Social inequalities in children's oral health-related quality of life: the Generation R Study

Inequalities in the Oral Health-Related Quality of Life Among Children in Saudi Arabia

OBJECTIVE

This study aims to examine the Oral Health-Related Quality of Life (OHRQoL) and its determinants among elementary school children in Saudi Arabia, recognizing OHRQoL as a critical aspect of overall health and well-being.

BACKGROUND

OHRQoL is an essential element of health, influencing children's ability to engage in daily activities, learning, and social interactions. In Saudi Arabia, despite free dental care, significant occurrences of untreated dental caries among children highlight disparities in oral health outcomes, likely influenced by socioeconomic factors.

METHOD

Baseline data from a longitudinal randomized controlled trial conducted in Riyadh, Saudi Arabia was utilized. Participants were elementary school students attending public schools, selected using stratified cluster random sampling. The study focused on both deciduous and permanent dentition, excluding children with medical issues. Data collection involved clinical evaluations and parental questionnaires, adhering to WHO criteria.

RESULTS

The results of the study revealed significant associations between age (mean: 98.99 months, 95% confidence interval (CI): 97.8-100.1) and untreated caries (mean: 2.54, 95% CI: 2.34-2.74) with OHRQoL among children in Saudi Arabia. Older children (Rate Ratio (RR) = 1.01; 95% CI: 1.01-1.06) and those with untreated caries (RR = 1.04; 95% CI: 1.01-1.07) had higher rates of experiencing suboptimal oral health outcomes. However, no statistically significant associations were found for other variables such as gender, family income, parental education, oral hygiene frequency, and dental visits with respect to OHRQoL.

CONCLUSION

The study underscores that age and untreated caries are significantly and positively associated with OHRQoL in children. These findings point to the need for targeted oral health interventions and policies within the sociocultural context of Saudi Arabia, particularly focusing on early prevention and addressing socioeconomic inequalities.

Oral and craniofacial research in the Generation R study: an executive summary

OBJECTIVES

Oral conditions are of high prevalence and chronic character within the general population. Identifying the risk factors and determinants of oral disease is important, not only to reduce the burden of oral diseases, but also to improve (equal access to) oral health care systems, and to develop effective oral health promotion programs. Longitudinal population-based (birth-)cohort studies are very suitable to study risk factors on common oral diseases and have the potential to emphasize the importance of a healthy start for oral health. In this paper, we provide an overview of the comprehensive oral and craniofacial dataset that has been collected in the Generation R study: a population-based prospective birth cohort in the Netherlands that was designed to identify causes of health from fetal life until adulthood.

METHODS

Within the multidisciplinary context of the Generation R study, oral and craniofacial data has been collected from the age of 3 years onwards, and continued at the age of six, nine, and thirteen. Data collection is continuing in 17-year-old participants.

RESEARCH OUTCOMES

In total, the cohort population comprised 9749 children at birth, and 7405 eligible participants at the age of seventeen. Based on questionnaires, the dataset contains information on oral hygiene, dental visits, oral habits, oral health-related quality of life, orthodontic treatment, and obstructive sleep apnea. Based on direct measurements, the dataset contains information on dental caries, developmental defects of enamel, objective orthodontic treatment need, dental development, craniofacial characteristics, mandibular cortical thickness, and 3D facial measurements.

CONCLUSIONS

Several research lines have been set up using the oral and craniofacial data linked with the extensive data collection that exists within the Generation R study.

CLINICAL RELEVANCE

Being embedded in a multidisciplinary and longitudinal birth cohort study allows researchers to study several determinants of oral and craniofacial health, and to provide answers and insight into unknown etiologies and oral health problems in the general population.

Association between socioeconomic status and dental caries among Chinese preschool children: a cross-sectional national study

OBJECTIVES

Socioeconomic inequalities in oral health are often neglected in oral health promotion. This cross-sectional study assessed the association between dental caries and socioeconomic status (SES) among preschool children in China.

DESIGN

Cross-sectional study.

SETTING

Data from the Fourth National Oral Health Survey of China (2015), comprising of 40 360 children aged 3-5 years was used.

METHODS

Dental caries indicators including prevalence of dental caries, dental pain experience and number of decayed, missing and filling teeth (dmft). SES indicators included parental education and household income. The associations between SES and dental caries were analysed by using negative binomial regression or Poisson regression models according to data distribution. Relative and absolute inequalities in dental caries were quantified by using the Relative Index of Inequality (RII) and Slope Index of Inequality (SII), respectively.

