Dental needs and socioeconomic status associated with utilization of dental services in the presence of dental pain: a case-control study in children

AIMS

To identify the effect of unmet dental treatment needs and socioeconomic and sociodemographic variables on the patterns of dental visits in the presence of dental pain in 6- to 12-year-old Mexican schoolchildren.

METHODS

A case-control study included 379 patients that had a dental visit because of dental pain in the 12 months preceding this study and 1,137 controls. Mothers and/or guardians supplied sociodemographic, socioeconomic, and oral health-related information through a questionnaire. The profiles of unmet dental needs and of oral hygiene were ascertained by means of a standardized dental examination administered to participating children. Odds ratios (OR) and 95% confidence intervals (CIs) were calculated with logistic regression.

RESULTS

Higher unmet dental needs and lack of health insurance were associated with the experience of dental visits because of dental pain in the preceding 12 months. Boys who attended public schools had a 70% (95% CI = 1.29 to 2.23) higher probability of having had a dental visit in which dental pain was one of the main reasons for attendance, compared to boys attending private schools. The effect for girls was only 28% (95% CI = 1.10 to 1.50) higher for girls attending a public school, compared to girls attending private schools. Older children had a higher occurrence of dental visits because of dental pain than younger children.

CONCLUSIONS

While higher unmet dental needs and lack of health insurance were strong predictors of having had dental visits because of dental pain in the preceding 12 months, some socioeconomic variables and sociodemographic variables modified these relationships.

Dental caries in American Indian toddlers after a community-based beverage intervention

OBJECTIVE/SETTING

The Toddler Overweight and Tooth Decay Prevention Study (TOTS) was an overweight and early childhood caries (ECC) project in the Pacific Northwest. It targeted American Indian (AI) toddlers from birth, to effect changes in breastfeeding and sweetened beverage consumption.

DESIGN/INTERVENTION/PARTICIPANTS

The intervention cohort was children born in three communities during 12 months; expectant mothers were identified through prenatal visits, and recruited by tribal coordinators. The local comparison cohorts were children in those communities who were aged 18-30 months at study start. A control longitudinal cohort consisted of annual samples of children aged 18-30 months in a fourth community, supplying secular trends.

OUTCOME MEASURES

d1-2mfs was used to identify incident caries in intervention, comparison, and control cohorts after 18-to-30 months of follow-up in 2006.

RESULTS

No missing or filled teeth were found. For d1t, all three intervention cohorts showed statistically significant downward intervention effects, decreases of between 0.300 and 0.631 in terms of the fraction of affected mouths. The results for d2t were similar but of smaller magnitudes, decreases of between 0.342 and 0.449; these results met the .05 level for significance in two of three cases. In light of an estimated secular increase in dental caries in the control site, all three intervention cohorts showed improvements in both d1t and d1t.

CONCLUSION

Simple interventions targeting sweetened beverage availability (in combination with related measures) reduced high tooth decay trends, and were both feasible and acceptable to the AI communities we studied.

[Socioeconomic inequalities in oral health: factors associated with tooth brushing frequency among Nicaraguan schoolchildren]

OBJECTIVE

To identify the association between tooth brushing frequency and variables of socioeconomic position in Nicaraguan schoolchildren.

MATERIAL AND METHODS

A cross sectional study was undertaken in 1353 schoolchildren ages 6 to 12 randomly selected from 25 elementary schools in Leon, Nicaragua. Using a questionnaire addressed to mothers, sociodemographic, socioeconomic and behavioral variables were collected. The dependent variable was tooth brushing frequency, which was dichotomized in 0 "at least one 7 times/week" and 1 "7 or more times/week". A multivariate analysis was carried out with logistic regression in STATA 9.

