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Du S, Cheng M, Cui Z, Wang X, Feng X, Tai B, Hu D, Lin H, Wang B, Wang C, Zheng S, Liu X, Rong W, Wang W, Si Y. Decomposing Socioeconomic Inequality in Early Childhood Caries Among 3 to 5-Year-Old Children in China. Int Dent J 2024:S0020-6539(24)00106-0. [PMID: 38821780 DOI: 10.1016/j.identj.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 03/20/2024] [Accepted: 04/02/2024] [Indexed: 06/02/2024] Open
Abstract
INTRODUCTION AND AIMS Early childhood caries (ECC) is a widespread oral disease that harms children's health in China. Although previous studies have linked ECC prevalence to socioeconomic status, few have measured the degree of socioeconomic inequality. This study aimed to evaluate the socioeconomic inequality of ECC in children aged 3 to 5 years in China and identify the contributor to the inequality. METHODS We extracted data on 3 to 5-year-old children from the fourth National Oral Health Survey. We measured the inequality of ECC by the average household income per capita. We used the average household income per capita to measure the inequality of ECC. To describe inequality both qualitatively and quantitatively, we used the following methods: concentration curve, Erreygers-corrected concentration index, relative index of inequality and slope index of inequality. We also applied a decomposition based on the probit model to identify the factors that contributed to inequality. RESULTS The prevalence of ECC in Chinese preschool children was 63.11% (95% CIs: 60.54%, 65.61%). The negative value of the Erreygers-corrected concentration index (-0.0459; 95% CIs: -0.0594, -0.0324), slope index of inequality (-0.0674; 95% CIs: -0.0876, -0.0471) and the positive value of relative index of inequality (0.7484; 95% CIs: 0.6856, 0.8169) all indicated that ECC prevalence was higher among children from low-income families. The main factors contributing to inequality were average household income, parents' educational level and living areas. CONCLUSION There is a pro-poor inequality in ECC among 3 to 5-year-old children in China. CLINICAL RELEVANCE To improve oral health equality, policymakers should focus more on children from low-income families, with less educated parents and living in rural areas.
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Affiliation(s)
- Shuo Du
- Department of Preventive Dentistry, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, & Beijing Key Laboratory of Digital Stomatology & NHC Key Laboratory of Digital Stomatology & NMPA Key Laboratory for Dental Materials, Beijing, China
| | - Menglin Cheng
- Department of Stomatology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhiying Cui
- Department of Preventive Dentistry, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, & Beijing Key Laboratory of Digital Stomatology & NHC Key Laboratory of Digital Stomatology & NMPA Key Laboratory for Dental Materials, Beijing, China
| | - Xing Wang
- Chinese Stomatological Association, Beijing, China
| | - Xiping Feng
- Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Baojun Tai
- School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Deyu Hu
- West China School of Stomatology, Sichuan University, Chengdu, China
| | - Huancai Lin
- Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangzhou, China
| | - Bo Wang
- Chinese Stomatological Association, Beijing, China
| | - Chunxiao Wang
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Shuguo Zheng
- Department of Preventive Dentistry, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, & Beijing Key Laboratory of Digital Stomatology & NHC Key Laboratory of Digital Stomatology & NMPA Key Laboratory for Dental Materials, Beijing, China
| | - Xuenan Liu
- Department of Preventive Dentistry, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, & Beijing Key Laboratory of Digital Stomatology & NHC Key Laboratory of Digital Stomatology & NMPA Key Laboratory for Dental Materials, Beijing, China
| | - Wensheng Rong
- Department of Preventive Dentistry, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, & Beijing Key Laboratory of Digital Stomatology & NHC Key Laboratory of Digital Stomatology & NMPA Key Laboratory for Dental Materials, Beijing, China
| | - Weijian Wang
- Department of Preventive Dentistry, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, & Beijing Key Laboratory of Digital Stomatology & NHC Key Laboratory of Digital Stomatology & NMPA Key Laboratory for Dental Materials, Beijing, China
| | - Yan Si
- Department of Preventive Dentistry, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, & Beijing Key Laboratory of Digital Stomatology & NHC Key Laboratory of Digital Stomatology & NMPA Key Laboratory for Dental Materials, Beijing, China.
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Ishimaru M, Zaitsu T, Kino S, Taira K, Inoue Y, Takahashi H, Tamiya N. Dental Utilization Stratified by the Purpose of Visit: A Population-Based Study in Japan. Int Dent J 2023; 73:896-903. [PMID: 37414691 PMCID: PMC10658419 DOI: 10.1016/j.identj.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 05/30/2023] [Accepted: 06/16/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND This study aimed to provide a stratified description of dental visit utilisation by Japanese residents based on patient age, sex, prefecture, and the purpose of the visits. METHODS This cross-sectional study used the National Database of Health Insurance Claims of Japan to identify participants visiting dental clinics in Japan (April 2018-March 2019). Dental care utilisation by populations stratified by age, sex, and prefecture was assessed. We estimated the slope index of inequality (SII) and relative index of inequality (RII) to evaluate regional differences based on regional income and education. RESULTS Amongst the Japanese population, 18.6% utilised preventive dental care visits; 59,709,084 participants visited dental clinics, with children aged 5 to 9 years having the highest proportion. SII and RII were higher for preventive dental visits than those for treatments in all settings. The largest regional differences for preventive care were observed in SII of children aged 5 to 9 years and in RII of men in their 30s and women aged 80 years and older. CONCLUSIONS This nationwide population-based study revealed that the proportion of people utilising preventive dental care in Japan was low, with regional differences. Preventive care needs to be more easily accessible and available to improve the oral health of residents. The above findings may provide an important basis for improving policies related to dental care for residents.
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Affiliation(s)
- Miho Ishimaru
- Department of Oral Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan; Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.
| | - Takashi Zaitsu
- Department of Oral Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Shiho Kino
- Department of Oral Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Kento Taira
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Yuko Inoue
- Department of Oral Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | | | - Nanako Tamiya
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
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Luo H, Moss ME, Wright W, Webb M, Pardi V, Lazorick S. Racial/ethnic disparities in preventive dental services use and dental caries among children. J Public Health Dent 2023; 83:161-168. [PMID: 36883255 PMCID: PMC10258156 DOI: 10.1111/jphd.12563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 01/03/2023] [Accepted: 01/20/2023] [Indexed: 03/09/2023]
Abstract
OBJECTIVE To assess disparities in preventive dental service use in four major racial/ethnic groups and assess whether racial/ethnic and income-related disparities among children were reduced from 2016 to 2020. METHODS Data were from the 2016 and 2020 National Survey of Children's Health (NSCH). The outcomes of interest were having dental sealants, fluoride treatment, and dental caries in the past 12 months. Racial/ethnic groups included non-Hispanic (NH) whites, blacks, Hispanics, Asians, and others. Family income level was categorized as below or above the 200% federal poverty level (low-income vs. high-income). Children ages 2-17 were included (N = 161,539). All data were self-reported by parents/guardians. We estimated the trends of racial/ethnic disparities in having fluoride treatment, dental sealants, and dental caries from 2016 to 2020 and tested two 2-way interactions (i.e., year by race/ethnicity, year by income) and one 3-way interaction (year by income by race/ethnicity) to assess the change in disparities from 2016 to 2020. RESULTS Overall, no significant trends in receipt of fluoride treatment, dental sealants, or having dental caries were found from 2016 to 2020 among the racial/ethnic groups, except for a decreasing trend in dental sealants for Asian American children (p = 0.03). Overall, NH white children were more likely to have received preventive dental services than children from minority groups (all p < 0.05); Asian American children (AOR = 1.31) were more likely to have dental caries than NH white children. CONCLUSION Disparities in receipt of evidence-based preventive services by children persisted. Continuous efforts are needed to promote the use of preventive dental services among children of minority populations.
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Affiliation(s)
- Huabin Luo
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC 27834
| | - Mark E. Moss
- Department of Foundational Sciences, School of Dental Medicine, East Carolina University, Greenville, NC 27834
| | - Wanda Wright
- Department of Foundational Sciences, School of Dental Medicine, East Carolina University, Greenville, NC 27834
| | - Michael Webb
- Department of Pediatric Dentistry and Orthodontics and Dentofacial Orthopedics, School of Dental Medicine, East Carolina University, Greenville, NC 27834
| | - Vanessa Pardi
- Department of Foundational Sciences, School of Dental Medicine, East Carolina University, Greenville, NC 27834
| | - Suzanne Lazorick
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC 27834
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Design for a cluster randomized controlled trial to evaluate the effects of the CATCH Healthy Smiles school-based oral health promotion intervention among elementary school children. Contemp Clin Trials Commun 2022; 30:101033. [PMID: 36387989 PMCID: PMC9664405 DOI: 10.1016/j.conctc.2022.101033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/22/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022] Open
Abstract
Background The top two oral diseases (tooth decay and gum disease) are preventable, yet dental caries is the most common childhood disease with 68% of children entering kindergarten having tooth decay. CATCH Healthy Smiles is a coordinated school health program to prevent cavities for students in kindergarten, 1st, and 2nd grade, and is based on the framework of Coordinated Approach to Child Health (CATCH), an evidence-based coordinated school health program. CATCH has undergone several cluster-randomized controlled trials (CRCT) demonstrating sustainable long-term effectiveness in incorporating the factors surrounding children, in improving eating and physical activity behaviors, and reductions in obesity prevalence among low-income, ethnically diverse children. The aim of this paper is to describe the design of the CATCH Healthy Smiles CRCT to determine the effectiveness of an oral health school-based behavioral intervention in reducing incidence of dental caries among children. Methods In this CRCT, 30 schools serving low-income, ethnically-diverse children in greater Houston area are recruited and randomized into intervention and comparison groups. From which, 1020 kindergarten children (n = 510 children from 15 schools for each group) will be recruited and followed through 2nd grade. The intervention consists of four components (classroom curriculum, toothbrushing routine, family outreach, and schoolwide coordinated activities) will be implemented for three years in the intervention schools, whereas the control schools will be offered free trainings and materials to implement a sun safety curriculum in the meantime. Outcome evaluation will be conducted at four time points throughout the study period, each consists of three components: dental assessment, child anthropometric measures, and parent survey. The dental assessment will use International Caries Detection and Assessment System (ICDAS) to measures the primary outcome of this study: incidence of dental caries in primary teeth as measured at the tooth surface level (dfs). The parent self-report survey measures secondary outcomes of this study, such as oral health related behavioral and psychosocial factors. A modified crude caries increment (mCCI) will be used to calculate the primary outcome of the CATCH Healthy Smiles CRCT, and a two-tailed test of the null hypothesis will be conducted to evaluate the intervention effect, while considering between- and within-cluster variances through computing the weighted-average of the mCCI ratios by cluster. Conclusion If found to be effective, a platform for scalability, sustainability and dissemination of CATCH already exists, and opens a new line of research in school oral health. Clinical trials identifier At ClinicalTrials.gov - NCT04632667.
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Ferrazzano GF, Di Benedetto G, Caruso S, Di Fabio G, Caruso S, De Felice ME, Gatto R. Experience and Prevalence of Dental Caries in Migrant and Nonmigrant Low-SES Families’ Children Aged 3 to 5 Years in Italy. CHILDREN 2022; 9:children9091384. [PMID: 36138693 PMCID: PMC9497930 DOI: 10.3390/children9091384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/06/2022] [Accepted: 09/08/2022] [Indexed: 11/26/2022]
Abstract
Dental caries is a public health problem in children and is more prevalent in low-socioeconomic-status groups. The aim of this study is to assess the association between migrant families and the prevalence of caries among young children in Italy. This is a cross-sectional study. In the age range of 3 to 5 years, a total of 266 migrant children and 301 nonmigrant children were examined in three Italian charity dental centers. All children had families with low SES. The dmft was determined by intraoral examination performed by six pediatric dentist specialists to assess their dental health. In this study, the prevalence of caries (71%) and the mean dmft (3.68; SD: 1.52) of migrant children were statistically significantly higher than the percentage (52%) and the mean dmft of the nonmigrant control group (3.10; SD: 1.65) with no differences between genders. For the migrant children, the mean (0.49; SD: 0.32) of restorations (filled teeth) was statistically significantly lower than that of nonmigrant children (1.20; SD: 0.48). This study highlights that dmft values and the prevalence of caries are higher in migrant children than in nonmigrant children. In addition, the control group shows a higher level of dental caries than the national mean.
