Caries in primary dentition and social class in high and low fluoride areas

Community Water Fluoridation Benefits US Children From Poor Families More Than Those From More Affluent Families

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION

Association Between Water Fluoridation and Income-Related Dental Caries of US Children and Adolescents. Sanders AE, Grider WB, Maas WR, Curiel JA, Slade GD. JAMA Pediatr 2019;173(3):288-90.

SOURCE OF FUNDING

National Institute of Dental and Craniofacial Research of the National Institutes of Health under award number UH2DE025494.

TYPE OF STUDY/DESIGN

Cross-sectional study.

Trends in socioeconomic inequalities in oral health among 15-year-old Danish adolescents during 1995-2013: A nationwide, register-based, repeated cross-sectional study

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.

Declínio da cárie em um município da região noroeste do Estado de São Paulo, Brasil, no período de 1998 a 2004

O objetivo do estudo foi analisar os índices CPOD, ceod, SiC Index e a porcentagem de crianças livres de cárie, em escolares de 5 a 12 anos da rede pública do Município de Bilac, São Paulo, Brasil, em estudos realizados nos anos de 1998, 2000, 2002 e 2004. Utilizou-se a mesma metodologia (OMS-1997) em todos os levantamentos. O teste estatístico kappa foi calculado a cada estudo, obtendo-se o valor de concordância interexaminadores mínimo de 0,86 e máximo de 0,89, e intra-examinador mínimo de 0,91. O índice ceod diminuiu pouco nos anos de 1998 e 2004. Houve uma redução contínua do índice CPOD aos 12 anos, passando de 5,28 em 1998 para 4,11 em 2000, 3,47 em 2002 e 2,62 em 2004, e o fenômeno da polarização. Na proporção inversa, a porcentagem de crianças com 5 anos livres de cárie aumentou de 37,9% em 1998 para 40% em 2000 e 2002, e 45,3% em 2004. Conclui-se que está ocorrendo a redução da cárie dentária na faixa etária de 12 anos entre escolares do ensino público do município.

Dental health of dentists' children in Mongolia

OBJECTIVES

To describe the dental health of dentists' children, to evaluate its association with their dentist-parents' background and work-related characteristics and to compare it with that of children in the general population in Mongolia.

DESIGN

Cross-sectional survey, questionnaire-based data.

SUBJECTS

Dentists' children, aged 3-13 years.

SAMPLE

All dentists (n = 250) actively practising in the capital city of Mongolia.

RESULTS

The dentists' children's dmft ranged from 0 to 12, and DMFT from 0 to 8; 50% were caries-free. The younger the children, the higher was their total caries experience expressed as the sum of DMFT + dmft scores (r = -0.22; P = 0.001). Dentist-parents' background and work-related factors were not associated with their children's caries status (P > 0.05). When dentists' children were compared with their counterparts at the population level, mean dmft for 6-year-olds was 2.6 for (urban) dentists' children, 6.5 for children in the urban population and 0.9 for those in rural population of equivalent age. Mean DMFT for 12-year-olds were 1.0, 1.8 and 1.2, respectively, in the same three groups. In general, (urban) dentists' children in all age groups had better dental health than did their urban counterparts at the population level. Among 5-7-year-olds, dentists' children had worse dental health than did their counterparts in the rural population.

CONCLUSIONS

Despite the dentists' knowledge and awareness, their children demonstrated higher rates of dental caries than expected. This suggests that Mongolian dentists may have insufficient preventive orientation. In particular, the primary dentition of younger children seems to be poorly valued. In Mongolia, dentists should have better training and education in modern methods of caries prevention and their advantages. Appreciation and care of the primary dentition need to be improved at all levels of oral health promotion in Mongolia.

Social deprivation, income inequality, social cohesion and dental caries in Brazilian school children

This ecological study investigated the associations between social deprivation, income inequality and social cohesion and dental caries levels in school children of the Distrito Federal, Brazil. Three sources of data were used: (1) area-based data from a 1997 social survey carried out on 13,000 families, (2) 1995 census data collected for the Government of the Distrito Federal (GDF), and (3) dental caries data from a 1997 oral health survey on 7296 6-12-year-old school children. Results of simple linear regression showed that percent with less than eight years of education (P = 0.03) and percent who did not have a maid (P = 0.009), were negatively statistically significantly associated with the percent of children free of caries. None of the deprivation measures were statistically significantly associated with mean DMF-T scores (P > 0.05). GINI coefficient, an indicator of social inequalities, was negatively statistically significantly associated with both measures of dental caries experience, percent of caries free (P = 0.003) and mean DMF-T scores (P = 0.01). Per thousand number of homicides or attempted homicides, an indicator of social cohesion was of marginal statistical significance associated with caries experience. Results of multiple linear regression analyses showed that only the Gini coefficient remained statistically significantly associated with both dental clinical measures used, after adjusting for potential confounding. In conclusion, relative rather than absolute levels of income were stronger determinants of the onset of caries in this study.

