Family composition and children's dental health behavior: evidence from Germany

Medicaid Dental Benefits for Pregnant People and Dental Care Use Among Very Young Children

OBJECTIVES

The aim of this study was to examine the association between Medicaid dental benefits for pregnant people and dental care use among very young children in Medicaid. We hypothesized that children living in states with more generous dental benefits for Medicaid-enrolled pregnant people would be more likely to have a recent dental visit.

METHODS

This national cross-sectional study used pooled 2017-2019 data from the National Survey of Children's Health, as well as state Medicaid policy data. The study sample included children aged 0-2 enrolled in Medicaid. Multivariable logistic regression models estimated the association between Medicaid dental benefit generosity for pregnant people and the child having a dental visit in the past year.

RESULTS

Children in states with emergency-only dental coverage for pregnant people were 2.5 times as likely to have had a dental visit than children in states with extensive coverage (OR 2.48, 95% CI 1.35-4.53). In supplemental analyses excluding children living in Texas, there was no longer an association between dental coverage for pregnant people and dental utilization among young children (OR 1.52, 95% CI 0.82-2.83).

CONCLUSIONS FOR PRACTICE

Young children in states that provided emergency-only dental benefits for pregnant people in Medicaid had significantly higher odds of dental utilization than young children in states with more generous dental benefits for pregnant people. This relationship disappeared after excluding the state Texas, which had the highest rate of child dental utilization in the country and provided emergency-only dental benefits for pregnant people in Medicaid.

Pathway of Effects of Socioeconomic Status on Rural Left-behind Children to Receive Oral Health Services: A Structural Equation Modeling

In a rural area with a high proportion of left-behind children (LBC), we aimed to identify the pathway of influence of socioeconomic status (SES) on LBCs to receive oral health services after individualized advice. Between September and October 2020, in a rural area of Yunnan, a survey of 238 LBC and 210 non-left-behind children (NLBC) showed that 91.9% and 94.2% had primary teeth caries, respectively. Their caregivers were advised on (1) dental care: bringing the children to seek professional dental care; and (2) self-care: supervising the children's oral health behaviors. Two to three months later, the children and their caregivers were visited to assess the compliance with these items of advice. Structural equation modeling (SEM) was used to handle the association between SES and compliance with the advice. A heatmap was used to visualize the data of reasons for seeking dental care or not. A total of 183 (87.1%) NLBCs and 206 (86.6%) LBCs were given the above advice; 32.9% of caregivers complied with dental care advice without a statistical difference between the LBC and NLBC group; 69.9% of caregivers of NLBCs complied with self-care advice, statistically more than those LBCs (59.2%). The education of caregivers was significantly associated with compliance with both advice items in univariate analysis. SES had a direct effect on the children being left behind and the level of oral health knowledge and awareness of the caregivers. Being left behind did not have an independent effect on receiving oral health services for children. "Dental disease was not severe" and "having no pain" were the main reasons for not seeking dental care. There was no clear grouping of participants with different background information based on the reasons given for seeking or not seeking dental care. Our study pointed to the importance of SES level. Being left behind alone may not be a risk factor for missing oral health services among rural children.

Socio-demographic factors, dental status, oral health knowledge and attitude, and health-related behaviors in dental visits among 12-year-old Shenzhen adolescents: a multilevel analysis

Background

Dental visits can provide education, prevention and treatment measures for teenagers, and help to form correct oral health knowledge and attitude. The purpose of this study was to evaluate the effects of socio-demographic factors, dental status, oral health literacy, and health-related behaviors on dental visits in early 12-year-old adolescents.

Methods

953 subjects aged 12 in Longhua district of Shenzhen were investigated. The questionnaire and clinical examination were applied in schools, and two-level logistic regression models were constructed to interpret the effect of individual and contextual factors on Shenzhen adolescents' dental visits.

Results

A total of 27.6% of the participants had not been to a dentist. After the multiple factors binary logistic regression analysis, it confirmed that the following variables: Shenzhen Hukou (OR 2.133, 95% CI 1.429–3.185), moderate caries (OR 1.404, 95% CI 1.022–1.928) and severe caries (OR 2.546, 95% CI 1.461–4.437), Angle Class II malocclusion (OR 1.703, 95% CI 1.134–2.556), sometimes or never toothbrushing (OR 2.985, 95% CI 1.491–5.975), dental floss usage (OR 1.829, 95% CI 1.250–2.677), having had a toothache within the last 12 months (OR 1.469, 95% CI 1.086–1.986), high knowledge attitude level (OR 1.570, 95% CI 1.106–2.229), moderate knowledge attitude level (OR 1.534, 95% CI 1.073–2.193), were associated factors for dental visit experience.