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Affiliation(s)
- Gianmaria Fabrizio Ferrazzano
- UNESCO Chair in Health Education and Sustainable Development, Paediatric Dentistry Section, University of Naples “Federico II”, 80138 Naples, Italy
| | - Giulia Di Benedetto
- Department of Life, Health and Environmental Sciences, Paediatric Dentistry, University of L’Aquila, 67100 L’Aquila, Italy
- Correspondence:
| | - Silvia Caruso
- Department of Life, Health and Environmental Sciences, Paediatric Dentistry, University of L’Aquila, 67100 L’Aquila, Italy
| | - Giuseppe Di Fabio
- Department of Life, Health and Environmental Sciences, Paediatric Dentistry, University of L’Aquila, 67100 L’Aquila, Italy
| | - Sara Caruso
- Department of Life, Health and Environmental Sciences, Paediatric Dentistry, University of L’Aquila, 67100 L’Aquila, Italy
| | - Maria Elena De Felice
- Department of Life, Health and Environmental Sciences, Paediatric Dentistry, University of L’Aquila, 67100 L’Aquila, Italy
| | - Roberto Gatto
- Department of Life, Health and Environmental Sciences, Paediatric Dentistry, University of L’Aquila, 67100 L’Aquila, Italy
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Sharma SV, Kelder S, Yamal JM, Chuang RJ, Byrd-Williams C, Bona G, Bajaj N, Brito F, Neumann AS. Development and Feasibility Testing of CATCH Healthy Smiles, an Oral Health Promotion Intervention for Prevention of Dental Caries Among Elementary School Children. THE JOURNAL OF SCHOOL HEALTH 2022; 92:20-30. [PMID: 34788893 DOI: 10.1111/josh.13100] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 02/09/2021] [Accepted: 03/22/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND We present results of the development and feasibility testing of CATCH Healthy Smiles, a school-based oral health program, among children in grades K-2 in Houston, Texas. METHODS Study design was cross-sectional (N = 2 schools; N = 125 parent-child dyads; 31 kindergarteners, 42 first graders, and 52 second graders). CATCH Healthy Smiles program was implemented by trained school teachers in the 2016-2017 school year. Trained dentists conducted dental assessments to measure dental caries increment score (d3mfs). Parent-reported 24-hour dietary recalls and surveys assessed child and parent behavioral, environmental, and psychosocial factors. Logistic regression analysis assessed factors associated with caries experience adjusting for covariates. RESULTS Of the 113 children with complete dental assessments, 54% children in grade K, 62% in first grade, and 73% in second grade had caries experience. Children with caries experience had a higher body weight (AdjOR = 1.13, 95% confidence interval [CI]: 1.02-1.29), were less likely to be girls (AdjOR = 0.22, 95% CI: 0.05-0.82), had greater odds of difficulty drinking hot or cold beverages because of dental problems (AdjOR = 13.13, 95% CI: 1.09-275.14), greater frequency of consuming sugar-sweetened beverages (AdjOR = 11.53, 95% CI: 2.10-87.19), greater odds of receiving government assistance (AdjOR = 14.62, 95% CI: 2.74-119.81), and lower odds of seeing a dental provider (AdjOR = 0.11, 95% CI: 0.02-0.45). Process evaluation showed that 100% of the CATCH Healthy Smiles lessons and activities were taught in the two schools with a high degree of program fidelity and acceptability across the schools, children, and parents. CONCLUSIONS These data will be used to conduct a subsequent fully powered cluster randomized controlled trial.
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Affiliation(s)
- Shreela V Sharma
- Department of Epidemiology, Human Genetics & Environmental Sciences, Michael & Susan Dell Center for Healthy Living, University of Texas Health Science Center at Houston School of Public Health, 1200 Pressler, RAS E643, Houston, TX, 77030, USA
| | - Steven Kelder
- Department of Epidemiology, Human Genetics, and Environmental Sciences, Michael & Susan Dell Center for Healthy Living, University of Texas Health Science Center, School of Public Health, Austin Regional Campus, 1616 Guadalupe St., Suite 6300, Austin, TX, 78701, USA
| | - Jose-Miguel Yamal
- Department of Biostatistics and Data Science, University of Texas Health Science Center at Houston School of Public Health, 1200 Pressler, RAS W817, Houston, TX, 77030, USA
| | - Ru-Jye Chuang
- Department of Epidemiology, Human Genetics & Environmental Sciences, Michael & Susan Dell Center for Healthy Living, University of Texas Health Science Center at Houston School of Public Health, 1200 Pressler Street, RAS E615, Houston, TX, 77030, USA
| | - Courtney Byrd-Williams
- Department of Health Promotion and Behavior Sciences, Director, Maternal and Child Health Training Program, Michael & Susan Dell Center for Healthy Living, University of Texas Health Science Center, School of Public Health, Austin Regional Campus, 1616 Guadalupe, Austin, TX, 78701, USA
| | - Gisela Bona
- Pediatric Dentistry, Pre-doctoral Clinical Director Pediatric Dentistry, Department of Pediatric Dentistry, 7500 Cambridge St, Suite 5403, Houston, TX, 77054, USA
| | - Nimit Bajaj
- Henry M. Goldman School of Dental Medicine, Boston University, 635 Albany St, Boston, MA, 02118, USA
| | - Frances Brito
- Department of Biostatistics and Data Science, University of Texas Health Science Center at Houston School of Public Health, 1200 Pressler Street, Houston, TX, 77030, USA
| | - Ana S Neumann
- Department of General Practice and Dental Public Health, Director of Dental Public Health, The University of Texas Health Science Center at Houston School of Dentistry, 7500 Cambridge St, Suite 5423, Houston, TX, 77054, USA
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Aldosari MA, Bukhari OM, Ruff RR, Palmisano JN, Nguyen H, Douglass CW, Niederman R, Starr JR. Comprehensive, School-Based Preventive Dentistry: Program Details and Students' Unmet Dental Needs. THE JOURNAL OF SCHOOL HEALTH 2021; 91:761-770. [PMID: 34389994 DOI: 10.1111/josh.13063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 01/28/2021] [Accepted: 02/03/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND In this paper, we describe the design, program details, and baseline demographics and oral health of participants in ForsythKids, a regional, comprehensive, school-based mobile caries prevention program. METHODS We solicited all Massachusetts elementary schools with greater than 50% of students receiving free or reduced-price meals. Six schools initially elected to participate, ultimately followed by over 50 schools. Interventions were based on systematic reviews and randomized controlled caries prevention trials. Participating students received semiannual dental examinations, followed by comprehensive preventive care. Summary statistics regarding oral health indicators were derived from individual tooth- and surface-level data. RESULTS Over a 6-year period, data were collected on 6927 children. The number of students per school ranged from 58 to 681. The overall participation rate was 15%, ranging from 10% to 29%. Overall, 57% of the children were younger than 8 years at baseline. Approximately, 54% of children experienced dental decay on any tooth at baseline; 32% had untreated decay on any tooth, 29% had untreated decay on primary teeth, and 10% untreated decay on permanent teeth. CONCLUSIONS Untreated dental decay was double the national average, even in schools within several blocks of community dental clinics. These data demonstrate the need for caries prevention beyond the traditional dental practice.
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Affiliation(s)
- Muath A Aldosari
- Assistant Professor, , Department of Periodontics and Community Dentistry, College of Dentistry, 3094 King Saud University, Riyadh 12372-7224, Saudi Arabia; Lecturer, Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, 188 Longwood Avenue, Boston, MA 02115., USA
| | - Omair M Bukhari
- Assistant Professor, , Department of Preventive Dentistry, Umm Al-Qura University Faculty of Dentistry, 2275 Al Awali District, Mecca, Saudi Arabia
| | - Ryan Richard Ruff
- Associate Professor, , Department of Epidemiology & Health Promotion, New York University College of Dentistry and College of Global Public Health, 433 First Avenue, 7th Floor, New York, NY, 10044., USA
| | - Joseph N Palmisano
- Director, , Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, 85 East Newton Street, M921, Boston, MA, 02118., USA
| | - Helen Nguyen
- Public Health Dentist, , Forsyth Institute, 245 First Street, Cambridge, MA 02142; Lecturer, Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, 188 Longwood Avenue, Boston, MA, 02115., USA
| | - Chester W Douglass
- Professor Emeritus, , Department of Epidemiology, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115; Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, 188 Longwood Avenue, Boston, MA, 02115., USA
| | - Richard Niederman
- Professor, , Department of Epidemiology & Health Promotion, New York University College of Dentistry, 433 First Avenue, 7th Floor, New York, NY, 10044., USA
| | - Jacqueline R Starr
- Director of Strategic Initiatives, , Channing Division of Network Medicine, Brigham and Women's Hospital, 181 Longwood Avenue, Boston, MA 02115; Lecturer, Department of Medicine, Harvard Medical School, Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine., USA
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Li A, Vermaire JH, Chen Y, van der Sluis LWM, Thomas RZ, Tjakkes GHE, Schuller AA. Trends in socioeconomic inequality of periodontal health status among Dutch adults: a repeated cross-sectional analysis over two decades. BMC Oral Health 2021; 21:346. [PMID: 34266415 PMCID: PMC8284001 DOI: 10.1186/s12903-021-01713-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 07/03/2021] [Indexed: 01/25/2023] Open
Abstract
Background Studies exclusively focusing on trends in socioeconomic inequality of oral health status in industrialized countries are relatively sparse. This study aimed to assess possible differences in oral hygiene and periodontal status among people of different socioeconomic status (SES) in the Netherlands over two decades.
Methods A repeated cross-sectional analysis of 3083 participants aged 25–54 years was conducted on the Dutch National Oral Health Surveys of 1995, 2002, 2007, and 2013. Plaque-free was defined according to the Simplified Oral Hygiene Index (OHI-S = 0). Periodontal status was classified in two different ways, either periodontal health/disease (probing pocket depth index [PDI] = 0/ ≥ 1) or with/without deep pockets (PDI = 2). We used the regression-based absolute and relative effect index to measure the absolute and relative socioeconomic inequalities. Multivariable logistic regressions were used to explore temporal trends in oral hygiene and periodontal status by low- and high-SES groups. Results Age-standardized percentages of individuals with plaque-free increased in the whole population from 1995 to 2013 (12.7% [95% CI 10.5–14.9] to 28.1% [24.8–31.5]). Plaque-free showed significant socioeconomic differences in absolute and relative inequalities in 2007 and 2013. Between 1995 and 2013, age-standardized percentage of periodontal health increased (from 51.4% [48.1–54.7] to 60.6% [57.0–64.1]). The significant absolute inequalities for periodontal health were seen in 2002 and 2013. The relative scale presented a similar pattern. Regarding deep pockets, there was little difference in the age-standardized overall prevalence in 1995 versus 2013 (from 6.5% [4.9–8.2] to 5.4% [3.7–7.0]). The significant absolute and relative inequalities in deep pockets prevalence were found in 1995. Yet, all interaction terms between survey year and SES did not reach significance (plaque-free: P = .198; periodontal health: P = .490; deep pockets: P = .678). Conclusions Socioeconomic inequalities in oral hygiene and periodontal status were present in the Netherlands in the last two decades.