RESULTS

The average age of child participants was 8.99 +/- 2.00 years and 49.7% were women. In the final model, older age (OR = 2.04), female sex (OR = 1.39) and having a mother with positive attitudes toward oral health (OR = 2.5) were positively associated with the tooth brushing frequency (p < 0.05). Larger family size (OR = 0.89) and having low socioeconomic status (1st quartile; OR = 0.54, 2nd quartile; OR = 0.62, 3rd quartile; OR = 0.67) showed a negative relationship with the tooth brushing frequency. To have had at least one preventive dental visit in the previous year was positively associated (p < 0.10) with tooth brushing frequency.

CONCLUSION

This study suggested that existence of indicators of socioeconomic inequalities exist even within less developed countries, and thus emphasize the need to target health promotion programs to vulnerable socioeconomic groups.

National survey on edentulism and its geographic distribution, among Mexicans 18 years of age and older (with emphasis in WHO age groups)

To determine the prevalence of edentulism in adults aged 18 years and older in Mexico and to describe its distribution in 20 of the 32 States in Mexico, highlighting the experience in the WHO age groups. A secondary analysis of the National Performance Evaluation Survey 2002-2003 (representative at the state level and part of the Word Health Survey) was undertaken. The sample design was probabilistic, stratified and through conglomerates. Data on dental conditions were available only for 20 of the 32 states of Mexico, leading to a total of 24 159 households (N = 54 638 654). The percentage of edentulism was determined as the proportion of subjects that self-reported complete loss of teeth. Data were analyzed using the SVY module for complex surveys in STATA 8.2. The mean age was 41.3 +/- 17.0 years (range 18-99). An estimated 6.3% (N = 3 437 816) of the population > or =18 years was edentulous. Lowest prevalences were observed in the states of Tlaxcala, Puebla and the Estado de Mexico with 3.4%, 3.8% and 4.5%, respectively. Highest prevalences were observed in San Luis Potosí, Colima, and Michoacán with 10.3%, 10.2% and 10.1%, respectively. Following the WHO age groups, the prevalence ranged from 2.4% in the 35-44 group through 25.5% in the 65-74 group. No obvious association between socio-economic and socio-demographic indicators at the state level and prevalence of edentulism was found. The prevalence of complete tooth loss observed in the present study varied greatly across states, although no straightforward association was found with socio-economic and socio-demographic indicators at the state level. This study could serve as a baseline to enable future evaluations of the oral status of Mexican adults and elders, following WHO age groups.

Dental health services utilization and associated factors in children 6 to 12 years old in a low-income country

OBJECTIVE

To determine the factors associated with the dental health services utilization among children ages 6 to 12 in León, Nicaragua.

MATERIAL AND METHODS

A cross-sectional study was carried out in 1,400 schoolchildren. Using a questionnaire, we determined information related to utilization and independent variables in the previous year. Oral health needs were established by means of a dental examination. To identify the independent variables associated with dental health services utilization, two types of multivariate regression models were used, according to the measurement scale of the outcome variable: a) frequency of utilization as (0) none, (1) one, and (2) two or more, analyzed with the ordered logistic regression and b) the type of service utilized as (0) none, (1) preventive services, (2) curative services, and (3) both services, analyzed with the multinomial logistic regression.

RESULTS

The proportion of children who received at least one dental service in the 12 months prior to the study was 27.7 percent. The variables associated with utilization in the two models were older age, female sex, more frequent toothbrushing, positive attitude of the mother toward the child's oral health, higher socioeconomic level, and higher oral health needs.

CONCLUSION

Various predisposing, enabling, and oral health needs variables were associated with higher dental health services utilization. As in prior reports elsewhere, these results from Nicaragua confirmed that utilization inequalities exist between socioeconomic groups. The multinomial logistic regression model evidenced the association of different variables depending on the type of service used.

A comparison of dental treatment utilization and costs by HMO members living in fluoridated and nonfluoridated areas

OBJECTIVES

To compare dental treatment experiences and costs in members of a health maintenance organization (HMO) in areas with and without community water fluoridation.

