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Dasson Bajaj P, Shenoy R, Davda LS, Mala K, Bajaj G, Rao A, K S A, Pai M, Jodalli P, B R A. A scoping review exploring oral health inequalities in India: a call for action to reform policy, practice and research. Int J Equity Health 2023; 22:242. [PMID: 37990194 PMCID: PMC10664303 DOI: 10.1186/s12939-023-02056-5] [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: 09/11/2023] [Accepted: 11/12/2023] [Indexed: 11/23/2023] Open
Abstract
INTRODUCTION Reduction in health inequalities and providing universal access to health care have been identified as two important global milestones by the World Health Organization for countries to achieve by 2030. Therefore, recognizing the magnitude of oral health inequalities in India has become a pressing priority to improve access to dental care within the country. This scoping review was conducted with the aim of reviewing, collating and analysing the current knowledge base on oral health inequalities in India. METHODOLOGY The scoping review followed Arksey and O'Malley's approach, and reporting was performed in accordance with the PRISMA-ScR guidelines. A systematic search was conducted on Scopus, PubMed, Web of Science, and EMBASE to identify literature addressing one or more dimensions of oral health inequalities in India, published in English between January 2002 and April 2022. The data were charted, and qualitative analysis was performed to derive themes, highlighting the key concepts emerging from this review. RESULTS In accordance with the eligibility criteria, a total of 71 articles retrieved through database search and backward citation search were included in this scoping review. The major themes ranged from individual to diverse sociodemographic factors acting as barriers to and facilitators of access to dental care. Deficiencies in human resources for oral health, along with a wide diversity in dental service provision and dental education were other major themes contributing to inequality. Subsequently, this has resulted in recommendations on restructuring the dental workforce and their development and modifications in oral health care policies and practices. The qualitative synthesis demonstrates the intertwined nature of the multiple factors that influence the goal of achieving an affordable, accessible, extensive and inclusive oral healthcare system in India. CONCLUSIONS This comprehensive review provides a broad perspective on oral health inequalities in India, providing valuable insights for both researchers and policymakers in this area and guiding their efforts towards achieving universal oral health coverage in the Indian context.
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Affiliation(s)
- Parul Dasson Bajaj
- Department of Public Health Dentistry, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Ramya Shenoy
- Department of Public Health Dentistry, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India.
| | - Latha Sanjay Davda
- Civilian Dental Surgeon, UK and Adjunct Faculty, Manipal College of Dental Sciences Mangalore, Ministry of Defense, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Kundabala Mala
- Department of Conservative Dentistry and Endodontics, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Gagan Bajaj
- Department of Audiology and Speech Language Pathology, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Ashwini Rao
- Department of Public Health Dentistry, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Aparna K S
- Department of Public Health Dentistry, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Mithun Pai
- Department of Public Health Dentistry, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Praveen Jodalli
- Department of Public Health Dentistry, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Avinash B R
- Department of Public Health Dentistry, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
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Korolenkova MV, Khachatryan AG, Poberezhnaya AA, Krechetova MS. [Dental caries prevention program in children and adolescents living in residential institutions]. STOMATOLOGIIA 2022; 101:61-67. [PMID: 35943502 DOI: 10.17116/stomat202210104161] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
THE AIM OF THE STUDY Was to assess the effectiveness of a new dental caries prevention program in children of various ages living in residential institutions. MATERIALS AND METHODS The program of oral health promotion and caries prevention was introduced in the autonomous non-profit organization «Social rehabilitation center Solba». The study comprised 98 children aged 12-17 years divided into two groups: the main group of 52 children aged 12-16 years enrolled in the program in 2013 in pre-school (32 children) and primary school age (20 children) and the control group of 46 adolescents aged 12-17 years not included in the program. DMFT and OHI-S index were compared in both groups as well as in children enrolled in the program at various ages. RESULTS The overall caries prevalence was 84.7%. Statistically significant differences were documented between children enrolled in the program in pre-school and primary school ages regarding both caries prevalence (78% and 89%, respectively) and intensity (3.5 and 5.4 tooth, respectively (p=0.01)). Non-satisfactory, poor and very poor OHI-S was observed in 15.4% of children in the main group and 54.3% of controls. Good oral hygiene was seen in 67.3 and 37%, satisfactory - in 17.3 and 8.7% of children, respectively (p<0.05). CONCLUSION Programs of dental caries prevention with oral health promotion component are effective for oral hygiene improvement in children living in residential institutions. The key for long-term effectiveness and dental caries prevalence and intensity reduction is the start of the program in pre-school age and education of caregivers and teachers to provide control of dental care in pre-school and primary school children.