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Affiliation(s)
- An Li
- Department of Periodontology, Center for Dentistry and Oral Hygiene, University Medical Center Groningen (UMCG), University of Groningen, Groningen, The Netherlands.
| | - Jan Hendrik Vermaire
- Department of Periodontology, Center for Dentistry and Oral Hygiene, University Medical Center Groningen (UMCG), University of Groningen, Groningen, The Netherlands.,Department of Child Health, The Netherlands Organization for Applied Scientific Research (TNO), Leiden, The Netherlands
| | - Yuntao Chen
- Medical Statistics and Decision Making, Department of Epidemiology, UMCG, University of Groningen, Groningen, The Netherlands
| | - Luc W M van der Sluis
- Department of Periodontology, Center for Dentistry and Oral Hygiene, University Medical Center Groningen (UMCG), University of Groningen, Groningen, The Netherlands
| | - Renske Z Thomas
- Department of Periodontology, Center for Dentistry and Oral Hygiene, University Medical Center Groningen (UMCG), University of Groningen, Groningen, The Netherlands.,Department of Dentistry, Radboud Institute for Health Sciences, Radboud University Medical Center, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Geerten-Has E Tjakkes
- Department of Periodontology, Center for Dentistry and Oral Hygiene, University Medical Center Groningen (UMCG), University of Groningen, Groningen, The Netherlands
| | - Annemarie A Schuller
- Department of Periodontology, Center for Dentistry and Oral Hygiene, University Medical Center Groningen (UMCG), University of Groningen, Groningen, The Netherlands.,Department of Child Health, The Netherlands Organization for Applied Scientific Research (TNO), Leiden, The Netherlands
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Bezamat M, Modesto A, Vieira AR. Phenome-Wide Association Study With Focus on Oral Health Disparities and Individuals Who Did Not Have Cancer. FRONTIERS IN DENTAL MEDICINE 2021. [DOI: 10.3389/fdmed.2021.641246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The goal of this study was to test if oral health outcomes are associated with the same genetic markers in Black and White individuals who did not have cancer. From a total of 6,100 subjects from the Dental Registry and DNA Repository project, 1,042 individuals who self-identified as White and 266 as Black without a history of cancer were included in this analysis. Genotyping data from IRE1—rs196929, RHEB—rs2374261 and rs1109089, AXIN2—rs2240308 and rs11867417, and RPTOR—rs4396582, present in cell regulatory pathways, were analyzed. We ran separate analyses in self-reported Black and White groups to reduce possible confounding effects of population stratification. Internal diagnostic codes from our dental registry were converted into Phecodes in order to run the analysis using the PheWAS package, installed in R Studio software. Periodontitis was associated with RHEB in both Black and White patients, with the minor allele increasing the likelihood of developing periodontitis in the White group and yielding a protective effect in the Black individuals. The presence of ulcers and gingivitis were associated with RPTOR and AXIN2, respectively, in the White group, but an association was not detected for the Black group. On the other hand, phenotypes such as dental fracture, diseases of the tongue, attrition, erosion, abrasion, fordyce granules, and torus and exostosis were uniquely associated with the Black group. Periodontitis associated with RHEB in both Black and White patients, and associations found in Black individuals may be the result of social disparities that lead to higher levels of stress, and these observed differences require further study.
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Fleitas Alfonzo L, Bentley R, Singh A. Home ownership, income and oral health of children in Australia-A population-based study. Community Dent Oral Epidemiol 2021; 50:156-163. [PMID: 33870544 DOI: 10.1111/cdoe.12646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 01/25/2021] [Accepted: 03/28/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Income inequalities in children's oral health have been well described. It is plausible that the security of tenure reflected by the ownership status of children's housing dynamically interacts with household income to shape these inequalities. We examined whether housing tenure modifies the known association between household income and oral health. METHODS Data were analysed on 3344 10- to 11-year-old children from the Longitudinal Study of Australian Children. Multivariable regression models tested associations between household income and dental caries and tooth loss due to caries. Effect modification by home ownership (yes/no) was tested on the additive and multiplicative scales. Models were adjusted for sex, Indigenous status, main language spoken at home, area of residence, main carer education and family arrangement. RESULTS Children in households in the low income group had worse oral health than children in the high group for caries and tooth loss. Models only weakly supported an additive interaction for tooth loss; that is, the relative excess risk due to interaction (RERI) for low household income was -0.903 (-2.38; 0.571) for tooth loss and -0.076 (-0.42; 0.271) for dental decay, although we note that the low proportion of children from low-income homeowning households (6%) reduces the power to detect interactions. Notably, our models suggest renters in both high- and low-income categories had the highest risk of tooth loss compared to owners (PR for high-income renters: 2.19 (95% CI: 1.25, 3.85); PR for low-income renters: 2.11 (95% CI: 1.42, 3.16)). CONCLUSION Our study confirms that children in low-income households have poorer oral health outcomes than their high-income counterparts. Our findings additionally suggest that children in rental households may fare the worst of all housing and income combinations considered. Improving the security of housing for families privately renting may have wider health benefits that currently acknowledged.
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Affiliation(s)
- Ludmila Fleitas Alfonzo
- Centre for Health Equity, Melbourne School of Population & Global Health, The University of Melbourne, Melbourne, Vic., Australia
| | - Rebecca Bentley
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic., Australia
| | - Ankur Singh
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic., Australia.,Melbourne Dental School, The University of Melbourne, Melbourne, Vic., Australia
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Sousa FSD, Lopes BC, Costa EM, Alves CMC, Queiroz RCDS, Tonello AS, Ribeiro CCC, Thomaz EBAF. Do social inequalities persist in the distribution of dental caries in adolescents from Maranhão? Contributions of a population-based study. CIENCIA & SAUDE COLETIVA 2021; 26:2625-2634. [PMID: 34231675 DOI: 10.1590/1413-81232021267.08562021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 04/14/2021] [Indexed: 11/22/2022] Open
Abstract
This study aimed to analyze the association of socioeconomic factors with the prevalence of dental caries in adolescents from São Luís, Maranhão, Brazil, to answer whether social inequalities persist in distributing this disease. This is a cross-sectional study nested in a prospective cohort. We included 2,413 adolescents aged 18-19 years evaluated in the 2016 second follow-up. The outcome was teeth with untreated dental caries (yes or no) assessed by the DMFT index. Socioeconomic and demographic characteristics were the independent variables. Descriptive statistical and Poisson regression analyses were performed, calculating crude and adjusted prevalence ratios (PRs) (alpha=5%). Belonging to economic classes C (PR=1.23; 95% CI: 1.11-1.37) or D-E (PR=1.48; 95% CI: 1.32-1.65), being married/living with a partner (PR=1.22; 95% CI: 1.07-1.39), having separated parents (PR=1.11; 95% CI 1.03-1.19) and a greater number of people in the household (PR=1.05; 95% CI: 1.03-1.07) were associated with a higher prevalence of dental caries. Social inequalities in adolescent oral health persist despite the implementation of the National Oral Health Policy. The current health care model should seek to reorient health education strategies, targeting them at vulnerable populations.
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Affiliation(s)
- Francenilde Silva de Sousa
- Departamento de Saúde Pública, Universidade Federal do Maranhão (UFMA). R. Barão de Itapari 155, Centro. 65020-070 São Luís MA Brasil.
| | | | - Elisa Miranda Costa
- Departamento de Saúde Pública, Universidade Federal do Maranhão (UFMA). R. Barão de Itapari 155, Centro. 65020-070 São Luís MA Brasil.
| | | | - Rejane Christine de Sousa Queiroz
- Departamento de Saúde Pública, Universidade Federal do Maranhão (UFMA). R. Barão de Itapari 155, Centro. 65020-070 São Luís MA Brasil.
| | - Aline Sampieri Tonello
- Departamento de Saúde Pública, Universidade Federal do Maranhão (UFMA). R. Barão de Itapari 155, Centro. 65020-070 São Luís MA Brasil.
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Starr JR, Ruff RR, Palmisano J, Goodson JM, Bukhari OM, Niederman R. Longitudinal caries prevalence in a comprehensive, multicomponent, school-based prevention program. J Am Dent Assoc 2021; 152:224-233.e11. [PMID: 33632412 DOI: 10.1016/j.adaj.2020.12.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 11/19/2020] [Accepted: 12/11/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Globally, children's caries prevalence exceeds 30% and has not markedly changed in 30 years. School-based caries prevention programs can be an effective method to reduce caries prevalence, obviate traditional barriers to care, and use aerosol-free interventions. The objective of this study was to explore the clinical effectiveness of a comprehensive school-based, aerosol-free, caries prevention program. METHODS The authors conducted a 6-year prospective open cohort study in 33 US public elementary schools, providing care to 6,927 children in communities with and without water fluoridation. After dental examinations, dental hygienists provided twice-yearly prophylaxis, glass ionomer sealants, glass ionomer interim therapeutic restorations, fluoride varnish, toothbrushes, fluoride toothpaste, oral hygiene instruction, and referral to community dentists as needed. The authors used generalized estimating equations to estimate the change in the prevalence of untreated caries over time. RESULTS The prevalence of untreated caries decreased by more than 50%: from 39% through 18% in phase 1, and from 28% through 10% in phase 2. The per-visit adjusted odds ratio of untreated caries was 0.79 (95% confidence interval, 0.73 to 0.85). CONCLUSIONS AND PRACTICAL IMPLICATIONS This school-based comprehensive caries prevention program was associated with substantial reductions in children's untreated caries, supporting the concept of expanding traditional practices to include office- and community-based aerosol-free care.
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Maldupa I, Sopule A, Uribe SE, Brinkmane A, Senakola E. Caries Prevalence and Severity for 12-Year-Old Children in Latvia. Int Dent J 2021; 71:214-223. [PMID: 34024331 PMCID: PMC9275297 DOI: 10.1111/idj.12627] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objectives To study caries prevalence/severity in 12-year-old children in Latvia and potential risk indicators. Methods A cross-sectional oral-health national survey of 12-year-old children was conducted in 2016. A nationally representative stratified-cluster probabilistic sample of 2,138 pupils in 92 schools was selected. Children were examined by seven calibrated examiners (kappa inter-examiner, intra-examiner scores of 0.71–0.77, 0.81–0.97, respectively) at school. Enamel-non-cavitated decay (D1), enamel cavitation (D3), dentine cavitation (D5), missing (M) or filled (F) status at the tooth (T)/surface (S) levels were evaluated, and decayed, missing, and filled (DMF) index scores for severity, along with the Significant Caries Index (SiC), were calculated. An associated caries factor questionnaire was completed by participants. Results The prevalence of caries was 98.5% for D1MFT, 79.7% for D3MFT, and 71.9% for D5MFT. The means (standard deviations) for severity were 9.2 (5.3) for D1MFT, 3.3 (3.0) for D3MFT, and 2.4 (2.4) for D5MFT, and 5.6 (2.1) for the SiC. Indicators associated with a lower risk of caries (D5MFT) were irregular dental visits (prevalence odds ratio POR = 0.45, 95% confidence interval (CI): 0.36, 0.56) and irregular use of mouthwashes (POR = 0.73, 95% CI: 0.60, 0.89). Conclusions We found a high caries prevalence and severity in 12 year-old children in Latvia. Although the WHO target for 2010 (D5MFT ≤ 3) is met, the values for caries prevalence (D5MFT > 0 = 71.9%) and severity (D5MFT = 2.5) in 12-year-old Latvian children are higher than the European averages (D5MFT > 0 = 52%, D5MFT = 1.1).
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Affiliation(s)
- Ilze Maldupa
- Department of Conservative Dentistry and Oral Health, Riga Stradins University, Riga, Latvia; School of Dentistry, Universidad Austral de Chile, Valdivia, Chile
| | - Anete Sopule
- Department of Conservative Dentistry and Oral Health, Riga Stradins University, Riga, Latvia
| | - Sergio E Uribe
- Department of Conservative Dentistry and Oral Health, Riga Stradins University, Riga, Latvia; School of Dentistry, Universidad Austral de Chile, Valdivia, Chile.
| | - Anda Brinkmane
- Department of Conservative Dentistry and Oral Health, Riga Stradins University, Riga, Latvia
| | - Egita Senakola
- Department of Conservative Dentistry and Oral Health, Riga Stradins University, Riga, Latvia
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Shin BM, Jung SH, Kim MH, Ryu JI. Did the extended coverage policy contribute to alleviating socioeconomic inequality in untreated dental caries of both children and adolescents in South Korea? BMC Oral Health 2020; 20:124. [PMID: 32321493 PMCID: PMC7178997 DOI: 10.1186/s12903-020-01112-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 04/13/2020] [Indexed: 11/29/2022] Open
Abstract
Background Dental sealants have been covered by the National Health Insurance Service (NHIS) since December 2009 in South Korea. This study aims to determine whether the socioeconomic inequality in untreated dental caries decreased after implementing the extended coverage policy for dental sealant. Methods The data were derived from the fourth (2007–2009) and sixth (2013–2015) waves of the Korean National Health and Nutrition Examination Survey (KNHANES) conducted by the Korea Centers for Disease Control and Prevention (KCDC). Dental caries and sealant experience by income quartiles were tested using the Rao-Scott chi-squared test. In order to examine socioeconomic inequalities and their trends over time, the prevalence ratios (PRs), slope index of inequality (SII), and relative index of inequality (RII) were estimated for each wave and age group. All analyses were conducted using SAS version 9.3. Results The adjusted PRs of untreated dental caries and sealants in the poorest in the aged 6–11 group were significantly higher and lower, respectively, compared to the most affluent quartile group for the fourth wave; however, all significant differences disappeared for the sixth wave, after the sealant coverage. The gap between the lowest and the highest was similar for the aged 12–18 group but it widened in the untreated dental caries even after the sealant coverage. The statistical significance of the PRs was maintained at the sixth wave for both caries and sealants. Children showed decreases in both SII and RII over time so its significance disappeared. The SII among adolescents decreased over time but the RII of untreated dental caries increased. Conclusions This study found that the NHIS coverage expansion of dental care had a positive effect on overall status in dental health among children and adolescents. However, younger children benefited more in terms of inequalities. Our findings indicate that strategies to enhance access to preventive dental services should consider the differential effects for the vulnerable population in terms of socioeconomic status and age from the beginning stage of the policy.