METHODS

HMO members with continuous dental eligibility (January 1, 1990 to December 31, 1995) who resided in Oregon and Washington were identified using administrative databases. Fluoridation status was determined by geocoding subscriber address. Measures were utilization of dental procedures, fluoride dispensings, and associated costs. Costs were based on nonmember fees, adjusted to 1995 dollar values. Data were analyzed using analysis of covariance, controlling for age and interactions.

RESULTS

About 85 percent of eligible members (n = 51,683) were classified as residing either in a fluoridated (n = 12,194) or nonfluoridated (n = 39,489) area. Mean age was 40.0 years; 52.3 percent were women. More than 92 percent of members had one or more dental visits. Community water fluoridation was associated with reduced total and restorative costs among members with one or more visits, but the magnitude and direction of the effect varied with locale and age and the effects were generally small. In two locales, the cost of restorations was higher in nonfluoridated areas in young people (<age 18) and older adults (>age 58). In younger adults, the opposite effect was observed. The impact of fluoridation may be attenuated by higher use of preventive procedures, in particular supplemental fluorides, in the nonfluoridated areas.

CONCLUSIONS

These results are particularly relevant to insured populations with established access to dental care. Differences in treatment costs (savings) associated with water fluoridation should be estimated and included in future cost-effectiveness analyses of community water fluoridation.

Socioeconomic and sociodemographic variables associated with oral hygiene status in Mexican schoolchildren aged 6 to 12 years

BACKGROUND

The purpose of this study was to identify the socioeconomic and sociodemographic variables associated with oral hygiene status in schoolchildren aged 6 to 12 years in Navolato, Sinaloa, Mexico.

METHODS

A cross-sectional study was carried out in 3,048 schoolchildren. A questionnaire was used to determine socioeconomic and sociodemographic variables, and a clinical oral examination was carried out to establish oral hygiene status. The "plaque" component of the simplified oral hygiene index (S-OHI) was the criterion used to determine oral hygiene status in children. Using principal component analysis, five socioeconomic factors were streamlined to one principal component to determine the individual socioeconomic level. Data were analyzed with non-parametric tests and multivariable logistic regression.

RESULTS

The population included 1,456 boys and 1,592 girls. The mean value for S-OHI was 1.10 +/- 0.34. The largest percentage (50.8%) of the S-OHI scores ranged between 0 and 1. In the multivariate model, younger age, male gender, and lower toothbrushing frequency (P <0.05) were associated with poor oral hygiene. Children with better socioeconomic status had better oral hygiene (P <0.05).

CONCLUSIONS

Most children ( approximately 60%) had an acceptable level of oral hygiene. Diverse variables were associated with oral hygiene in these Mexican children, highlighting a gradient distribution throughout the socioeconomic spectrum. It is necessary to implement strategies that would help to diminish the disparities observed across diverse socioeconomic groups.

[Dental caries in schoolchildren from a northwestern community of Mexico with mixed dentition, and some associated clinical, socioeconomic and socio-demographic variables]

OBJECTIVES

To identify some of the clinical, socio-demographic, and socio-economic variables associated with dental caries prevalence in primary teeth, as well as the prevalence and severity of caries in permanent teeth, among 6-to-10 years old with mixed dentition.

MATERIAL AND METHOD

A cross-sectional study on 2270 school children with mixed dentition in Northwest Mexico was undertaken, with oral exams used to collect data on oral hygiene and dental caries experience--based on criteria by the World Health Organization, and on Pitts D1/d1 lesion classification. Dependent variables were d1eft > 0, D1MFT >0, and D1MFT > or =4. We used questionnaires filled out by the mothers/guardians to ascertain socio-demographic and socio-economic variables. Data were analyzed using logistic regression.