The relationship between water fluoridation and socioeconomic deprivation on tooth decay in 5-year-old children

AIM

To examine the relationship between water fluoridation, socioeconomic deprivation and tooth decay in 5-year-olds.

SETTING

10,004 children: 1,051 in naturally fluoridated Hartlepool in 1991/92, 3,816 in fluoridated Newcastle & North Tyneside and 5,137 in non-fluoridated Salford & Trafford in 1993/94.

OUTCOME MEASURES

Correlations between mean electoral ward dmft and ward Townsend Scores from the 1991 census.

RESULTS

Regardless of the level of water fluoridation significant correlations were found between deprivation and tooth decay. Multiple linear regression models for dmft showed a statistically significant interaction between ward Townsend score, and both types of water fluoridation, confirming the more deprived the area the greater the reduction in tooth decay. At a Townsend score of zero (the English average) there was a predicted 43% reduction in decay in 5-year-olds in fluoridated areas.

CONCLUSIONS

Tooth decay is strongly associated with social deprivation. The findings confirm that the implementation of water fluoridation has halved tooth decay in 5-year-old children and that the dental caries divide between rich and poor is reduced.

Oral health behavior of 6-year-old Danish children

In Denmark the Public Dental Health Service (PDHS) is now in the process of evaluation and revision of oral health education programs. The purpose of the present survey was 1) to evaluate the pattern of oral health behavior among 6-year-old children in relation to family and social characteristics; 2) to describe the level of dental knowledge and attitudes among the parents; and 3) to estimate the relative effect on caries experience of social and behavioral risk factors. The study comprised 212 children (response, 73%), and the parents responded to self-administered questionnaires. Moreover, information on def-s and DMF-S was collected from the epidemiologic recording systems for the PDHS. With regard to dental caries, 98% of the parents were aware of the harmful effect of sugar, and 88% knew about the role of bacteria. The causal effect of bacteria in relation to periodontal disease was stressed by 81%. Most of the parents (93%) believed that the dental diseases are preventable by means of proper oral hygiene habits, restriction of sugar and sweets, and the use of fluorides. The high level of dental knowledge among the parents was related to information given by the PDHS. Toothbrushing at least twice a day was performed by 88% of the children, and most used fluoridated toothpaste. Practical support to the children was given by 45% of the parents, and 55% checked the teeth. On a daily basis, the children had healthy foods like vegetables (59%), fruits (87%), and milk (89%), and orangeade was consumed by 53%; 45% of the children consumed sweets on a specific weekday ('Saturday sweets').(ABSTRACT TRUNCATED AT 250 WORDS)

Epidemiology of childhood diabetes mellitus in Finland--background of a nationwide study of type 1 (insulin-dependent) diabetes mellitus. The Childhood Diabetes in Finland (DiMe) Study Group

A nationwide study of childhood Type 1 (insulin-dependent) diabetes mellitus was established in 1986 in Finland, the country with the highest incidence of this disease worldwide. The aim of the project called "Childhood Diabetes in Finland" is to evaluate the role of genetic, environmental and immunological factors and particularly the interaction between genetic and environmental factors in the development of Type 1 diabetes. From September 1986 to April 1989, 801 families with a newly-diagnosed child aged 14 years or younger at the time of diagnosis were invited to participate in this study. The vast majority of the families agreed to participate in the comprehensive investigations of the study. HLA genotypes and haplotypes were determined in 757 families (95%). Our study also incorporates a prospective family study among non-diabetic siblings aged 3-19 years, and two case-control studies among the young-onset cases of Type 1 diabetes. During 1987-1989, the overall incidence of Type 1 diabetes was about 35.2 per 100,000 per year. It was higher in boys (38.4) than in girls (32.2). There was no clear geographic variation in incidence among the 12 provinces of Finland. Of the 1,014 cases during these 3 years only six cases were diagnosed before their first birthday. The incidence was high already in the age group 1-4-years old: 33.2 in boys and 29.5 in girls. Of the 801 families 90 (11.2%) were multiple case families, of which 66 had a parent with Type 1 diabetes at the time of diagnosis of the proband.(ABSTRACT TRUNCATED AT 250 WORDS)

Association between dental health and acute myocardial infarction

Known risk factors for coronary heart disease do not explain all of the clinical and epidemiological features of the disease. To examine the role of chronic bacterial infections as risk factors for the disease the association between poor dental health and acute myocardial infarction was investigated in two separate case-control studies of a total of 100 patients with acute myocardial infarction and 102 controls selected from the community at random. Dental health was graded by using two indexes, one of which was assessed blind. Based on these indexes dental health was significantly worse in patients with acute myocardial infarction than in controls. The association remained valid after adjustment for age, social class, smoking, serum lipid concentrations, and the presence of diabetes. Further prospective studies are required in different populations to confirm the association and to elucidate its nature.

