immigrants in the United States

Background: The aim of this study was to understand the associations between acculturation and oral health among older Chinese immigrants in the United States. Method: We used data from the PINE study, which included the foreign-born older Chinese immigrants (N = 3,128). We measured acculturation by measuring participants' length of stay and behavioral acculturation. Participants' tooth and gum symptoms were the outcome variables. Results: Longer stay in the United States was significantly associated with fewer gum symptoms but not with tooth symptoms. Behavioral acculturation was not significantly associated with either tooth or gum symptoms. The middle tertile of behavioral acculturation, compared with its upper and lower tertiles, deemed to be a more significant risk factor of tooth/gum symptoms. In addition, older immigrants with more social interactions with the Americans were more likely to have tooth symptoms. Discussion: In the future, we will conduct a study using longitudinal data to help us better understand the relationship between acculturation and oral health in Chinese American population.

Health literacy, acculturation, and the use of preventive oral health care by Somali refugees living in massachusetts

This study investigated the impact of English health literacy and spoken proficiency and acculturation on preventive dental care use among Somali refugees in Massachusetts. 439 adult Somalis in the US ≤10 years were interviewed. English functional health literacy, dental word recognition, and spoken proficiency were measured using STOFHLA, REALD, and BEST Plus. Logistic regression tested associations of language measures with preventive dental care use. Without controlling for acculturation, participants with higher health literacy were 2.0 times more likely to have had preventive care (P = 0.02). Subjects with higher word recognition were 1.8 times as likely to have had preventive care (P = 0.04). Controlling for acculturation, these were no longer significant, and spoken proficiency was not associated with increased preventive care use. English health literacy and spoken proficiency were not associated with preventive dental care. Other factors, like acculturation, were more predictive of care use than language skills.

The deterioration of Canadian immigrants' oral health: analysis of the Longitudinal Survey of Immigrants to Canada

OBJECTIVE

To examine the effect of immigration on the self-reported oral health of immigrants to Canada over a 4-year period.

METHODS

The study used Statistics Canada's Longitudinal Survey of Immigrants to Canada (LSIC 2001-2005). The target population comprised 3976 non-refugee immigrants to Canada. The dependent variable was self-reported dental problems. The independent variables were as follows: age, sex, ethnicity, income, education, perceived discrimination, history of social assistance, social support, and official language proficiency. A generalized estimation equation approach was used to assess the association between dependent and independent variables.

RESULTS

After 2 years, the proportion of immigrants reporting dental problems more than tripled (32.6%) and remained approximately the same at 4 years after immigrating (33.3%). Over time, immigrants were more likely to report dental problems (OR = 2.77; 95% CI 2.55-3.02). An increase in self-reported dental problems over time was associated with sex, history of social assistance, total household income, and self-perceived discrimination.

CONCLUSION

An increased likelihood of reporting dental problems occurred over time. Immigrants should arguably constitute an important focus of public policy and programmes aimed at improving their oral health and access to dental care in Canada.

The impact of functional health literacy and acculturation on the oral health status of Somali refugees living in Massachusetts

OBJECTIVES

We assessed the impact of health literacy and acculturation on oral health status of Somali refugees in Massachusetts.

METHODS

Between December 2009 and June 2011, we surveyed 439 adult Somalis who had lived in the United States 10 years or less. Assessments included oral examinations with decayed, missing, and filled teeth (DMFT) counts and measurement of spoken English and health literacy. We tested associations with generalized linear regression models.

RESULTS

Participants had means of 1.4 decayed, 2.8 missing, and 1.3 filled teeth. Among participants who had been in the United States 0 to 4 years, lower health literacy scores correlated with lower DMFT (rate ratio [RR] = 0.78; P = .016). Among participants who had been in the country 5 to 10 years, lower literacy scores correlated with higher DMFT (RR = 1.37; P = .012). Literacy was not significantly associated with decayed teeth. Lower literacy scores correlated marginally with lower risk of periodontal disease (odds ratio = 0.22; P = .047).

CONCLUSIONS

Worsening oral health of Somali refugees over time may be linked to less access to preventive care and less utilization of beneficial oral hygiene practices.