RESULTS

Mean age was 8.1 +/- 1.3 years, and 50.9% of participants were female. Mean deft was 5.0 +/- 3.2 (d1eft > 0 = 91.6% of participants), and mean D1MFT was 2.5 +/- 1.9 (D1MFT >0 = 77.1% of participants). Variables associated with caries in the primary dentition were younger age (odds ratio (OR) = 0.76), high sugar intake (OR = 1.34), mediocre oral hygiene (OR = 2.24) and poor/very poor hygiene (OR = 3.86), frequent intake of soft drinks (OR = 2.25), having had a preventive dental visit in the 12 months prior to the study (OR = 0.70), having health insurance with a public sector provider (OR = 0.63), and having low socio-economic level (OR = 1.92). For the primary dentition, variables were female sex (OR = 1.43), older age of the child (OR = 2.21), older age of the father (OR = 1.03), high sugar intake (OR = 1.38), mediocre oral hygiene (OR = 4.89), poor/very poor hygiene (OR = 8.74), and having had caries in the primary dentition (OR = 6.88). In terms of severity (D1MFT > or =4), trends were similar to prevalence.

CONCLUSIONS

Dental caries remains a public health problem for this population. Diverse clinical, sociodemographic, and socio-economic variables were associated with dental caries experience in both dentitions.

Defectos del esmalte, caries en dentición primaria, fuentes de fluoruro y su relación con caries en dientes permanentes

OBJECTIVE

To examine the relationship between the presence of enamel defects, dental caries in primary teeth, and exposure to various fluoride technologies and the presence of dental caries in permanent teeth in children with mixed dentition.

MATERIALS AND METHODS

A cross-sectional study was conducted in 713 children aged 6-9 years old in 4 elementary schools in Campeche, Mexico through the use of a questionnaire for the mothers and an oral examination in the children. The dependent variable was the prevalence of caries in permanent dentition.

RESULTS

The mean number of decay, missing or filling teeth in primary dentition (dmft) and in permanent dentition (DMFT) was 2.48 (2.82) (deft > 0 = 58.9%) and 0.40 (0.98) (DMFT > 0 = 18.2%), respectively. The significant caries index (SiC), which is calculated in deciduous dentition, was 5.85 for 6 year-olds. Multivariate logistic regression adjusted for variables related to fluoride exposure revealed that older age (OR = 2.99), a deft of > 0 (OR = 5.46), and lower maternal educational level (OR = 1.57) were significantly associated with a higher number of dental caries in permanent teeth. An interaction between sex and enamel defects was also found.

CONCLUSIONS

The number of dental caries in both primary and permanent dentitions was relatively smaller than that found in prior studies performed in Mexican populations. The results confirm that the presence of caries in primary dentition is strongly associated with caries in permanent dentition. No significant relationship was found between fluoride exposure and dental caries in permanent dentition.

The Relationship Between Cardiovascular Xerogenic Medication Intake and the Incidence of Crown/Root Restorations

OBJECTIVES

This retrospective, longitudinal cohort study quantified the strength of the association between xerogenic cardiovascular medication use and dental restorations, using the latter as a proxy measure for dental caries experience.

METHODS

Study data were collected from 11 years of electronic clinical/pharmacy records in two large dental group practices associated with managed care organizations (MCO). Records were extracted for all members who were at least 55 years old at the end of the 11 year window, and had at least 48 months of concurrent dental, medical, and pharmacy coverage. The authors identified 4448 individuals whose only xerogenic medication exposure was to drugs treating a cardiovascular condition. This group was compared to a group not taking any medications (n=1183), and a group taking medications with no known xerostomic side effect (n=5622). Poisson regression compared restoration incidence and mean restoration rates among the three groups.

RESULTS

MCO members taking cardiovascular or nonxerogenic medications had higher restoration incidence and mean restoration rates than individuals taking no medications. A small difference in mean restoration rate between the non-xerogenic medication group and the cardiovascular drug group was observed; no significant difference in restoration incidence was seen between these two groups.

CONCLUSIONS

This study provides objective quantification of cardiovascular medication's long-term effects on increased restorations in older adults. When grouped under a single category labeled "cardiovascular", drugs with effects targeting the cardiovascular system did not appear to unequivocally lead to higher restorative experiences.

Are statins associated with decreased tooth loss in chronic periodontitis?

AIM

To evaluate whether statin use was associated with decreased tooth loss among patients with chronic periodontitis.