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Affiliation(s)
- Bo-Mi Shin
- Department of Dental Hygiene, College of Dentistry, Gangneung-Wonju National University, 120 Gangneungdaehag-ro, Gangneung City, Gangwon Province, 25457, South Korea
| | - Se-Hwan Jung
- Department of Preventive and Public Health Dentistry, College of Dentistry, Gangneung-Wonju National University, 120 Gangneungdaehag-ro, Gangneung City, Gangwon Province, 25457, South Korea
| | - Myoung-Hee Kim
- Center for Health Equity Research, People's Health Institute, 36 Sadangro 13-gil, 2nd floor, Dongjak-gu, Seoul, 07004, South Korea
| | - Jae-In Ryu
- Department of Preventive and Social Dentistry, College of Dentistry, Kyung Hee University, 26 Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, South Korea.
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Medina-Solís CE, Ávila-Burgos L, Borges-Yañez SA, Irigoyen-Camacho ME, Sánchez-Pérez L, Zepeda-Zepeda MA, Lucas-Rincón SE, Medina-Solís JJ, Márquez-Corona MDL, Islas-Granillo H, Casanova-Rosado JF, Casanova-Rosado AJ, Minaya-Sánchez M, Villalobos-Rodelo JJ, Patiño-Marín N, Mendoza-Rodríguez M, Pontigo-Loyola AP, de la Rosa-Santillana R, Escoffié-Ramirez M, Fernández-Barrera MA, Maupomé G. Ecological study on needs and cost of treatment for dental caries in schoolchildren aged 6, 12, and 15 years: Data from a national survey in Mexico. Medicine (Baltimore) 2020; 99:e19092. [PMID: 32049814 PMCID: PMC7035119 DOI: 10.1097/md.0000000000019092] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
To determine the treatment needs and the care index for dental caries in the primary dentition and permanent dentition of schoolchildren and to quantify the cost of care that would represent the treatment of dental caries in Mexico.A secondary analysis of data from the First National Caries Survey was conducted, which was a cross-sectional study conducted in the 32 states of Mexico. Based on dmft (average number of decayed, extracted, and filled teeth in the primary dentition) and DMFT (average number of decayed, extracted, and filled teeth in permanent dentition) information, a treatment needs index (TNI) and a caries care index (CI) were calculated.At age 6, the TNI for the primary dentition ranged from 81.7% to 99.5% and the CI ranged from 0.5% to 17.6%. In the permanent dentition, the TNI ranged from 58.8% to 100%, and the CI ranged from 0.0% to 41.2%. At age 12, the TNI ranged from 55.4% to 93.4%, and the CI ranged from 6.5% to 43.4%. At age 15, the TNI ranged from 50.4% to 98.4%, and the CI ranged from 1.4% to 48.3%. The total cost of treatment at 6 years of age was estimated to range from a purchasing power parity (PPP) of USD $49.1 to 287.7 million in the primary dentition, and from a PPP of USD $3.7 to 24 million in the permanent dentition. For the treatment of the permanent dentition of 12-year-olds, the PPP ranged from USD $13.3 to 85.4 million. The estimated cost of treatment of the permanent dentition of the 15-year-olds ranged from a PPP of USD $10.9 to 70.3 million. The total estimated cost of caries treatment ranged from a PPP of USD $77.1 to 499.6 million, depending on the type of treatment and provider (public or private).High percentages of TNI for dental caries and low CI values were observed. The estimated costs associated with the treatment for caries have an impact because they represent a considerable percentage of the total health expenditure in Mexico.
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Affiliation(s)
- Carlo E. Medina-Solís
- Academic Area of Dentistry of Institute of Health Sciences at Autonomous University of Hidalgo State, Pachuca
- Advanced Studies and Research Center in Dentistry “Dr. Keisaburo Miyata” of School of Dentistry at Autonomous University State of Mexico, Toluca
| | - Leticia Ávila-Burgos
- Health Systems Research Centre at National Institute of Public Health, Cuernavaca
| | | | | | - Leonor Sánchez-Pérez
- Health Care Department, Metropolitan Autonomous University-Xochimilco, Mexico City
| | | | - Salvador E. Lucas-Rincón
- Academic Area of Dentistry of Institute of Health Sciences at Autonomous University of Hidalgo State, Pachuca
- Clinic of Dental Specialties of the General Hospital of Pachuca, campus Arista of the Ministry of Health of Hidalgo, Pachuca
| | - June J. Medina-Solís
- Ministry of Education of Campeche, Sub-secretary of Educational Coordination, Direction of Coordination and Budgetary Management, Campeche
| | - María de L. Márquez-Corona
- Academic Area of Dentistry of Institute of Health Sciences at Autonomous University of Hidalgo State, Pachuca
| | - Horacio Islas-Granillo
- Academic Area of Dentistry of Institute of Health Sciences at Autonomous University of Hidalgo State, Pachuca
| | | | | | | | - Juan J. Villalobos-Rodelo
- Department of Epidemiology at Institute of Social Security and Services for Government Workers (ISSSTE), Culiacan
| | - Nuria Patiño-Marín
- Clinical Research Laboratory, Program of Doctorate in Dental Sciences at Autonomous University of San Luis Potosi, San Luis Potosi
| | - Martha Mendoza-Rodríguez
- Academic Area of Dentistry of Institute of Health Sciences at Autonomous University of Hidalgo State, Pachuca
| | - América P. Pontigo-Loyola
- Academic Area of Dentistry of Institute of Health Sciences at Autonomous University of Hidalgo State, Pachuca
| | - Rubén de la Rosa-Santillana
- Academic Area of Dentistry of Institute of Health Sciences at Autonomous University of Hidalgo State, Pachuca
- Clinic of Dental Specialties of the General Hospital of Pachuca, campus Arista of the Ministry of Health of Hidalgo, Pachuca
| | | | - Miguel A. Fernández-Barrera
- Academic Area of Dentistry of Institute of Health Sciences at Autonomous University of Hidalgo State, Pachuca
| | - Gerardo Maupomé
- Richard M. Fairbanks School of Public Health, Indiana University/Purdue University, Indianapolis
- Indiana University Network Science Institute, Bloomington, IN, USA
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Gupta A, Sonis S, Uppaluri R, Bergmark RW, Villa A. Disparities in Oral Cancer Screening Among Dental Professionals: NHANES 2011-2016. Am J Prev Med 2019; 57:447-457. [PMID: 31443957 DOI: 10.1016/j.amepre.2019.04.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 04/23/2019] [Accepted: 04/24/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION As early detection of oral cancers is associated with better survival, oral cancer screening should be included in dental visits for adults. This study examines the rate and predictors of oral cancer screening exams among U.S. adults with a recent dental visit. METHODS Individuals aged ≥30 years who received a dental visit in the last 2 years, in the 2011-2016 National Health and Nutrition Examination Survey were analyzed in December 2018. Weighted multivariable logistic regression models examined the likelihood of intraoral and extraoral oral cancer screening exams, adjusting for age, sex, race/ethnicity, education, marital status, poverty income ratio, health insurance, tobacco smoking, and alcohol consumption. Subgroup analyses were conducted among races/ethnicities, smokers, and alcohol consumers. Statistical significance was set at p<0.01. RESULTS A total of 37.6% and 31.3% reported receiving an intraoral and extraoral oral cancer screening exam, respectively. Minority racial/ethnic groups versus white, non-Hispanics, less-educated versus more-educated, uninsured and Medicaid-insured versus privately insured, and low-income versus high-income participants were less likely to have received intraoral or extraoral oral cancer screening exams. There was no difference in the likelihood of being screened based on smoking status. Alcohol consumers were more likely to be screened. Among subgroups, less-educated and low-income individuals were less likely to be screened. CONCLUSIONS A significantly higher proportion of minority race/ethnicity and low SES individuals report not receiving an oral cancer screening exam, despite a recent dental visit. This selective screening by dental professionals is incompliant with guidelines and concerning because these groups are more likely to present with an advanced stage of oral cancer at diagnosis. An understanding of the reasons for discriminatory oral cancer screening practices could help develop effective interventions.
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Affiliation(s)
- Avni Gupta
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts.
| | - Stephen Sonis
- Division of Oral Medicine, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, Massachusetts
| | - Ravindra Uppaluri
- Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts
| | - Regan W Bergmark
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts; Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts; Patient Reported Outcomes, Value, and Experience Center, Brigham and Women's Hospital, Boston, Massachusetts
| | - Alessandro Villa
- Division of Oral Medicine, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, Massachusetts
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Gupta A, Feldman S, Perkins RB, Stokes A, Sankar V, Villa A. Predictors of dental care use, unmet dental care need, and barriers to unmet need among women: results from NHANES, 2011 to 2016. J Public Health Dent 2019; 79:324-333. [PMID: 31407356 DOI: 10.1111/jphd.12334] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 06/11/2019] [Accepted: 07/09/2019] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To examine socio-demographic and economic predictors of dental care access among women in the United States. METHODS A total of 52,493,940 women at the US national level aged 20-44 years were identified from the National Health and Nutrition Examination Survey, 2011 to 2016. Weighted multivariate logistic regression models were computed to identify predictors of dental care use, unmet dental-care need, and reported reasons for unmet need. RESULTS Young, Mexican-American, other minority race-ethnicities, less educated, and uninsured women were independently more likely to have never visited a dental clinic (P < 0.025). Mexican-Americanwomen with a poverty income ratio (PIR) <2.00 and less than excellent health status and those uninsured were independently more likely to have unmet dental need (P < 0.025). Women with PIR <1.00 and those uninsured were independently more likely to have an unmet need because of unaffordable cost (P < 0.0008) or lack of procedure coverage by insurance (P < 0.0008). Younger women were more likely to think that the dental problem would go away (P < 0.0001). CONCLUSIONS While young, less educated, and women from minority race-ethnicities were less likely to report ever use of dental care, only low income, poor health, and uninsured women were more likely to report unmet dental care need. Racial-ethnic minority, less educated, and young women may benefit from improved education about the value of dental care. Expanding insurance coverage for dental care and improving access for women with poor health may address racial-ethnic and education-level disparities in unmet dental care need.
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Affiliation(s)
- Avni Gupta
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
| | - Sarah Feldman
- Division of Gynecological Oncology, Brigham and Women's Hospital, Boston, MA, USA
| | - Rebecca B Perkins
- Department of Obstetrics and Gynecology, Boston University School of Medicine/Boston Medical Center, Boston, MA, USA
| | - Andrew Stokes
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Vidya Sankar
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, MA, USA.,Department of Oral Medicine Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, USA.,Division of Oral Medicine and Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Alessandro Villa
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, MA, USA.,Department of Oral Medicine Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, USA.,Division of Oral Medicine and Oncology, Dana Farber Cancer Institute, Boston, MA, USA
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Reliability of colour and hardness clinical examinations in detecting dentine caries severity: a systematic review and meta-analysis. Sci Rep 2019; 9:6533. [PMID: 31024013 PMCID: PMC6484026 DOI: 10.1038/s41598-019-41270-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 02/19/2019] [Indexed: 11/26/2022] Open
Abstract
Dental caries is the most common human infectious disease and is caused by microorganisms producing acids, resulting in changes in dental tissue hardness and colour. However, the accuracy and reliability of dentine colour and hardness as indicators for carious lesion severity has never been assessed in a systematic review. By applying strict criteria, only seven papers (five randomized control trials and two diagnostic studies) were considered for full text qualitative and quantitative assessment. Only three studies produced high quality evidence and only four articles were considered for meta-analysis, as these provided log10 colony forming units (CFU) data from caries biopsies following colour and hardness clinical examinations. When comparing the amount of CFU isolated from carious biopsies from different colour and hardness categories, hardness clinical examination was found to be a statistically more discriminate test than colour clinical examination. Therefore, hardness clinical examination is more specific and reliable than colour to detect dentine carious lesion severity. Further large carefully designed clinical studies are needed to consolidate the findings of this systematic review.