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Affiliation(s)
- M V Korolenkova
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
- Moscow Regional Research Institute named after M.F. Vladimirskiy, Moscow, Russia
| | - A G Khachatryan
- Moscow Regional Research Institute named after M.F. Vladimirskiy, Moscow, Russia
| | - A A Poberezhnaya
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | - M S Krechetova
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
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Caries prevalence, clinical consequences and self-reported pain experienced by children living in the West Bank. Eur Arch Paediatr Dent 2019; 20:333-338. [DOI: 10.1007/s40368-018-00412-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 12/13/2018] [Indexed: 10/27/2022]
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Nagrath D, Mathur MR, Gupta R, Zodpey SP. Socio-demographic and socioeconomic differences in tobacco use prevalence among Indian youth. Prev Med Rep 2019; 14:100832. [PMID: 31011516 PMCID: PMC6460423 DOI: 10.1016/j.pmedr.2019.100832] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 02/10/2019] [Accepted: 02/16/2019] [Indexed: 10/27/2022] Open
Abstract
The study aims to assess the association between socio-demographic factors such as age, gender, area of residence, father's education, and standard of living and the likelihood of tobacco use in adolescence. We conducted secondary data analysis on a large scale cross-sectional study comprising of 1386 adolescents, living in regions representative of three different socioeconomic positions in New Delhi. Data was collected through clinical oral examination and interviewer-administered questionnaire. Multiple logistic regression analysis with an unadjusted model for assessing the association between the respective explanatory variable and ever tobacco use. Sequential models were adjusted for confounders as well as the other explanatory variables. The number of tobacco users was 185 (13%). Gender wise tobacco use shows significant (P = 0.001) difference between girls vs. boys; the girls are about 40% less likely to use tobacco than boys (OR = 0.58, 95% CI = 0.42-0.80). Among socio-economic classes, residents of resettlement colonies were twice as likely to use tobacco as middle/upper middle class residents (OR = 2.26, 95% CI = 1.45-3.53). Adolescents with fathers educated up to the primary or secondary levels were almost twice likely to have used tobacco than those with fathers educated till graduation or above (OR = 2.08 95% CI = 1.30-3.34 vs. OR = 2.24, 95% CI = 1.43-3.51, respectively). Significant (P = 0.001) difference in tobacco use among adolescents was also observed based on their standard of living. A significant association exists in terms of area of residence, father's education, and standard of living.
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Affiliation(s)
- Deepti Nagrath
- Public Health Foundation of India, Plot No. 47 Sector 44, Institutional Area, Gurgaon 122002, Haryana, India
| | - Manu R Mathur
- Public Health Foundation of India, Plot No. 47 Sector 44, Institutional Area, Gurgaon 122002, Haryana, India
| | - Rakesh Gupta
- Santokba Durlabhji Memorial Hospital & President, Rajasthan Cancer Foundation, B-113, 10 B Scheme, Gopalpura Bypass, Jaipur, 302018, Rajasthan, India
| | - Sanjay P Zodpey
- Public Health Foundation of India, New Delhi, Director - Indian Institute of Public Health Delhi, Public Health Foundation of India, Plot No. 47 Sector 44, Institutional Area, Gurgaon 122002, Haryana, India
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Tebb KP, Pica G, Twietmeyer L, Diaz A, Brindis CD. Innovative Approaches to Address Social Determinants of Health Among Adolescents and Young Adults. Health Equity 2018; 2:321-328. [PMID: 30450488 PMCID: PMC6238651 DOI: 10.1089/heq.2018.0011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background: Social determinants are the leading causes of health disparities. Yet health care systems have not systemically addressed social determinants of health as it pertains to adolescents and young adults (AYAs), among other populations in need. This study identified promising innovative programs across the United States. Methods: Thirteen representatives from 10 programs completed a 45-min telephone interview. Transcripts were reviewed and analyzed to identify cross-cutting themes. Results: Strategies included increasing access to quality, comprehensive and confidential health services, addressing the holistic needs of AYAs, collaborations across the health care delivery systems and other community services, and leveraging technology. Conclusion: This study showcased innovative approaches to inform future efforts.