MATERIAL AND METHODS

We evaluated administrative health plan data from 1996 to 2002 covering dental and periodontal treatment utilization, dental extractions, and prescription medication fills of 12,631 adults aged 48-64 in 2002. With tooth loss as the outcome, we evaluated a number of different patterns of statin prescription across time in multivariate generalized linear models.

RESULTS

Unadjusted, statin use was associated with increased tooth loss. After adjustment for potential confounders, there was no suggestion of either increased or decreased tooth loss associated with statin use.

CONCLUSIONS

Statin use was not associated with either a decreased or an increased risk of tooth loss.

Prevalence of bruxism among Mexican children with Down syndrome

This study sought to determine the prevalence of bruxism in a Mexican community of children with Down syndrome, and to evaluate bruxism's relationship with age, sex, intellectual disability level, and type of chromosomal abnormality of trisomy 21. Using a cross-sectional design, 57 boys and girls (3 to 14 years old) were examined. Three approaches to establish presence or absence of bruxism were employed: parental questionnaire, clinical examination, and dental study casts. Data were analysed using bivariate analyses and conditional logistic regression. We found that the overall prevalence of bruxism was 42%. No statistically significant associations between bruxism and age, sex, or intellectual disability level were found. There was, however, a significant association between bruxism and type of chromosomal abnormality, with mosaicism being more frequently associated with bruxism.

Factors associated with dental health care coverage in Mexico: findings from the National Performance Evaluation Survey 2002?2003

OBJECTIVES

To determine the level of dental health care coverage in people aged > or =18 years across the country, and to identify the factors associated with coverage.

MATERIAL AND METHODS

Using the instruments and sampling strategies developed by the World Health Organization for the World Health Survey, a cross-sectional national survey was carried out at the household and individual (adult) levels. Dental data were collected in 20 of Mexico's 32 states. The relationship between coverage and environmental and individual characteristics was examined through logistic regression models.

RESULTS

Only 6098 of 24 159 individual respondents reported having oral problems during the preceding 12 months (accounting for 14 284 621 inhabitants of the country if weighted). Only 48% of respondents reporting problems were covered, although details of the appropriateness, timeliness and effectiveness of the intervention(s) were not assessed. The multivariate regression model showed that higher level of education, better socioeconomic status, having at least one chronic disease and having medical insurance were positively associated with better dental care coverage. Age and sex were also associated.

CONCLUSIONS

Overall dental health care coverage could be improved, assuming that ideal coverage is 100%. Some equality of access issues are apparent because there are differences in coverage across populations in terms of wealth and social status. Identifying the factors associated with sparse coverage is a step in the right direction allowing policymakers to establish strategies aimed at increasing this coverage, focusing on more vulnerable groups and on individuals in greater need of preventive and rehabilitative interventions.

Outcomes associated with dentists' risk assessment

OBJECTIVE

To examine retrospectively the caries-related restorative experience of at-risk individuals who received fluoride-based preventive interventions to determine if the intervention resulted in fewer caries-related procedures.

METHODS

Administrative data from two dental health plans were used to determine the relationship between caries risk assessment (CRA) scores, preventive treatment and caries-related treatment procedures. We identified 45 693 adults who were consecutively enrolled for at least 1 year before and 2.5 years after the CRA. Variables representing the number of teeth with any caries-related treatment procedure and receipt of preventive treatment were created.

RESULTS

The outcome variable of interest was having at least one tooth with a caries-related procedure in the 2-year follow-up period. In plan A, the recommendation for home-use fluoride was not significantly related to caries-related treatment procedures in the follow-up period for individuals at low, moderate or high risk (P > 0.300). In plan B, application of in-office fluoride was associated with having at least one tooth with a caries-related treatment procedure in the follow-up period (P < 0.001).

CONCLUSIONS

We found incomplete compliance with guidelines for recommendation or administration of preventive treatment for patients at elevated risk for caries. We were also unable to identify any significant reductions in caries-related procedures for individuals receiving a fluoride intervention, compared with those who did not, when stratified by risk level.