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Verlinden DA, Reijneveld SA, Lanting CI, van Wouwe JP, Schuller AA. Socio-economic inequality in oral health in childhood to young adulthood, despite full dental coverage. Eur J Oral Sci 2019; 127:248-253. [PMID: 30791128 PMCID: PMC6593773 DOI: 10.1111/eos.12609] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2018] [Indexed: 01/04/2023]
Abstract
The aim of this cross‐sectional study was to assess differences in caries experience according to socio‐economic status (SES) in a health‐care system with full coverage of dental costs for children up to the age of 18 yr. In 2011 and 2014, by performing hurdle negative binomial models, we obtained data on 3,022 children and young adults aged 5, 8, 11, 14, 17, 20, and 23 yr, living in four cities in the Netherlands. At all ages between 5 and 23 yr, the percentages of children with caries‐free dentitions were lower and mean caries experience were higher in low‐SES than in high‐SES participants. In 5‐yr‐old children with dmft > 0, mean caries experience was 3.6 in those with low SES and 2.3 in those with high SES. In 23‐yr‐old participants, these estimates were 6.8 and 4.4, respectively (P < 0.05). Low‐SES children have a greater risk of more caries experience than high‐SES children. Thus, in a system with full free paediatric dental coverage, socio‐economic inequality in caries experience still exists. Dental health professionals, well‐child care doctors and nurses, general practitioners, and elementary school teachers should collaborate to promote oral health at the community level, with specific targeting of low‐SES families. We further need policy measures to curtail, at community level, the increasing availability and consumption of highly processed, carbohydrate‐rich foods, with particular attention for low‐SES families.
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Affiliation(s)
- Deborah A Verlinden
- Centre of Dentistry and Oral Hygiene, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Child Health, the Netherlands Organization for Applied Scientific Research TNO, Leiden, The Netherlands
| | - Sijmen A Reijneveld
- Department of Child Health, the Netherlands Organization for Applied Scientific Research TNO, Leiden, The Netherlands.,Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Caren I Lanting
- Department of Child Health, the Netherlands Organization for Applied Scientific Research TNO, Leiden, The Netherlands
| | - Jacobus P van Wouwe
- Department of Child Health, the Netherlands Organization for Applied Scientific Research TNO, Leiden, The Netherlands
| | - Annemarie A Schuller
- Centre of Dentistry and Oral Hygiene, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Child Health, the Netherlands Organization for Applied Scientific Research TNO, Leiden, The Netherlands
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20
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Bress LE, Horowitz AM, Capobianco DM, Fleming DE, Kleinman DV. Assessing Dental Hygiene Students' and Community Caregivers' Knowledge of Strategies for Caries Prevention. J Dent Educ 2019; 83:351-358. [PMID: 30692188 DOI: 10.21815/jde.019.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 08/30/2018] [Indexed: 11/20/2022]
Abstract
With dental caries being a common chronic disease in children and adults, oral health literacy is needed to improve oral health and prevent caries. If oral health providers themselves are confused about preventive strategies, they cannot effectively educate the public or other health care providers. The aim of this study was to assess University of Maryland dental hygiene students' understanding of and ability to communicate caries preventive strategies to low-income populations during a community service-learning program in 2013 and 2014. Fifty baccalaureate degree dental hygiene students were asked to complete surveys before and after receiving a presentation on caries preventive strategies and after an outreach event, and 77 low-income caregivers were asked to complete surveys before and after receiving oral health education from the students. The key knowledge question on all surveys asked respondents to select the "single best way to prevent tooth decay" (i.e., provide caries prevention) from a list that included the following items: limit sweets, going to the dentist, brushing teeth, using fluoride toothpaste, flossing, drinking fluoridated water, fluoride varnish, and sealants. Of the 50 students, 41 completed all three surveys, for a response rate of 82%; all 77 caregivers (100%) completed the survey before the counseling session, and 37 (48%) completed the survey afterwards. While the results showed a significant knowledge increase for the students that drinking fluoridated water is the best caries prevention strategy, only 44% of them correctly ranked that option first even on the final survey, and only 8% of the caregivers ranked that option first even after counseling. These results suggested that neither the students nor the caregivers understood the benefits of community water fluoridation (CWF), even after the interventions. In spite of their low knowledge scores, it was encouraging that 86-92% of the caregivers reported that the students demonstrated respect for them and spent an appropriate amount of time with them and that they understood the information the students communicated. In discussions after the surveys, the students reported that they had received inconsistent messages from faculty members regarding the benefits of CWF, which resulted in their confusion. These results led the authors to revise their program's instruction to increase the students' knowledge of caries prevention strategies.
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Affiliation(s)
- Lisa E Bress
- Lisa E. Bress is Assistant Professor, University of Maryland School of Dentistry; Alice M. Horowitz is Research Associate Professor, University of Maryland School of Public Health; Diana M. Capobianco is Owner and Founder of Growing Smiles Dental Practice, Bel Air, MD; Deborah E. Fleming is Academic Manager, Colgate Oral Pharmaceuticals, Inc.; and Dushanka V. Kleinman is Associate Dean for Research, University of Maryland School of Public Health.
| | - Alice M Horowitz
- Lisa E. Bress is Assistant Professor, University of Maryland School of Dentistry; Alice M. Horowitz is Research Associate Professor, University of Maryland School of Public Health; Diana M. Capobianco is Owner and Founder of Growing Smiles Dental Practice, Bel Air, MD; Deborah E. Fleming is Academic Manager, Colgate Oral Pharmaceuticals, Inc.; and Dushanka V. Kleinman is Associate Dean for Research, University of Maryland School of Public Health
| | - Diana M Capobianco
- Lisa E. Bress is Assistant Professor, University of Maryland School of Dentistry; Alice M. Horowitz is Research Associate Professor, University of Maryland School of Public Health; Diana M. Capobianco is Owner and Founder of Growing Smiles Dental Practice, Bel Air, MD; Deborah E. Fleming is Academic Manager, Colgate Oral Pharmaceuticals, Inc.; and Dushanka V. Kleinman is Associate Dean for Research, University of Maryland School of Public Health
| | - Deborah E Fleming
- Lisa E. Bress is Assistant Professor, University of Maryland School of Dentistry; Alice M. Horowitz is Research Associate Professor, University of Maryland School of Public Health; Diana M. Capobianco is Owner and Founder of Growing Smiles Dental Practice, Bel Air, MD; Deborah E. Fleming is Academic Manager, Colgate Oral Pharmaceuticals, Inc.; and Dushanka V. Kleinman is Associate Dean for Research, University of Maryland School of Public Health
| | - Dushanka V Kleinman
- Lisa E. Bress is Assistant Professor, University of Maryland School of Dentistry; Alice M. Horowitz is Research Associate Professor, University of Maryland School of Public Health; Diana M. Capobianco is Owner and Founder of Growing Smiles Dental Practice, Bel Air, MD; Deborah E. Fleming is Academic Manager, Colgate Oral Pharmaceuticals, Inc.; and Dushanka V. Kleinman is Associate Dean for Research, University of Maryland School of Public Health
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21
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de Sousa Queiroz RC, Ribeiro AGA, Tonello AS, Pinheiro ACM, Júnior JA, Rocha TAH, da Silva NC, Costa EM, Vissoci JRN, Staton C, Facchini LA, Thomaz EBAF. Is there a fair distribution of the structure of dental services in the capitals of the Brazilian Federative Units? Int J Equity Health 2019; 18:5. [PMID: 30621709 PMCID: PMC6325759 DOI: 10.1186/s12939-018-0899-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 11/28/2018] [Indexed: 11/10/2022] Open
Abstract
Background Brazilian Primary Care Facilities (PCF) provide primary care and must offer dental services for diagnosis, prevention, and treatment of diseases. According to a logic of promoting equity, PCF should be better structured in less developed places and with higher need for oral health services. Objective To analyze the structure of dental caries services in the capitals of the Brazilian Federative Units and identify whether socioeconomic factors and caries (need) are predictors of the oral health services structure. Methods This is an ecological study with variables retrieved from different secondary databases, clustered for the level of the federative capitals. Descriptive thematic maps were prepared, and structural equations were analyzed to identify oral health service structure’s predictors (Alpha = 5%). Four models with different outcomes related to dental caries treatment were tested: 1) % of PCF with a fully equipped office; 2) % of PCF with sufficient instruments, and 3) % of PCF with sufficient supplies; 4) % of PCF with total structure. Results 21.6% of the PCF of the Brazilian capitals had a fully equipped office; 46.9% had sufficient instruments, and 30.0% had sufficient supplies for caries prevention and treatment. The four models evidenced proper fit indexes. A correlation between socioeconomic factors and the structure of oral health services was only noted in model 3. The worse the socioeconomic conditions, the lower the availability of dental supplies (standard factor loading: 0.92, P = 0.012). Estimates of total, direct and indirect effects showed that dental caries experience observed in the Brazilian population by SB-Brasil in 2010 did not affect the outcomes investigated. Conclusion Material resources are not equitably distributed according to the socioeconomic conditions and oral health needs of the population of the Brazilian capitals, thus contributing to persistent oral health inequities in the country.
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Affiliation(s)
| | | | | | | | - José Aquino Júnior
- Department of Public Health, Postgraduate Program in Environmental Health, Federal University of Maranhão, São Luís, Maranhão, Brazil
| | - Thiago Augusto Hernandes Rocha
- Pan American Health Organization, Brasilia Federal District Brazil, Brasília, Brazil.,Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Núbia Cristina da Silva
- Center for Graduate Studies and Research in Administration (CEPEAD), Faculty of Economic Sciences (FACE), Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.,Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Elisa Miranda Costa
- Graduate Program in Public Health, Federal University of Maranhão, São Luís, Maranhão, Brazil
| | | | | | - Luiz Augusto Facchini
- Department of Social Medicine, Postgraduate Programs in Epidemiology and Nursing, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Erika Bárbara Abreu Fonseca Thomaz
- Department of Public Health, Postgraduate Program in Public Health, Postgraduate Program in Dentistry, Federal University of Maranhão, São Luís, Maranhão, Brazil
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22
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Reich SM, Ochoa W, Gaona A, Salcedo Y, Bardales GE, Newhart V, Lin J, Díaz G. Disparities in Caregivers' Experiences at the Dentist With Their Young Child. Acad Pediatr 2019; 19:969-977. [PMID: 30904582 PMCID: PMC6828576 DOI: 10.1016/j.acap.2019.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 03/02/2019] [Accepted: 03/08/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To understand the experiences of diverse families when taking their young children to the dentist and to document their prevalence. METHODS An exploratory sequential design was used. First, 4 focus groups (N = 33) comprised of low-income female caregivers of children under 6 years of age were conducted in English and Spanish. Discussions centered around facilitators and barriers to taking children to the dentist. Themes derived from the groups were then used to create a survey that was given to 1184 caregivers in English, Spanish, or Vietnamese. RESULTS Thematic coding of focus groups found little support for typically reported barriers to pediatric oral health care utilization (eg, transportation, cost, knowledge); instead, caregivers reported negative experiences (eg, restraint, separation) as barriers. In the surveys, 66% of caregivers reported being separated from their children, 25% reported that their children were restrained (53.7% for cleanings), 26% of children were given sedating medication for cleanings, and 22% of the caregivers reported experiences that made them not want to return to the dentist. The prevalence of these experiences differed significantly among Latino, Asian, and Caucasian families and for annual incomes under or above $50,000. CONCLUSIONS Families with lower incomes and/or from ethnic and linguistic minority groups were more likely to report negative experiences at the dentist than higher income and Caucasian families. These data document the high prevalence of negative experiences and suggest ethnic, financial, and linguistic disparities in the quality of experiences. More research is needed on the role of dentists in facilitating or hindering oral health care utilization among diverse families.