A review on the oral health impacts of acculturation

The impact of acculturation on systemic health has been extensively investigated and is regarded as an important explanatory factor for health disparity. However, information is limited and fragmented on the oral health implications of acculturation. This study aimed to review the current evidence on the oral health impact of acculturation. Papers were retrieved from five electronic databases. Twenty-seven studies were included in this review. Their scientific quality was rated and key findings were summarized. Seventeen studies investigated the impacts of acculturation on the utilization of dental services; among them, 16 reported positive associations between at least one acculturation indicator and use of dental services. All 15 studies relating acculturation to oral diseases (dental caries and periodontal disease) suggested better oral health among acculturated individuals. Evidence is lacking to support that better oral health of acculturated immigrants is attributable to their improved dental attendance. Further researches involving other oral health behaviors and diseases and incorporating refined acculturation scales are needed. Prospective studies will facilitate the understanding on the trajectory of immigrants’ oral health along the acculturation continuum.

Detection of depression with different interpreting methods among Chinese and Latino primary care patients: a randomized controlled trial

Language barriers may contribute to the under-detection of depression in Latinos and Asians. A total of 782 English, Spanish, and Chinese-speaking primary care patients were enrolled in a randomized controlled trial. Language discordant patients were randomized to Remote Simultaneous Medical Interpreting (RSMI) or usual and customary (U&C) interpreting. The Beck Depression Inventory-Fast Screen (BDI-FS) was administered. Patients were tracked for 1 year. A total of 462 patients completed the BDI-FS. Thirty-three percent had a positive (> or = 4) screen. Twenty-seven percent of BDI-FS positive patients were diagnosed with depression. Among BDI-FS positive patients, Chinese-speakers were less likely to be diagnosed compared with English speakers (31% vs. 10%, P < 0.05). There was a trend towards greater diagnosis with RSMI (27% detection with RSMI vs. 20% U&C, P = 0.41). The diagnosis of depression among BDI-FS positive patients in our population was low, particularly among Chinese-speakers. RSMI could be an important part of a multi-faceted approach to improving the detection of depression.

Are immigrant populations aware about their oral health status? A study among immigrants from Ethiopia

Background

Evidence from Western countries indicates that there are fundamental discrepancies between self-perceived illness of immigrants and the provision of health care, according to the Western bio-medical health service model. These need to be understood in the planning and implementation stages of public health care programs for new immigrants. The objectives of the present study were to investigate self-perceived versus clinically diagnosed dental and periodontal health status among immigrants from Ethiopia.

Methods

During 2004–2005, dental and periodontal health status was recorded among 340 Ethiopian immigrants, utilizing the DMFT and CPI indices. Additionally, participants were interviewed using a questionnaire which included perceived dental and periodontal health status. Sensitivity and specificity levels of this perception were calculated and compared with the published scientific literature.

Results

Regarding dental caries, according to the three operational cut-off points, sensitivity ranged from 70% to 81%, and specificity ranged from 56% to 67%. Regarding periodontal status, 75% of the subjects clinically diagnosed with periodontal pockets self-perceived a "bad" health status of gums (sensitivity) and 54% of the subjects diagnosed without periodontal pockets, reported a "good" health status of gums (specificity). These indications of perception levels were higher than a previous study conducted among native born Israelis.

Conclusion

Minority ethnic groups should not be prejudicially regarded as less knowledgeable. This is illustrated by the unexpected high level of oral health status perception in the present population. Oral health promotion initiatives among immigrants should be based upon optimal descriptive data in order to accomplish the inherent social commitment to these diverse populations.

The association of immigration and acculturation attributes with oral health among immigrants in New York City

OBJECTIVES

We examined associations between immigration and acculturation attributes and oral disease among immigrants.

METHODS

We conducted a large cross-sectional study of 1318 immigrants in New York City. We performed comprehensive interviews and oral examinations of the participants and used linear regression models to assess differences in oral disease levels among immigrant subgroups. We also constructed proportional odds models to evaluate the association of oral disease level with length of stay in the United States, age at immigration, and language preference.

RESULTS

After we controlled for most known risk factors, country of birth and age at immigration were associated with variations in oral disease prevalence and need for oral health care. Length of stay was inversely associated with need for treatment of dental caries but not with any other indicator of oral disease. Language preference was not associated with any indicator of oral disease.