Políticas de salud bucal en México: Disminuir las principales enfermedades. Una descripción

Se presenta una breve descripción de lo que ha sido hasta ahora la historia de las políticas de salud bucal en México. Este trabajo no intenta ser exhaustivo, ni mucho menos un estudio sobre evaluación de políticas de salud bucal, pues se vería enfrentado a la fuerte limitación de la disponibilidad de información desarrollada en el área de la salud bucal. En primer lugar se abordan los inicios de la profesión dental y la forma en la que se desarrolló; su comienzo como una profesión dirigida al individuo y su posterior inmersión en el campo de la Salud Pública. Posteriormente se presentan datos de estudios epidemiológicos realizados en los últimos años, principalmente sobre caries dental en escolares. Termina esta parte tomando en cuenta la definición de salud de la Organización Mundial de la Salud (OMS), y se trata la importancia de la salud bucal como un elemento de la salud general y por ende del bienestar y de la calidad de vida del individuo. Más adelante se describe la política de salud bucal mundial, como marco de referencia para la política de salud en el país. Con relación a México, describimos cómo a través de los años esta política ha planeado e instaurado estrategias tendientes a lograr una mejora en la salud bucal de la población. Concluimos el trabajo con un análisis acerca de cómo ha impactado la política de salud bucal a la salud de ciertos grupos poblacionales. Se propone generar información epidemiológica confiable para poder hacer una evaluación de esta política, con una metodología estricta y adecuada.

Caries increment in the permanent dentition of Mexican children in relation to prior caries experience on permanent and primary dentitions

OBJECTIVE

To evaluate the likelihood of caries increment in schoolchildren, based on their prior caries experience.

MATERIAL AND METHODS

We undertook a longitudinal study in 452 six-to-nine year olds between 1999 and 2001 in Mexico, with dental exams conducted by two standardized examiners (kappa>0.85). The dependent variable was the DMFT increment, dichotomized as without increment, and at least one unit of increment. Independent variables estimated caries experience at baseline. Data were analyzed using non-parametric tests and generalized linear models (log-binomial) to calculate relative risk (RR) adjusted for age and sex.

RESULTS

The percentage of caries-free children diminished by 20.5% from 1999 to 2001. DMFT index increased two-fold, from 0.25+/-0.70 in 1999 to 0.77+/-1.30 in 2001 (p<0.001). The overall risk for this sample was 24%. The DMFT increment was higher (p<0.001) in children with DMFT>0 and dmft>0 in 1999 (RR=1.89, 95% CI=1.37-2.62; RR=2.71, 95% CI=1.94-3.76, respectively). The likelihood for DMFT increment from the 1999 levels was: (1) 2.78 times higher (95% CI=2.06-3.76) if schoolchildren had caries in any of the first permanent molars and (2) 1.62 times higher (95% CI=1.20-2.19) if schoolchildren were affected by high severity caries at baseline.

CONCLUSIONS

Both caries prevalence and mean DMFT had significant increments in 18 months. Dental caries in the primary (dmft) and permanent (DMFT) dentitions at baseline are goods indicators of subsequent caries development in this group of children in a medium income country. This relationship became stronger when the occurrence of caries in the first permanent molars was included.

[Association between socioeconomic status and oral hygiene among preschoolers enrolled in the IMSS preventive dental program in Campeche]

OBJECTIVE

Determine the association between socioeconomic status and oral hygiene in the primary dentition of preschool children.

MATERIALS AND METHODS

We undertook a cross-sectional study of 1,303 children attending 10 schools in Campeche, Mexico. Every child was clinically examined in a portable dental chair by one of four examiners. We used a questionnaire addressed to the mothers to collect data on socioeconomic and socio demographic variables--including attitudinal variables dealing with the perceived importance of oral health. Oral hygiene was assessed appraising the frequency of tooth brushing and the presence of dental plaque. Data analysis included non-parametric tests using STATA 8.2.