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Affiliation(s)
| | | | | | | | | | | | - Joyce Lin
- Department of Human Development and Family Studies, Purdue University, Lafayette, IN
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23
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Fontana M, Eckert G, Keels M, Jackson R, Katz B, Kemper A, Levy B, Levy S, Yanca E, Kelly S, Daly J, Patterson B, McKnight P. Predicting Caries in Medical Settings: Risk Factors in Diverse Infant Groups. J Dent Res 2019; 98:68-76. [PMID: 30205016 PMCID: PMC6304713 DOI: 10.1177/0022034518799080] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Expanded partnership with the medical community is a promising strategy for reducing disparities in dental caries among young children. However, no validated caries risk instrument exists for use in primary health care settings. To help resolve this gap, a 52-item caries risk questionnaire was developed and targeted to primary caregivers (PCGs) to test in a 3-y prospective study. To begin to understand the validity of the questionnaire items, the purpose of this study was to compare responses to the questionnaire based on key demographic characteristics known to be associated with disparities in caries experience (e.g., race/ethnicity and insurance status). A total of 1,323 one-year-old children were recruited primarily through 3 medical research networks. Baseline questionnaire responses were analyzed via logistic regression. The sample was 49% female. Its racial/ethnic makeup was as follows: 13% Hispanic, 37% White, 37% Black, and 13% other or multiracial. Sixty-one percent were enrolled in Medicaid, and 95% resided in urban communities. Mothers represented 94% of PCGs. There were significant differences ( P < 0.05) in baseline responses based on Medicaid status and race/ethnicity. As compared with those not enrolled in Medicaid, children in the Medicaid group were significantly more likely (after adjusting for race/ethnicity) to 1) go to sleep while nursing or drinking something other than water, 2) eat sugary snacks between meals, 3) consume sugary drinks between meals, 4) receive topical fluoride from a health professional, 5) visit the dentist, and 6) not have an employed adult in the household. PCGs of children enrolled in Medicaid were significantly more likely to be the mother, have bleeding gums, eat sugary snacks between meals, consume sugary drinks between meals, eat or drink something other than water before going to bed, and not get regular dental checkups. In conclusion, there are significant differences in caries risk questionnaire responses based on Medicaid status and race/ethnicity that provide construct and criterion validity to the developed caries risk tool (ClinicalTrials.gov NCT01707797).
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Affiliation(s)
- M. Fontana
- University of Michigan, Ann Arbor, MI,
USA
| | | | | | - R. Jackson
- Indiana University, Indianapolis, IN,
USA
| | - B.P. Katz
- Indiana University, Indianapolis, IN,
USA
| | - A.R. Kemper
- Division of Ambulatory Pediatrics,
Nationwide Children’s Hospital, Columbus, OH, USA
| | - B.T. Levy
- University of Iowa, Iowa City, IA,
USA
| | - S.M. Levy
- University of Iowa, Iowa City, IA,
USA
| | - E. Yanca
- University of Michigan, Ann Arbor, MI,
USA
| | - S. Kelly
- Indiana University, Indianapolis, IN,
USA
| | - J.M. Daly
- University of Iowa, Iowa City, IA,
USA
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24
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Gupta A, Perkins RB, Ortega G, Feldman S, Villa A. Barrier use during oro-genital sex and oral Human Papillomavirus prevalence: Analysis of NHANES 2009-2014. Oral Dis 2018; 25:609-616. [DOI: 10.1111/odi.12997] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 09/25/2018] [Accepted: 10/17/2018] [Indexed: 01/13/2023]
Affiliation(s)
- Avni Gupta
- Center for Surgery and Public Health; Brigham and Women’s Hospital; Boston Massachusetts
| | - Rebecca B. Perkins
- Department of Obstetrics and Gynecology; Boston Medical Center; Boston University School of Medicine; Boston Massachusetts
| | - Gezzer Ortega
- Center for Surgery and Public Health; Brigham and Women’s Hospital; Boston Massachusetts
| | - Sarah Feldman
- Division of Gynecological Oncology; Brigham and Women’s Hospital; Boston Massachusetts
| | - Alessandro Villa
- Division of Oral Medicine and Dentistry; Brigham and Women’s Hospital; Boston Massachusetts
- Department of Oral Medicine Infection and Immunity; Harvard School of Dental Medicine; Boston Massachusetts
- Division of Oral Medicine and Oncology; Dana Farber Cancer Institute; Boston Massachusetts
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25
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Masood M, Mnatzaganian G, Baker SR. Inequalities in dental caries in children within the UK: Have there been changes over time? Community Dent Oral Epidemiol 2018; 47:71-77. [PMID: 30298932 DOI: 10.1111/cdoe.12426] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 08/20/2018] [Accepted: 09/09/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To examine any change over time in the association between deprivation and caries experience between 2003 and 2013 in a nationally representative sample of UK children. METHODS Data from UK Children's Dental Health Surveys, 2003 and 2013, were used. The target population was 5-, 8-, 12- and 15-year-olds. A total of 9604 children in 2003 and 9866 in 2013 were included in the surveys. Outcome variables were any active caries, caries experience and total number of carious teeth. Family socio-economic position (SEP) or deprivation level was measured at school level using eligibility for free school meals (FSM) to identify children from low-income families. Incidence rate ratios (IRR) and pooled standardized incidence rates ratios were calculated to measure dichotomous outcome variables by year, age group and status of deprivation. The study continuous outcome was modelled using a zero-inflated Poisson regression while the dichotomous outcomes were modelled using logistic regressions. The multivariable analyses were run by age groups accounting for year, sex and deprivation status. RESULTS The percentage of those identified as deprived was significantly higher in 2013 (35.8% in 2013 vs 26.0% in 2003, P < 0.001). Among both deprived and non-deprived children, the prevalence of any active caries significantly dropped over the years, observed in all age groups. Comparing 2013 with 2003 and accounting for sex, deprivation level, "any active caries," "any caries experience" and "total number of carious teeth" significantly dropped were observed in all age groups. Comparing the years, the association of deprivation with caries outcomes mostly remained the same or decreased. This decrease was predominantly seen in "any caries experience." Only among the 5-year-olds, did the association between deprivation and total number of carious teeth over the years significantly increase. For all age groups, the likelihood of "any active caries" and "total number of carious teeth" by deprivation remained the same comparing the two points in time: 2003 and 2013. However, irrespective of year, deprivation was significantly associated with caries observed in all age groups. CONCLUSION In the UK, the prevalence of active dental caries and caries experience has decreased in the period between 2003 and 2013. Similarly, the likelihood of having dental caries by deprivation in 2013 was predominantly lower than that observed in 2003.
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Affiliation(s)
- Mohd Masood
- Department of Dentistry and Oral Health, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia.,Department of Community Dentistry, Institute of Dentistry, University of Turku, Turku, Finland.,Division of Population & Patient Health, Dental Institute, King's College London, London, UK
| | - George Mnatzaganian
- Department of Community and Allied Health, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Sarah R Baker
- Unit of Oral Health, Dentistry and Society, School of Clinical Dentistry, University of Sheffield, Sheffield, UK
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26
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Elwood WN, Huss K, Morales DA, Norton JM, Riddle MW, Roof RA, Suls JM, Stoney CM, Bavendam TG, Kirkali Z. NIH research opportunities for the prevention and treatment for chronic conditions. Transl Behav Med 2018; 8:509-514. [PMID: 29800410 PMCID: PMC6256956 DOI: 10.1093/tbm/ibx085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Chronic conditions constitute the leading cause of death and disability in the USA and constitute 86 per cent of the nation's annual healthcare expenses. Approximately half of all American adults have at least one chronic condition; 25 per cent of these Americans have two or more chronic conditions. The National Institutes of Health have funded many projects that explain epidemiology, risk factors, and prevention and treatment of chronic conditions, though research questions remain. This commentary discusses some past projects, current areas of interest, and funding opportunities from many NIH Institutes, Centers, and Offices.
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Affiliation(s)
- William N Elwood
- Office of Behavioral and Social Sciences Research, National Institutes of Health, Bethesda, MD, USA
| | - Karen Huss
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, USA
| | - Dawn A Morales
- National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, USA
| | - Jenna M Norton
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Melissa W Riddle
- National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, USA
| | - Rebecca A Roof
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, USA
| | - Jerry M Suls
- National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Catherine M Stoney
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Tamara G Bavendam
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Ziya Kirkali
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
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Abstract
Despite improvements in the oral health status of the US population as a whole, a disproportionately higher burden of oral diseases and disorders are borne by those individuals from low-income and racial and ethnic minority groups. These differences in health status, health outcomes, or health care use between distinct socially disadvantaged and advantaged groups are well documented and known as health disparities. It is vital that members of the dental profession understand the distribution of oral health and disease across different populations and the life span and participate in developing innovative and sustainable approaches to eliminate oral health disparities.
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Affiliation(s)
- Michelle M Henshaw
- Office of Global and Population Health, Boston University Henry M. Goldman School of Dental Medicine, 560 Harrison Avenue, 3rd Floor, Boston, MA 02118, USA; Department of Health Policy & Health Services Research, Boston University Henry M. Goldman School of Dental Medicine, 560 Harrison Avenue, 3rd Floor, Boston, MA 02118, USA; Center for Research to Evaluate and Eliminate Dental Disparities (CREEDD), Boston University Henry M. Goldman School of Dental Medicine, 560 Harrison Avenue, Boston, MA 02118, USA.
| | - Raul I Garcia
- Department of Health Policy & Health Services Research, Boston University Henry M. Goldman School of Dental Medicine, 560 Harrison Avenue, 3rd Floor, Boston, MA 02118, USA; Center for Research to Evaluate and Eliminate Dental Disparities (CREEDD), Boston University Henry M. Goldman School of Dental Medicine, 560 Harrison Avenue, Boston, MA 02118, USA
| | - Jane A Weintraub
- UNC School of Dentistry, The University of North Carolina at Chapel Hill, Koury Oral Health Sciences Building, Room 4508, Chapel Hill, North Carolina 27599-7450
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28
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Do L, Ha D, Roberts-Thomson K, Jamieson L, Peres M, Spencer A. Race- and Income-Related Inequalities in Oral Health in Australian Children by Fluoridation Status. JDR Clin Trans Res 2018; 3:170-179. [DOI: 10.1177/2380084417751350] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- L.G. Do
- The Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, South Australia, Australia
| | - D.H. Ha
- The Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, South Australia, Australia
| | - K.F. Roberts-Thomson
- The Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, South Australia, Australia
| | - L. Jamieson
- The Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, South Australia, Australia
| | - M.A. Peres
- The Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, South Australia, Australia
| | - A.J. Spencer
- The Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, South Australia, Australia
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29
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Slade GD, Sanders AE. Two decades of persisting income-disparities in dental caries among U.S. children and adolescents. J Public Health Dent 2017. [PMID: 29243816 DOI: 10.1111/jphd.12261.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe trends in income disparities in dental caries among U.S. children and adolescents during two decades of fluctuating economic growth. METHODS Data were from National Health and Nutrition Examination Surveys conducted in 1988-1994, 1999-2004, and 2011-2014. The number of tooth surfaces with dental caries experience per child was computed for three age groups: 2-5, 6-11, and 12-17 years. Absolute and relative measures of inequality compared caries experience in families below the poverty level with families where income was at least three times the poverty threshold. RESULTS Conspicuous, inverse income gradients in dental caries were observed at each time period and in each age group. However, there was no consistent trend or statistically significant change in the degree of inequality between survey periods. CONCLUSIONS Persisting income disparities in dental caries among U.S. children and adolescents challenge public health dentistry to redouble efforts to redress the inequity.