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Affiliation(s)
- Kathleen P Tebb
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Benioff Children's Hospital and the Adolescent and Young Adult Health National Resource Center, University of California, San Francisco, California
| | | | - Lauren Twietmeyer
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Benioff Children's Hospital and the Adolescent and Young Adult Health National Resource Center, University of California, San Francisco, California
| | - Angela Diaz
- Icahn School of Medicine at Mount Sinai and Mount Sinai Adolescent Health Center, New York, New York
| | - Claire D Brindis
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Benioff Children's Hospital and the Adolescent and Young Adult Health National Resource Center, University of California, San Francisco, California.,Philip R. Lee Institute for Health Policy Studies and the Adolescent and Young Adult Health National Resource Center, University of California, San Francisco, California
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Jung SH, Kim MH, Ryu JI. Inequalities in oral health among adolescents in Gangneung, South Korea. BMC Oral Health 2018; 18:68. [PMID: 29699545 PMCID: PMC5921975 DOI: 10.1186/s12903-018-0533-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 04/17/2018] [Indexed: 11/30/2022] Open
Abstract
Background This study aims to evaluate inequality in oral health among adolescents and to explain the mechanisms of such inequalities in Gangneung, South Korea. Methods One thousand two hundred sixty-seven students in their first year from four vocational and three general schools participated in the baseline survey of 2011, and 84.7% of them were surveyed again in 2013. Oral examinations by the same dentist and a self-administered questionnaire were repeated during both waves. Outcome measure for oral health was the existence of untreated dental caries (DT). As socioeconomic position (SEP) indicators, school type (general vs. vocational), father’s and mother’s education, perceived economic status, and Family Affluence Scale (FAS) were measured. Variables measuring oral health related behaviours included tooth brushing frequency, frequency of eating snacks and drinking sodas, smoking, and annual visits to dental clinics. Chi-square tests and panel logistic regression were adopted to examine the associations between dental caries and SEP indicators by STATA version 15.1. Results Having a less educated father and attending a vocational school were significant predictors for untreated caries after controlling for SEP indicators. However, students from general schools, higher SEP by father’s education, perceived economic status, or FAS, or having non-smoking experience or annual visits to dental clinics were more likely to stay caries-free. Conclusions There were socioeconomic inequalities in oral health on an adolescent panel. Given that oral health status during adolescents can persist throughout the course of a person’s life, intervention to tackle such inequalities and school environments are required. Electronic supplementary material The online version of this article (10.1186/s12903-018-0533-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Se-Hwan Jung
- Department of Preventive Dentistry, College of Dentistry, Gangneung-Wonju 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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Asawa K, Sen N, Bhat N, Tak M, Sultane P, Mandal A. Influence of sleep disturbance, fatigue, vitality on oral health and academic performance in indian dental students. Med Pharm Rep 2017; 90:333-343. [PMID: 28781530 PMCID: PMC5536213 DOI: 10.15386/cjmed-749] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 01/07/2017] [Accepted: 01/25/2017] [Indexed: 11/23/2022] Open
Abstract
Background Oral health and academic performance are important contributing factors for a student’s professional life. Countless factors affect both, among which sleep, vitality and fatigue are less explored areas that also have a strong impact. Objective The objective of the study was to assess the association of sleep disturbances, fatigue and vitality with self reported oral health status, oral hygiene habits and academic performance of dental students of Udaipur. Methods A descriptive cross-sectional study was conducted among undergraduate and postgraduate dental students of Udaipur. Self-administered structured questionnaire was used to assess the psychological factors, vitality, sleep quality, fatigue, self reported oral health status, habits and academic performance. Analysis of variance and stepwise multiple linear regression were utilized for statistical analysis with 95% confidence level and 5% level of significance. Results Of the 230 participants, 180 (78.3%) were undergraduates and 50 (21.7%) were postgraduates. Among them, females showed higher scores in disturbed sleep index (2.69±2.14) as compared to males (2.45±1.91). Respondents who had “Poor” dental health, scored more in disturbed sleep index (3.15±1.64) and fatigue scale (20.00±4.88). Subjects who flossed “everyday”, were found to have good sleep and more energy (p=0.01) and those who assessed themselves as excellent students scored more in the Vitality Scale (p=0.01) and less in the Sleep index (p=0.01). Conclusion The present study confirms that disturbed sleep, aliveness and fatigue, all are interlinked with each other and are imperative factors having the potential to alter the oral health status, habits and academics of dental students.