RESULTS

Mean age was 4.36 +/- 0.79 years and 48.3% of children were girls. Of the study population, 17.8% (n = 232) were classified as having inadequate oral hygiene, 50.9% (n = 663) having moderate oral hygiene, and 31.3% (n = 408) having adequate oral hygiene. Children who were rated more frequently as having inadequate hygiene (p < 0.05) had mothers with a negative attitude toward oral health, were users only of public medical insurance (as opposed to users of private services), and had not used dental services in the year prior to the study. Finally, we observed a decrease in the adequacy of oral hygiene associated with a decrease in socioeconomic status.

CONCLUSIONS

Our findings showed that oral hygiene was closely associated with socioeconomic status. This implies that if a reduction of oral health inequalities is to be achieved, the strategies and resources targeting these goals must take into account the existing differences between population groups with more or fewer social disadvantages.

Dental fluorosis in cohorts born before, during, and after the national salt fluoridation program in a community in Mexico

OBJECTIVE

To determine the prevalence and severity of dental fluorosis, as well as factors associated with its occurrence, in seven cohorts of children before and after the implementation of a fluoridated salt program in 1991.

MATERIAL AND METHODS

A cross-sectional study was carried out in 1,373 children aged from 6 to 12 years in Campeche, Mexico. Data were collected by means of a questionnaire administered to mothers and a dental examination of the children. Modified Dean's criteria were used to diagnose dental fluorosis. A multivariate logistic regression model was used to evaluate the relationship between dental fluorosis and independent variables.

RESULTS

The prevalence of dental fluorosis was 51.9%. The most common degree of dental fluorosis was very mild, with 84.7%, followed by mild, moderate, and severe with 13.1%, 1.7%, and 0.6%, respectively. The multivariate model adjusted by number of additional sources of fluoride, age at the beginning of use of toothpaste, and level of schooling of the mother, showed that children born in 1990 (OR = 1.74; CI 95% = 1.36-2.22), 1991 (OR = 4.03; CI 95% = 2.58-6.28), and 1992 (OR = 10.41; CI 95% = 5.77-18.78) were more likely to have dental fluorosis than those born in the period 1986-1989. The frequency of toothbrushing (OR = 1.63; CI 95% = 1.37-1.95) was also associated with dental fluorosis.

CONCLUSIONS

A close relationship was found between exposure to toothpaste and dental fluorosis. Implementation of the fluoridated salt program greatly increased the risk of fluorosis.

Changes in dental fluorosis following the cessation of water fluoridation

OBJECTIVES

To determine changes in the prevalence of dental fluorosis, and in perceptions of aesthetic concerns due to dental fluorosis after water fluoridation ceased.

METHODS

Schoolchildren in second and third grades were examined in 1993-94, 1996-97 and 2002-03 to determine changes in the prevalence of dental fluorosis following fluoridation cessation of the public water supplies in 1992. The Thylstrup-Fejerskov Index (TFI) was used to quantify dental fluorosis. Perceptions of aesthetics were assessed by questionnaires which were sent home to parents. Residence and dental histories were confirmed on all children to determine the extent of exposure to all types of fluorides. Comparisons between the three surveys were used to establish the influence of fluoridated water and other fluoride sources on the occurrence and severity of dental fluorosis. Aesthetic ratings from parents were used to assess the aesthetic conditions of maxillary anterior teeth across the three surveys.

RESULTS

When fluoride was removed from the water supply in 1992, the prevalence and severity of TFI scores decreased significantly from the 1993-94 survey cycle when compared with the 1996-97 and 2002-03 survey cycles. The use of fluoride supplements and fluoride dentifrice also decreased during this study period. Analyses were unable to determine the influence of these different fluoride exposures on the changes in TFI scores over time. Comparisons of aesthetic ratings from parents between survey cycles failed to show any significant differences.

[Socioeconomic inequalities in oral health: dental caries in 6 to 12 year-old children]

OBJECTIVE

To explore the association between caries indices in primary and permanent dentition and socioeconomic indicators at the individual and ecologic levels in 6-12 year old children.