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Affiliation(s)
- Gary Douglas Slade
- Department of Dental Ecology, Koury Oral Health Sciences Building, University of North Carolina School of Dentistry, Chapel Hill, NC, USA
| | - Anne Elizabeth Sanders
- Department of Dental Ecology, Koury Oral Health Sciences Building, University of North Carolina School of Dentistry, Chapel Hill, NC, USA
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30
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Slade GD, Sanders AE. Two decades of persisting income-disparities in dental caries among U.S. children and adolescents. J Public Health Dent 2017; 78:187-191. [PMID: 29243816 DOI: 10.1111/jphd.12261] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 11/10/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To describe trends in income disparities in dental caries among U.S. children and adolescents during two decades of fluctuating economic growth. METHODS Data were from National Health and Nutrition Examination Surveys conducted in 1988-1994, 1999-2004, and 2011-2014. The number of tooth surfaces with dental caries experience per child was computed for three age groups: 2-5, 6-11, and 12-17 years. Absolute and relative measures of inequality compared caries experience in families below the poverty level with families where income was at least three times the poverty threshold. RESULTS Conspicuous, inverse income gradients in dental caries were observed at each time period and in each age group. However, there was no consistent trend or statistically significant change in the degree of inequality between survey periods. CONCLUSIONS Persisting income disparities in dental caries among U.S. children and adolescents challenge public health dentistry to redouble efforts to redress the inequity.
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Affiliation(s)
- Gary Douglas Slade
- Department of Dental Ecology, Koury Oral Health Sciences Building, University of North Carolina School of Dentistry, Chapel Hill, NC, USA
| | - Anne Elizabeth Sanders
- Department of Dental Ecology, Koury Oral Health Sciences Building, University of North Carolina School of Dentistry, Chapel Hill, NC, USA
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Li KY, Okunseri CE, McGrath C, Wong MC. Trends in self-reported oral health of US adults: National Health and Nutrition Examination Survey 1999-2014. Community Dent Oral Epidemiol 2017; 46:203-211. [DOI: 10.1111/cdoe.12355] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 11/07/2017] [Indexed: 01/02/2023]
Affiliation(s)
- Kar Yan Li
- Faculty of Dentistry; The University of Hong Kong; Hong Kong China
| | - Christopher E. Okunseri
- Department of Clinical Services; School of Dentistry; Marquette University Milwaukee; Milwaukee WI USA
| | - Colman McGrath
- Dental Public Health; Faculty of Dentistry; The University of Hong Kong; Hong Kong China
| | - May C.M. Wong
- Dental Public Health; Faculty of Dentistry; The University of Hong Kong; Hong Kong China
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Papageorgiou SN, Dimitraki D, Kotsanos N, Bekes K, van Waes H. Performance of pit and fissure sealants according to tooth characteristics: A systematic review and meta-analysis. J Dent 2017; 66:8-17. [DOI: 10.1016/j.jdent.2017.08.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 07/30/2017] [Accepted: 08/05/2017] [Indexed: 02/06/2023] Open
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Zhu W, Liu S, Zhuang P, Liu J, Wang Y, Lin H. Characterization of acid‑tolerance‑associated small RNAs in clinical isolates of Streptococcus mutans: Potential biomarkers for caries prevention. Mol Med Rep 2017; 16:9242-9250. [PMID: 29039505 DOI: 10.3892/mmr.2017.7751] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 08/18/2017] [Indexed: 11/05/2022] Open
Abstract
Streptococcus mutans is a cariogenic bacterium that contributes to dental caries due to its ability to produce lactic acid, which acidifies the local environment. The potential of S. mutans to respond to environmental stress and tolerate low pH is essential for its survival and predominance in caries lesions. Small noncoding RNAs (sRNAs) have been reported to be involved in bacterial stress and virulence. Few studies have investigated the sRNAs of S. mutans and the function of these sRNAs remains to be elucidated. In the present study, the association between sRNA133474 and acid tolerance, including potential underlying mechanisms, were investigated within clinical strains of S. mutans. From pediatric dental plaques, 20 strains of S. mutans were isolated. An acid killing assay was performed to analyze acid tolerance of S. mutans. Expression patterns of sRNA133474 were investigated during various growth phases under various acidic conditions via reverse transcription‑quantitative polymerase chain reaction. RNA predator and Kyoto Encyclopedia of Genes and Genomes analyses were performed to predict target mRNAs of sRNA133474 and to examine the involvement of putative pathways of target mRNAs, respectively. The results of the present study demonstrated that sRNA133474 activity was growth phase‑dependent, and two distinct expression patterns were identified in 10 clinical strains. At pH 5.5 and 7.5 the expression levels of sRNA133474 were significantly different, and high‑acid tolerant strains exhibited reduced expression levels of sRNA133474 compared with low‑acid tolerant strains. A correlation between sRNA133474 expression levels and acid tolerance was observed in 20 clinical isolates of S. mutans (r=‑0.6298, P<0.01). Finally, five target mRNAs (liaS, liaR, comE, covR and ciaR) involved in the two‑component system (TCS) were selected for further evaluation; the expression levels of three target mRNAs (liaR, ciaR and covR) were negatively correlated with sRNA133474 expression levels. In conclusion, the results of the present study suggested that S. mutans may utilize sRNA133474 to orchestrate TCSs for optimal adaption to acidic pH in clinical strains.
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Affiliation(s)
- Wenhui Zhu
- Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat‑Sen University, Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, Guangdong 510055, P.R. China
| | - Shanshan Liu
- Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat‑Sen University, Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, Guangdong 510055, P.R. China
| | - Peilin Zhuang
- Department of Stomatology, Sun Yat‑Sen Memorial Hospital, Sun Yat‑Sen University, Guangzhou, Guangdong 510120, P.R. China
| | - Jia Liu
- Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat‑Sen University, Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, Guangdong 510055, P.R. China
| | - Yan Wang
- Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat‑Sen University, Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, Guangdong 510055, P.R. China
| | - Huancai Lin
- Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat‑Sen University, Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, Guangdong 510055, P.R. China
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Wang L, Cheng L, Yuan B, Hong X, Hu T. Association between socio-economic status and dental caries in elderly people in Sichuan Province, China: a cross-sectional study. BMJ Open 2017; 7:e016557. [PMID: 28947446 PMCID: PMC5623543 DOI: 10.1136/bmjopen-2017-016557] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 06/14/2017] [Accepted: 08/22/2017] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES As a vulnerable group, the elders' oral health gained less attention, particularly the relationship between socioeconomic status (SES) and dental caries. This study aimed to assess the associations and to explore the effects of confounders on the associations in elderly people. DESIGN Cross-sectional study. SETTINGS 3 neighbourhood committees and 3 village committees in Sichuan Province, China. PARTICIPANTS 744 people (362 men and 382 women) aged 65-74 years were included. OUTCOME MEASURES Oral health outcomes included the decayed, missing and filled teeth (DMFT) index and its components. SES was assigned by educational level, household income and type of household. The bivariate association between the participants' characteristics and DMFT was analysed using non-parametric tests. Four logistic regression models were used to analyse the associations between SES and dental caries by regulating confounders. RESULTS Poor oral health was observed in these participants. Bivariate analysis showed a significant association between SES and DMFT (p﹤0.05). Only adjusting gender, high educational level (adjusted (AOR)=0.34, 95% CI 0.17 to 0.66), high household income (AOR=0.47, 95% CI 0.41 to 0.77) were protective factors against dental caries, and living in agricultural families (AOR=1.86, 95% CI 1.32 to 2.63) was risk factor (p﹤0.05). After adjusting other confounders, SES was partly related to the dental caries. Moreover, an interaction existed among SES indicators. CONCLUSIONS SES is associated with dental caries, and older people with low SES have poor oral health. The associations were explained partly by diet, behaviour and awareness. Our results provide effective evidence in targeted policy-making and intervention measures and implicate that pertinence measures, economic assistance and medical insurance funds should be provided to older people of low SES. Furthermore, a follow-up design should attempt to confirm the causal relationship between SES and dental caries and evaluate the effect of intervention.
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Affiliation(s)
- Linyan Wang
- Department of Preventive Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Li Cheng
- Department of Preventive Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Bo Yuan
- Department of Preventive Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Xiao Hong
- Department of General Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Tao Hu
- Department of Preventive Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
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Rozier RG, White BA, Slade GD. Trends in Oral Diseases in the U.S. Population. J Dent Educ 2017; 81:eS97-eS109. [PMID: 28765461 DOI: 10.21815/jde.017.016] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 02/21/2017] [Indexed: 01/01/2023]
Abstract
This article reviews trends in dental caries, periodontal disease, and tooth loss for the United States along with population dynamics and risk factors that might influence these trends going forward. Dental caries experience remains high in the primary dentition. Caries severity in permanent teeth of children has declined to historically low levels, and long-standing inequalities in untreated caries appear to be narrowing. Declines in caries severity of children's permanent teeth have stabilized at a low level, but likely will contribute to future reductions in dental caries severity in adults. The prevalence of periodontal disease is high in adults, and only a small percentage have severe forms of the disease. Countervailing trends in determinants would suggest little change in the prevalence of periodontal disease in the future, but the lack of an obvious trend over the last two decades makes projections uncertain. Tooth loss as a consequence of dental disease has declined markedly over the last half century and has been all but eliminated in high-income groups. However, notable exceptions to these favorable trends are evident. Progress in prevention policies and programs that affect disease experience appears slower than progress in meeting population-level caries treatment needs. Clearly, long-standing inequities related to political and social determinants remain for all dental diseases, and income disparities in dental disease are widening for some indicators. Growing inequalities raise ethical and public health concerns that should be prominent in discussions of dental workforce needs and strategies for the next 25 years. This article was written as part of the project "Advancing Dental Education in the 21st Century."
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Affiliation(s)
- R Gary Rozier
- Dr. Rozier is with the Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Dr. White is with the Department of Health Policy and Management, Gillings School of Global Public Health, and Department of Dental Ecology, School of Dentistry, University of North Carolina at Chapel Hill; and Dr. Slade is with the Department of Dental Ecology, School of Dentistry, University of North Carolina at Chapel Hill.
| | - B Alexander White
- Dr. Rozier is with the Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Dr. White is with the Department of Health Policy and Management, Gillings School of Global Public Health, and Department of Dental Ecology, School of Dentistry, University of North Carolina at Chapel Hill; and Dr. Slade is with the Department of Dental Ecology, School of Dentistry, University of North Carolina at Chapel Hill
| | - Gary D Slade
- Dr. Rozier is with the Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Dr. White is with the Department of Health Policy and Management, Gillings School of Global Public Health, and Department of Dental Ecology, School of Dentistry, University of North Carolina at Chapel Hill; and Dr. Slade is with the Department of Dental Ecology, School of Dentistry, University of North Carolina at Chapel Hill
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Fontana M, González-Cabezas C, de Peralta T, Johnsen DC. Dental Education Required for the Changing Health Care Environment. J Dent Educ 2017; 81:eS153-eS161. [PMID: 28765467 DOI: 10.21815/jde.017.022] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 02/28/2017] [Indexed: 11/20/2022]
Abstract
To be able to meet the demands for care in 2040, dental graduates will need to address challenges resulting from the rapidly changing health care environment with knowledge and sets of skills to build on current standards and adapt to the future. The purposes of this article are to 1) analyze key challenges likely to evolve considerably between now and 2040 that will impact dental education and practice and 2) propose several sets of skills and educational outcomes necessary to address these challenges. The challenges discussed include changes in prevalence of oral diseases, dental practice patterns, materials and technologies, integrated medical-dental care, role of electronic health records, cultural competence, integrated curricula, interprofessional education, specialty-general balance, and web/cloud-based collaborations. To meet these challenges, the dental graduate will need skills such as core knowledge in basic and clinical dentistry, technical proficiency, critical thinking skills for lifelong learning, ethical and professional values, ability to manage a practice, social responsibility, and ability to function in a collegial intra- and interprofessional setting. Beyond the skills of the individual dentist will be the need for leadership in academia and the practice community. Academic and professional leaders will need to engage key constituencies to develop strategic directions and agendas with all parties pointed toward high standards for individual patients and the public at large. This article was written as part of the project "Advancing Dental Education in the 21st Century."