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Affiliation(s)
- Kailash Asawa
- Public Health Dentistry, Pacific Dental College & Hospital, Udaipur, India
| | - Nandini Sen
- Public Health Dentistry, Pacific Dental College & Hospital, Udaipur, India
| | - Nagesh Bhat
- Public Health Dentistry, Pacific Dental College & Hospital, Udaipur, India
| | - Mridula Tak
- Public Health Dentistry, Pacific Dental College & Hospital, Udaipur, India
| | - Pratibha Sultane
- Public Health Dentistry, Pacific Dental College & Hospital, Udaipur, India
| | - Aritra Mandal
- Public Health Dentistry, Pacific Dental College & Hospital, Udaipur, India
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Karnam RR, Kumar NS, Eshwar S, Deolia S. Cognitive Ability as a Determinant of Socioeconomic and Oral Health Status among Adolescent College Students of Bengaluru, India. J Clin Diagn Res 2017; 10:ZC62-ZC66. [PMID: 28209007 DOI: 10.7860/jcdr/2016/21132.9102] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 08/16/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Levels of oral health and economic status are unequally distributed throughout the population. Inequality has multiple causes and that the effect of Socio Economic Status (SES) and demographic factors, on oral health is mediated through several factors. Association between cognitive ability and oral health had been demonstrated in older age groups but adolescents and younger adults have received relatively little attention in this field. AIM To establish the role of cognitive ability as a determinant of SES and oral health status among adolescent college students of Benagluru, Karnataka, India. MATERIALS AND METHODS A cross-sectional study was conducted among 1000 adolescents aged 17-19 years. Six government and six private first grade colleges were selected by multi-stage random sampling. Cognitive ability was assessed using digit symbol substitution test and digit span test. Dental caries and periodontal status were recorded by extent of bleeding, presence of calculus, periodontal pockets, loss of attachments using Community Periodontal Index, decayed, missing and filled teeth surfaces using Decayed, Missing, Filled Teeth and Surfaces Index. SES status was assessed using Kuppuswamy scale. Chi-square test was used to check the association of cognitive ability with oral health indicators and SES status. Regression analysis was performed to assess the effect of cognitive ability on oral health indicators after adjusting for SES and effect of SES status on oral health indicators after adjusting for indicators of cognitive ability. RESULTS Significant association and negative correlation between cognitive ability and indicators for oral health was seen in the regression models. Cognitive ability attributed for nearly 30% changes in the indicators for oral health after adjusting for SES and SES attributed for nearly 25% variance in indicators for oral health after adjusting for cognitive ability. CONCLUSION There is a potential role of cognitive ability in SES and oral health.
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Affiliation(s)
- Rekha Rao Karnam
- Senior Lecturer, Department of Public Health Dentistry, KLE Dental College and Hosiptal , Bengaluru, Karnataka, India
| | | | - Shruthi Eshwar
- Reader, Department of Public Health Dentistry, KLE Dental College and Hospital , Bengaluru, Karnataka, India
| | - Shravani Deolia
- Senior Lecturer, Department of Public Health Dentistry, Sharad Pawar Dental College , Wardha, Maharasthra, India
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Das UM, Vadakkekuttical RJ, Kanakkath H, Shankunni SP. Dental health awareness, attitude, and dental health-care seeking practices as risk indicators for the prevalence of periodontal disease among 15-17-year-old school children in Kozhikode district, Kerala, India. J Indian Soc Periodontol 2017; 21:144-151. [PMID: 29398860 PMCID: PMC5771112 DOI: 10.4103/jisp.jisp_160_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Periodontal disease prevalence in children is an indicator of future disease burden in the adult population. Knowledge about the prevalence and risk status of periodontal disease in children can prove instrumental in the initiation of appropriate preventive and therapeutic measures. Aim This school-based cross-sectional survey estimated the prevalence and severity of periodontal disease among 15-17-year-old children in Kozhikode district and assessed the risk factors. Materials and Methods Multistage stratified random sampling and randomized cluster sampling were used in the selection of schools and study participants, respectively, in three educational districts of Kozhikode. Periodontal disease was assessed among 2000 school children aged 15-17 years, by community periodontal index. A content validated questionnaire was used to evaluate the sociodemographic characteristics and other risk factors. Results The prevalence of periodontal disease was estimated as 75% (72% gingivitis and 3% mild periodontitis). The prevalence was higher in urban population (P = 0.049) and males had significantly (P = 0.001) higher prevalence. Lower socioeconomic strata experienced slightly more periodontal disease burden. Satisfactory oral hygiene practices (material and frequency) were observed, but oral hygiene techniques were erroneous. Unhealthy dental treatment-seeking practices and unfavorable attitude toward dental treatment (ATDT) significantly influenced periodontal health status. Overall awareness about dental treatment was poor in this study population. Conclusion The prevalence of periodontal disease among 15-17-year-old school children in Kozhikode district is 75% and is influenced by sociodemographic characteristics. Other risk factors identified were unhealthy dental treatment-seeking practices and unfavorable ATDT. Implementation of well-formulated oral health education programs is thus mandatory.