CONCLUSIONS

Immigrants' country of birth, length of stay in the United States, and age at immigration played important roles in their oral disease prevalence, independently of most known risk factors for oral diseases. Our findings emphasize the need for more studies to elucidate the complex relationships of ethnicity, socioeconomic status, and culturally influenced factors that impact immigrants' oral health.

Changing dental caries and periodontal disease patterns among a cohort of Ethiopian immigrants to Israel: 1999-2005

Background

Dental epidemiology has indicated that immigrants and minority ethnic groups should be regarded as high risk populations on the verge of oral health deterioration. The objectives of this study were to measure the changing pattern of dental caries, periodontal health status and tooth cleaning behaviour among a cohort of Ethiopian immigrants to Israel between the years 1999–2005.

Methods

Increment of dental caries and periodontal health status was recorded among a cohort of 672 Ethiopian immigrants, utilizing the DMFT and CPI indices. Data were gathered during 1999–2000 and five years later, during 2004–2005. Participants were asked about their oral hygiene habits in Ethiopia and in Israel five years since their immigration.

Results

Regarding dental caries, at baseline 70.1% of the examinees were caries-free, as compared to 57.3% after five years. DMFT had increased from 1.48 to 2.31. For periodontal health status, at baseline, 94.7% demonstrated no periodontal pockets (CPI scores 0–2) and 5.3% revealed periodontal pockets (CPI scores 3&4), compared to 75.6% and 24.4%, respectively after five years. At baseline, 74% reported cleaning their teeth exclusively utilizing chewing and cleaning sticks common in Ethiopia. After five years, 97% reported cleaning their teeth exclusively utilizing toothbrushes.

Conclusion

The deterioration in the oral health status, especially the alarming and significant worsening of periodontal health status, among this immigrant group, emphasizes the need for health promotion and maintenance among immigrants and minority groups in changing societies. An "acclimatizing and integrating" model of oral health promotion among minority and immigrant groups is suggested.

Influence of immigration and other factors on caries in 12- and 15-yr-old children

In recent years the Valencia region has undergone mass immigration, mainly of people from eastern Europe, North Africa, and Latin America. The objective of this study was to assess the effect of immigration on caries prevalence and experience in 12- and 15-yr-old children in the Valencia region, and to relate this to other socio-economic and oral hygiene-related variables. The data were obtained from the epidemiological study of oral health carried out in the Valencia Region in 2004. The study group comprised 478, 12-yr-old children and 401, 15-yr-old children. Immigration status, age, toothbrushing frequency, and intake of cariogenic foods between meals showed significant association in a multiple linear regression model using the decayed, missing or filled teeth (DMFT) count as the dependent variable. Of all the predictive variables, the one that made the highest contribution to the model was immigration status. In a multiple logistic regression analysis with caries presence as the dependent variable, immigration status, intake of cariogenic foods, social class, and age were significantly associated with the presence of caries. As immigrant children have significantly higher caries levels than Spanish children, future public health service planning should pay attention to this risk group.

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.

An assessment of oral self-care in the student population of a Turkish university

OBJECTIVES

The aim of this study was to determine the oral health behavior of Turkish non-dental university students.

STUDY DESIGN AND METHODS

A sample of 610 non-dental university students attending the University of Ondokuz Mayis in Samsun were randomly selected from the whole student population (n=12604) via the random number method. The students were asked to fill out a standardized self-completion questionnaire about daily frequency of toothbrushing, kind of toothbrush, frequency of toothbrush replacement, frequency of dental flossing, use of antibacterial rinse, or any other oral hygiene aid, receiving of oral hygiene instruction and frequency of oral check-up. The data were analysed using the SPSS version 12.0.1 statistical software package.

RESULTS

Sixty-eight per cent of the students brushed their teeth two or more times per day. Two or more times a day toothbrushing was more common among females than males (P<0.001). Few subjects (3%) used dental floss daily. Forty per cent of students used only the toothpick as an interdental oral hygiene device. Thirty per cent of the students visited a dentist for preventive treatment at least once a year. There was no significant difference in regularity of visits to the dentist between females and males (P>0.05).

CONCLUSION

This study indicated that self-preventive oral behaviour of the Turkish university student is at a lower level than in industrialized countries.