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Affiliation(s)
- Margherita Fontana
- Dr. Fontana is Professor, University of Michigan School of Dentistry; Dr. González-Cabezas is Richard Christiansen Collegiate Professor of Oral and Craniofacial Global Initiatives and Associate Professor, University of Michigan School of Dentistry; Dr. de Peralta is Clinical Associate Professor, University of Michigan School of Dentistry; and Dr. Johnsen is Dean and Professor, University of Iowa College of Dentistry & Dental Clinics.
| | - Carlos González-Cabezas
- Dr. Fontana is Professor, University of Michigan School of Dentistry; Dr. González-Cabezas is Richard Christiansen Collegiate Professor of Oral and Craniofacial Global Initiatives and Associate Professor, University of Michigan School of Dentistry; Dr. de Peralta is Clinical Associate Professor, University of Michigan School of Dentistry; and Dr. Johnsen is Dean and Professor, University of Iowa College of Dentistry & Dental Clinics
| | - Tracy de Peralta
- Dr. Fontana is Professor, University of Michigan School of Dentistry; Dr. González-Cabezas is Richard Christiansen Collegiate Professor of Oral and Craniofacial Global Initiatives and Associate Professor, University of Michigan School of Dentistry; Dr. de Peralta is Clinical Associate Professor, University of Michigan School of Dentistry; and Dr. Johnsen is Dean and Professor, University of Iowa College of Dentistry & Dental Clinics
| | - David C Johnsen
- Dr. Fontana is Professor, University of Michigan School of Dentistry; Dr. González-Cabezas is Richard Christiansen Collegiate Professor of Oral and Craniofacial Global Initiatives and Associate Professor, University of Michigan School of Dentistry; Dr. de Peralta is Clinical Associate Professor, University of Michigan School of Dentistry; and Dr. Johnsen is Dean and Professor, University of Iowa College of Dentistry & Dental Clinics
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Abstract
Social determinants of health are defined as conditions in which people are born and live and the role these conditions play on health outcomes. Research indicates that risk factors and their interactions are far more complex than originally thought. This article outlines social determinant constructs and their role in understanding oral health promotion. Due to the complex interactions, oral health must be promoted using a multilevel chronic disease model or common risk factor approach. An understanding of social determinants is particularly important for the pediatric population because optimum oral health and general health in adulthood are heavily influenced by childhood.
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Affiliation(s)
- Marcio A da Fonseca
- Department of Pediatric Dentistry, College of Dentistry, University of Illinois at Chicago, 801 South Paulina Street, 254 DENT, Chicago, IL 60612-7211, USA.
| | - David Avenetti
- Department of Pediatric Dentistry, College of Dentistry, University of Illinois at Chicago, 801 South Paulina Street, 254 DENT, Chicago, IL 60612-7211, USA
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Sengupta K, Christensen LB, Mortensen LH, Skovgaard LT, Andersen I. Trends in socioeconomic inequalities in oral health among 15-year-old Danish adolescents during 1995-2013: A nationwide, register-based, repeated cross-sectional study. Community Dent Oral Epidemiol 2017; 45:458-468. [PMID: 28653759 DOI: 10.1111/cdoe.12310] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 04/29/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Scandinavian welfare states, despite having better population oral health than less egalitarian societies, are characterized by ubiquitous social gradients and large relative socioeconomic inequalities in oral health. However, trends in these inequalities among Scandinavian children and adolescents have not been studied in detail. OBJECTIVES To describe the associations between socioeconomic position (SEP) and oral health in adolescents and to investigate the trends in these associations between 1995 and 2013. METHODS Nationwide repeated cross-sectional studies (using individual-level data) were conducted on 15-year-olds in Denmark from 1995, 2003, and 2013 (N=154,750). Dental data were obtained from the national dental register of the Danish Health Authority (Sundhedsstyrelsens Centrale Odontologiske Register [SCOR]) and data on social variables from administrative registers at Statistics Denmark. SEP measures included previous year's parental education (highest attained educational level by either of the parents), income (equivalized household disposable income), and occupational social class (highest recorded occupational class between the parents). Covariates were immigration status, country of origin, number of children and persons in the family, and household type. The outcome was dental caries experience, represented by the decayed, missing, and filled surfaces (DMFS) index. Negative binomial regression models were used to examine the association between DMFS count and each of the explanatory variables separately while accounting for cluster-correlated family data. Furthermore, hierarchical multiple regressions of DMFS on SEP indicators-using the zero-inflated negative binomial (ZINB) distribution as the outcome distribution-were estimated while successively adjusting for the potential effects of the included covariates. RESULTS Caries prevalence declined from 71% in 1995 to 63% in 2003 and 45% in 2013. Separate assessment of each covariate showed statistically significant graded associations between each covariate and DMFS count at all time points. Similarly, in the ZINB models, in all 3 years, clear gradients were observed in terms of caries differentials in all three SEP categories, with statistically significant associations (Type 3 P values, <.0001) even after adjustment for all other covariates. For instance, in 2013, even among adolescents with positive caries experience, being of lower occupational social class was associated with up to 2.4-fold (95% confidence interval [CI]: 2.2-2.6) higher caries experience. Between 1995 and 2013, relative inequalities increased in all SEP categories, while absolute inequalities decreased in the education and occupation categories. CONCLUSION Considerable progress has been made in reducing dental caries rates among Danish adolescents; however, this progress has benefited the disadvantaged social groups less than the better-off groups.
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Affiliation(s)
- Kaushik Sengupta
- Section of Social Medicine, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lisa Bøge Christensen
- Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Laust Hvas Mortensen
- Section of Social Medicine, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Methods and Analysis, Statistics Denmark, Copenhagen, Denmark
| | - Lene Theil Skovgaard
- Section of Biostatistics, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ingelise Andersen
- Section of Social Medicine, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Sistani MMN, Hataminia Z, Hajiahmadi M, Khodadadi E. Nine years' trend of dental caries and severe early childhood caries among 3-6-year-old children in Babol, Northern Iran. Electron Physician 2017; 9:4683-4688. [PMID: 28848648 PMCID: PMC5557153 DOI: 10.19082/4683] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Accepted: 03/18/2017] [Indexed: 11/29/2022] Open
Abstract
Background and objective Malnutrition, pain, and insomnia are common adverse effects of early dental caries among 3–6-year-old children. To increase our understanding of the dental caries status which will help in the control and prevention of it, this study aimed to assess the trend of dental caries, Severe Early Childhood Caries (S-ECC) and its related factors among 3–6-year-old children during a 9-year period in Babol, Northern Iran. Methods This was a cross-sectional study among 2,080 children aged 3–6 years old in Babol, Northern Iran. The studied samples were examined from May 2007 to June 2015. Oral examinations were performed with visual-touch technique. S-ECC was measured as number of decayed, missing, and filled teeth surface (dmfs). Data were evaluated by SPSS software for Windows version 23 and were analyzed using the one-way ANOVA, chi-square test and independent-samples t-test. Level of significance was set at ≤ 0.05. Results The trend of dental caries and S-ECC rose among 3–6-year-old children over a 9-year period. Of the children, 26.3% were caries free. The mean dmft was increased significantly among boys (p<0.001), among 3–4-year-old children (p=0.01), and those children with both employed parents (p=0.01) and low educated parents (p<0.001) from 2007 to 2015. Conclusion Dental caries status showed an increasing trend over the study period in Babol preschool children, therefore effective preventive strategies are required to decrease the prevalence of dental caries in children.
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Affiliation(s)
- Mohammad Mehdi Naghibi Sistani
- Ph.D. of Community Health, Assistant Professor, Department of Community Oral Health, Faculty of Dentistry, Babol University of Medical Science, Babol, Iran
| | - Zohreh Hataminia
- Student Research Committee, Babol University of Medical Science, Babol, Iran
| | - Mahmoud Hajiahmadi
- M.Sc. of Statistics, Health Research Institute, Babol University of Medical Science, Babol, Iran
| | - Effat Khodadadi
- Ph.D. of Pediatric, Assistant Professor, Department of Pediatrics, Faculty of Dentistry Babol University of Medical Science, Babol, Iran
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Aida J, Matsuyama Y, Tabuchi T, Komazaki Y, Tsuboya T, Kato T, Osaka K, Fujiwara T. Trajectory of social inequalities in the treatment of dental caries among preschool children in Japan. Community Dent Oral Epidemiol 2017; 45:407-412. [PMID: 28444902 DOI: 10.1111/cdoe.12304] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 04/02/2017] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The longitudinal trend of dental health inequalities among preschool children has not been described. In this study, we aimed to measure the trajectory of both relative and absolute inequalities in caries treatment among preschool children in Japan. METHODS We used data from the Longitudinal Survey of Babies in the 21st Century (LSB21), which is an ongoing national representative longitudinal study. The target population was families residing in Japan with newborn baby/babies born between 10 January and 17 January or 10 July and 17 July 2001. Data regarding caries treatment history and socioeconomic status (SES) were collected using a self-reported questionnaire. SES was assessed on the basis of the parents' educational attainment. In total, 35 260 children were followed from 2.5 to 5.5 years through annual surveys. To evaluate absolute and relative inequalities, we calculated the slope index of inequality (SII) and relative index of inequality (RII), respectively. RESULTS The rate of caries treatment at the age of 2.5 years was <10% for all SES groups; this increased to more than 30% at 5.5 years of age. Children with lower SES received more frequent caries treatment, and both absolute and relative social inequalities were statistically significant. SII showed a significant increase throughout the follow-up period, with values of 4.13% (95% confidence interval [CI], 3.16; 5.09) and 15.50% (95% CI, 13.68; 17.32) at 2.5 and 5.5 years of age, respectively. In contrast, RII decreased with an increase in the treatment rate for all groups, with values of 1.83 (95% CI, 1.59; 2.11) and 1.53 (95% CI, 1.46; 1.61) at 2.5 and 5.5 years of age, respectively. CONCLUSION Our results suggest that the rate of caries treatment is higher for preschool children with lower SES in Japan, with significant widening of absolute inequalities along with the growth of the children.
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Affiliation(s)
- Jun Aida
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Yusuke Matsuyama
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Takahiro Tabuchi
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | - Yuko Komazaki
- Section of Maxillofacial Orthognathics, Department of Maxillofacial Reconstruction and Function, Division of Maxillofacial/Neck Reconstruction, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Toru Tsuboya
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Tsuguhiko Kato
- Department of Social Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Ken Osaka
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Takeo Fujiwara
- Department of Global Health Promotion, Tokyo Medical and Dental University, Tokyo, Japan
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Weintraub JA, Rozier RG. Updated competencies for the dental public health specialist: using the past and present to frame the future. J Public Health Dent 2016; 76 Suppl 1:S4-S10. [DOI: 10.1111/jphd.12185] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 09/28/2016] [Indexed: 12/17/2022]
Affiliation(s)
- Jane A. Weintraub
- Department of Dental Ecology, School of Dentistry; University of North Carolina; Koury Oral Health Sciences Building Room 4508 Chapel Hill NC USA
| | - R. Gary Rozier
- Department of Health Policy and Management; Gillings School of Global Public Health, University of North Carolina; Chapel Hill NC USA
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The impact of a tax on sugar-sweetened beverages according to socio-economic position: a systematic review of the evidence. Public Health Nutr 2016; 19:3070-3084. [DOI: 10.1017/s136898001600104x] [Citation(s) in RCA: 121] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjectiveA tax on sugar-sweetened beverages (SSB) has been proposed to address population weight gain but the effect across socio-economic position (SEP) is unclear. The current study aimed to clarify the differential impact(s) of SSB taxes on beverage purchases and consumption, weight outcomes and the amount paid in SSB taxes according to SEP.DesignDatabases (OVID and EMBASE) and grey literature were systematically searched in June 2015 to identify studies that examined effects of an SSB price increase on beverage purchases or consumption, weight outcomes or the amount paid in tax across SEP, within high-income countries.ResultsOf the eleven included articles, three study types were identified: (i) those that examined the association between variation in SSB taxes and SSB consumption and/or body weight (n 3); (ii) price elasticity estimation of SSB demand (n 1); and (iii) modelling of hypothetical SSB taxes by combining price elasticity estimates with population SEP-specific beverage consumption, energy intake or body weight (n 7). Few studies statistically tested differences in outcomes between SEP groups. Nevertheless, of the seven studies that reported on changes in weight outcomes for the total population following an increase in SSB price, all reported either similar reductions in weight across SEP groups or greater reductions for lower compared with higher SEP groups. All studies that examined the average household amount paid in tax (n 5) reported that an SSB tax would be regressive, but with small differences between higher- and lower-income households (0·10–1·0 % and 0·03 %–0·60 % of annual household income paid in SSB tax for low- and high-income households, respectively).ConclusionsBased on the available evidence, a tax on SSB will deliver similar population weight benefits across socio-economic strata or greater benefits for lower SEP groups. An SSB tax is shown to be consistently financially regressive, but to a small degree.
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