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Affiliation(s)
- Uma Mohan Das
- Department of Periodontics, Government Dental College, Kozhikode, Kerala, India
| | | | - Harikumar Kanakkath
- Department of Periodontics, Government Dental College, Kozhikode, Kerala, India
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Rodríguez N, Moral J. Validation of the Oral Hygiene Habits Scale: Relationships with sociodemographic variables in the general and clinical population of Monterrey, Mexico. JOURNAL OF ORAL RESEARCH 2016. [DOI: 10.17126/joralres.2016.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Golkari A, Sabokseir A, Sheiham A, Watt RG. Socioeconomic gradients in general and oral health of primary school children in Shiraz, Iran. F1000Res 2016; 5:767. [PMID: 27239279 PMCID: PMC4879935 DOI: 10.12688/f1000research.8641.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/26/2016] [Indexed: 01/10/2023] Open
Abstract
Background: Health status is largely determined by socio-economic status. The general health of individuals at higher social hierarchy is better than people in lower levels. Likewise, people with higher socio-economic status have better oral health than lower socio-economic groups. There has not been much work regarding the influence of socio-economic status on the health conditions of children in developing countries, particularly in Iran. The aim of this study was to compare the oral and general health conditions of primary school children of three different socio-economic areas in the city of Shiraz, Iran. Methods: This cross-sectional study was conducted on 335, 8- to 11-year-old primary schoolchildren in Shiraz. The children were selected by a three-stage cluster sampling method from three socio-economically different areas. Tools and methods used by the United Kingdom’s Medical Research Council were used to obtain anthropometric variables as indicators of general health. The Decay, Missing, Filled Teeth (DMFT) Index for permanent teeth, dmft Index for primary teeth, the Modified Developmental Defects of Enamel (DDE) Index, the Gingival Index (GI) and the Debris Index-Simplified (DI-S) were used for oral health assessment. Results: Height (P<0.001), weight (P<0.001), and BMI (P=0.001) significantly increased as the socio-economic status of area increased. GI score (P<0.001), DI-S score (P<0.001), number of permanent teeth with DDE (P=0.008), and number of DDE lesions in permanent teeth (P=0.008) significantly decreased as the socio-economic status of area increased. Discussion: Findings of this study generally confirmed that social gradients exist in both general and oral health status of the primary schoolchildren of Shiraz. The influence of socio-economic status on health condition means children have different life chances based on their socio-economic conditions. These findings emphasize the significance of interventions for tackling socio-economic inequalities in order to improve the health status of children in lower socio-economic areas.
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Affiliation(s)
- Ali Golkari
- Department of Dental Public Health, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, 71345-1836, Iran; Research Department of Epidemiology and Public Health, University College London, London, WC1E 7HB, UK
| | - Aira Sabokseir
- Department of Dental Public Health, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, 71345-1836, Iran
| | - Aubrey Sheiham
- Research Department of Epidemiology and Public Health, University College London, London, WC1E 7HB, UK
| | - Richard G Watt
- Research Department of Epidemiology and Public Health, University College London, London, WC1E 7HB, UK
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