MATERIALS AND METHODS

A comparative analysis of two datasets depicting oral health status in Campeche, México, with 2,939 children distributed equally by age and sex, was carried out. Oral health indices were contrasted at different cut-off points in primary and permanent dentitions (dmft, DMFT, dmft+DMFT and SiC indices) with independent variables such as place of residence (urban, marginal-urban) and mother's highest level of schooling (years of formal education) as socioeconomic variables (SES), as well as other sociodemographic variables using models of binary logistic regression in STATA 8.2.

RESULTS

The mean age was 8.85 +/- 1.83 years and 56.6% were girls. Nine models were generated in which changes in socioeconomic variables were linked to changes in oral health features in this community (both in terms of prevalence and severity), except for DMFT > 0 at 12 years of age.

CONCLUSIONS

In general, children of lower SES had greater caries experience and higher caries severity, in both primary and permanent dentitions. The relationships between oral health disparities and independent variables were confirmed in children living in geographically contiguous areas.

Edentulism among Mexican adults aged 35 years and older and associated factors

We used National Performance Evaluation Survey data to estimate the prevalence and associated factors of edentulism among noninstitutionalized adults aged 35 years and older in Mexico. Statistically, the variables positively associated with edentulism were older age (odds ratio [OR]=1.08) and female gender (OR=1.79). Nonsmoking status (OR=0.70) and having a higher wealth index score (OR=0.72) were negatively associated. This information constitutes the first large-scale evaluation in Mexico for one of the World Health Organization's priority oral health problems.

Dental caries experience and factors among preschoolers in southeastern México: a brief communication

OBJECTIVE

To examine the association between dental caries prevalence and selected variables in preschool children.

METHODS

A cross-sectional study was carried out with 1,303 preschoolers (ages 3-6 years old), and the mothers completed questionnaires. The children were examined by one of three standardized dental examiners. Logistic regression was performed to identify associations between dental caries and other factors.

RESULTS

Mean dmft was 1.54+2.47, with 44.1% of children having dmft>0. Caries prevalence was associated with older children (OR=1.39); medium (OR=1.66) and low (OR=2.41) socioeconomic levels; mediocre (OR=1.71) and inadequate (OR=2.25) hygiene; negative attitude toward oral health (OR=1.51); and the presence of enamel defects (OR=1.74).

CONCLUSION

Both overall caries prevalence and dmft index were relatively low. The results of this study substantiate previous reports in the international literature for clinical, behavior, socio-demographic, and socio-economic variables that contribute to dental caries in Mexican children.

Introducing a clinical-behavioural scoring system for children's oral hygiene

OBJECTIVES

Developing and testing a clinical-behavioural scoring system for assessing children's oral hygiene.

MATERIALS AND METHODS

One clinical variable (the presence of dental plaque, measured using Silness and Loe's index) and one behavioural variable (self-reported tooth brushing frequency) were combined into secondary data analysis of research databases for 3-6-year-olds and 6-13-year-olds in a Mexican community. The combined scoring is an ordinal scale that depicts suitable, moderate and inadequate hygiene. Blinded dental examiners also collected dmft/DMFT data in standardised conditions. Data was analysed with Spearman's rho, Kruskall-Wallis, non-parametric tests for trends and Pearson's chi2 tests.

RESULTS

1303 children aged 3-6 years old and 1644 children aged 6-13 years old participated in the study. Clear relationships existed between the combined scoring system and dmft (p < 0.01) and between the scoring system and DMFT (p < 0.01), suggesting that the combined clinical-behavioural scoring system is a reasonably accurate measurement of the relationship between caries experience and oral hygiene in children in the given setting.

CONCLUSIONS

The combined clinical-behavioural scoring system is a simple, easy-to-use tool that incorporates clinical and behavioural data commonly found in dental systems. Whether the clinical-behavioural scoring system can be generalised remains to be established.