RESULTS

There were significant associations between SES and prevalence of dental caries and dmft (p<0.001). Children from lower educated (RII 1.36, 95% CI 1.3 to 1.43; SII 0.97, 95% CI 0.81 to 1.13) and lower household income (RII 1.17, 95% CI 1.11 to 1.24; SII 0.55, 95% CI 0.35 to 0.75) families had higher dmft than those from well-educated and most affluent families. Relative and absolute inequalities in dental caries were larger in urban areas by household income, and in rural areas by parental education.

CONCLUSIONS

Association between dental caries and SES was demonstrated and socioeconomic inequalities in dental caries existed among Chinese preschool children.

Association of siblings' presence and oral health-related quality of life among children: a cross-sectional study

Background

The quantity–quality trade-off theory indicates that an increase in siblings might decrease a child’s well-being, but little is known about the impacts of sibling number on children’s oral health-related quality of life (OHRQoL). This study aims to investigate the effects of presence of siblings on children’s OHRQoL, and to further test whether there is an interaction effect between siblings’ presence and locations on children’s OHRQoL.

Methods

Data were obtained from an oral-health survey of 12-year-old children in Beijing, China, which was a part of the 4th National Oral Health Survey in the Mainland of China (2015–2016). This study included 2158 children data for analysis. OHRQoL was assessed by the child’s Oral Impacts on Daily Performance (OIDP). OIDP prevalence served as an indicator of OHRQoL. Children with and without siblings were recorded as non-single and single children, respectively. Dental variables, including active caries, gingival bleeding, and calculus, were reported. A logistic regression model was applied to investigate the association of siblings’ presence and OIDP prevalence. A synergy index was used to assess the possible interaction effect between siblings’ presence and location on OIDP prevalence.

Results

Sixty percent of Chinese children reported suffering OIDP in the previous six months. OIDP prevalence for non-single and single children were 68.3% and 56.9%, respectively. The adjusted odds ratio (OR) of OIDP for non-single children was 1.31 (95% CI: 1.05, 1.63), and the adjusted OR of OIDP for non-single and rural children was 2.03 (95% CI: 1.47, 2.81). The synergy index between siblings’ presence and location on OIDP was 2.18 (85% CI: 1.30, 3.67), which indicates that an excessive risk increase for OIDP was observed among non-single and rural children.

Conclusions

Children with siblings are more likely to report OIDP and have lower OHRQoL, especially those from rural areas. These findings indicate that oral-health interventions should be given priority for non-single and rural children.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-021-01526-y.

Quality Appraisal of Child Oral Health-Related Quality of Life Measures: A Scoping Review

BACKGROUND

Children's oral health-related quality of life (COHQoL) measures are well known and widely used. However, rigorous systematic reviews of these measures and analyses of their quality are in absence.

OBJECTIVES

To systematically review and quantitatively assess the quality of COHQoL measures through a scoping review.

DATA SOURCES

Systematic literature search of PubMed, CINAHL (Cumulative Index to Nursing and Allied Health Literature), EMBASE (Excerpta Medica database), HaPI (Health and Psychosocial Instruments), and DOSS (Dentistry and Oral Sciences Source).

STUDY ELIGIBILITY

The measure's focus was COHQoL; the child age ranged from 5 to 14 years; the publication was either a research article or a systematic review and related to caries; and it was written in English or had an English abstract. Two authors independently selected the studies. Disagreements were reconciled by group discussions with a third author.

APPRAISAL

The International Society for Quality of Life Research minimum standards for patient-reported outcome measures were used for quality appraisal.

SYNTHESIS

Descriptive analysis.

RESULTS

We identified 18 measures. Their quality scores ranged from 9.5 to 15.0 on a scale of 16. The quality appeared to bear no relationship to the citation and use of these measures. However, elements of these measures might be more useful than others, depending on the age-specific use and primary quality concerns.

LIMITATIONS

Some of the information on the minimum standards of the 18 measures cannot be found in the existing literature. Measures published without English abstract were not searched.

CONCLUSIONS

The quality of these measures is suboptimal. Researchers and practitioners in this field should exercise caution when choosing and using these measures. Efforts at improving the quality of the COHQoL measures, such as refining existing ones or developing new measures, are warranted.

KNOWLEDGE TRANSFER STATEMENT

Researchers, clinician scientists, and clinicians can use the results of this study when deciding which oral health-related quality of life measure they wish to use in children.