Water fluoridation: a response to critics in Australia and New Zealand

Recent questions about the effectiveness of water fluoridation have come from Diesendorf in Australia and Colquhoun in New Zealand. This report examines the arguments of both authors in detail and finds errors in each. Diesendorf employed an outdated view of how fluoride exerts its anticariogenic action and took a number of quotations out of context. Colquhoun's data are questionable. Neither author has produced evidence to challenge the established safety and effectiveness of water fluoridation.

Relationships between exposure to additional fluoride, social background and dental health in 7-year-old children

The relationship between social background, water fluoridation, use of fluoride tablets and dmf scores was studied in a birth cohort of 7-yr-old New Zealand children. This analysis showed that the level of exposure to additional fluoride was a complex variable influenced by at least three factors: the use of fluoride toothpaste; the child's length of residence in a fluoridated area; the length of time for which the child had been provided fluoride tablets. Log linear modelling of the data suggested the presence of a relatively complex relationship between exposure to additional fluoride, social background and dental health. First, both duration of residence in a fluoridated area and the provision of fluoride tablets made significant net contributions to the variability in the dmf score. However, exposure to additional fluoride from these sources was differentially influenced by social background: while there were relatively strong associations between social background and the use of fluoride tablets, there was no significant association between duration of residence in a fluoridated area and social background. Finally, independently of an association with exposure to additional fluoride, family social background made a significant net contribution to the variability in dmf scores.

Influence of social class and fluoridation on child dental health

In this study in oral epidemiology, officially collected statistics are presented which show that, 15 yr after fluoridation commenced in Auckland, New Zealand, there was still a significant correlation between dental health of children and their social class. They also show that treatment levels have continued to decline in both fluoridated and unfluoridated areas, and are related to social class factors rather than to the presence or absence of water fluoridation. In the unfluoridated areas all the children, and in the fluoridated areas only selected children, had received regular topical fluoride treatments. In both areas the use of fluoride tooth-pastes and oral hygiene had been encouraged. When the socioeconomic variable is allowed for, child dental health appears to be better in the unfluoridated areas.

Caries patterns in Head Start children in a fluoridated community

Assessment of caries experience based on the person rather than on the tooth opens the possibility for qualitative descriptions of caries in a population, as well as for the study of specific factors associated with different caries experiences. The study of a Head Start population in adjacent fluoridated communities was divided into two parts. It was the purpose of part one of the study to determine the prevalence of specific caries patterns (presumably associated with different etiologies). Of the children, 39 percent were caries-free; 32 percent had carious lesions only in pit-and-fissure defects of molars; 6.5 percent had carious lesions in hypoplastic defects; 11 percent had facial-lingual lesions, compatible with "nursing caries"; and 11.5 percent had approximal lesions of molars; no child in the study had rampant caries. The second part compared specific lifestyle variables with specific caries patterns. Statistically significant differences or trends were found between caries-free children and those with smooth-surface lesions for mother's educational level, time spent with grandparents, mother's perceived primary reason for cavities, and mother's tendency to permit the child to eat sweets without restriction. No significant differences or trends were found for lifestyle variables between caries-free children and those having lesions associated only with tooth defects.

Relationship between fluoridation and socioeconomic status on dental caries experience in 5-year-old New Zealand children

This article examines the relationship between fluoridation and socioeconomic status on caries experience, as measured by the dmf index, in 5-yr-old New Zealand children in the city of Dunedin (fluoridated in 1967) and in adjacent non-fluoride communities. The children were subdivided into six socioeconomic status groups (SES 1, professional and managerial-SES 6, unskilled workers), but then for simplicity they were combined to form three groups. A two-way analysis of variance demonstrated that interaction between fluoride history and socioeconomic status was not significant. In all three SES groups, dmf was higher in non-fluoride communities, but the difference was significant only in SES group (5&6) (P less than 0.01). Caries experience increased with decreasing socioeconomic status in both fluoride and non-fluoride communities, but this effect was only significant between SES groups (1&2) and (3&4) in the fluoridated community (P less than 0.05), and between SES groups (3&4) and (5&6) in non-fluoride communities (P less than 0.01). These results are compared with those of similar studies, and it is concluded that so far, the relationship between fluoridation and socioeconomic status on caries experience remains equivocal. A note of caution is sounded regarding the interpretation of such results, and the difficulties faced when comparing studies is discussed.