Conclusions

The dental visits of 12-year-old children in Longhua district of Shenzhen is affected by multi-dimensional factors. It is suggested that oral health education should be strengthened, good oral hygiene habits should be cultivated, and the needs and utilization of oral health services for non-Shenzhen Hukou adolescents should be paid attention to, so as to effectively improve the overall oral health level of adolescents.

Oral health literacy, sociodemographic, family, and clinical predictors of dental visits among Brazilian early adolescents

BACKGROUND

The prevalence of dental caries is high in adolescents worldwide, and a large percentage have never been to a dentist or have not had regular dental appointments.

AIM

To evaluate the influence of oral health literacy and sociodemographic, clinical, and family factors on dental visits among early adolescents.

DESIGN

A cross-sectional study was conducted with 740 12-year-old students in Campina Grande, Brazil. Students answered about their level of oral health literacy (BREALD-30), levels of family adaptability and cohesion (FACES III), and visits to the dentist sometime in life. Dental caries experience was evaluated using Nyvad criteria. Robust Poisson regression for complex samples was performed.

RESULTS

A higher level of oral health literacy (PR = 1.01; 95% CI: 1.01-1.03), high social class (PR = 1.28; 95% CI: 1.09-1.50), higher mother's schooling (PR = 1.58; 95% CI: 1.37-1.83), family cohesion classified as enmeshed (PR = 1.55; 95% CI: 1.19-2.02) and connected (PR = 1.22; 95% CI: 1.02-1.44), and the absence of toothache (PR = 1.18; 95% CI: 1.01-1.38) remained associated with having visited a dentist.

CONCLUSIONS

Oral health literacy and sociodemographic, family, and clinical factors were predictors of having visited a dentist among early adolescents.

Socio-environmental determinants of the delay in the first dental visit: results of two population-based cohort studies in Brazil

The objective of this study was to describe the timing of the first dental visit and investigate the association of socioeconomic and behavioral factors with dental visit delay among 10/11-year-old children from two live-birth population cohorts with extremely contrasting socioeconomic profiles. Follow-up data (2004-2005) from cohorts of Ribeirão Preto (RP) (n=790) and São Luís (SL) (n=673) were evaluated. Delay in dental visit was defined as not visiting a dentist before the age of 7. Covariates included family socioeconomic characteristics, mother-related health behavior, and child-related characteristics. Prevalence ratios with robust standard errors were estimated. In both cohorts, less than 5% of children had visited a dentist before the age of two and about 35% of them had not visited a dentist before the age of seven. Lower mother’s schooling and lack of private health insurance were associated with the delay in first dental visit for both cohorts. A small number of mother's prenatal care visits and being from a single-father family or a family without parents were only associated in the RP cohort, while having ≥4 siblings and lifetime dental pain were associated in the SL cohort. The association with dental pain probably reveals a preventive care-seeking behavior. Therefore, the percentage of delayed first dental visit of children was very high even among those with the most educated mothers. Further studies are necessary to analyze recent changes and underlying factors related to access to first dental visit after the implementation of the National Oral Health Policy in 2006.

Impact of parental migration on oral health outcomes of left-behind school-aged children in Luchuan, southern China

Background

With rapid urbanization in China, an increasing number of rural adults have migrated to cities to seek job opportunities, leaving their school-aged children behind. These left-behind children (LBC) without one or both parents usually receive less attention from their caregivers. Whether the parental migration affects the children’s oral health is not well understood. This study aimed to explore the differences in dental caries status and oral health-related behaviors between children with different parental migration experiences in a rural area of Southern China.

Methods

A cross-sectional study was conducted in Luchuan County of Guangxi Province in 2015. A total of 1085 school children aged 8–12 participated in this study. Participants’ demographic characteristics, parental migration information, and eating and oral hygiene habits were collected using a self-administered questionnaire. Dental caries of permanent teeth was examined using the decayed, missing, and filled tooth (DMFT) index recommended by the World Health Organization. Dental caries experience and oral health-related behaviors were compared between LBC and non-LBC, as well as children with different experiences of parental migrations. The impact of various parental migration attributes on LBC oral health outcomes was examined by univariate and multivariate analyses.

Results

Among the school-aged children examined, 60.9% of them were LBC. Only 29.7% of the children brushed their teeth regularly; 86.5% of them did not know what fluoride toothpaste was. Caries prevalence was 51.4% for LBC and 40.8% for non-LBC (p < 0.001). The LBC experienced a greater DMFT mean (1.20 ± 1.59) compared to the non-LBC (0.85 ± 1.30) (p < 0.001). Oral health-related behaviors were not significantly different between LBC and non-LBC. Dental caries experience and oral health-related behaviors were not related to the type or duration of parental migration. Multiple regression analyses showed that parental migration was one of significant predictors of children’s caries outcome; LBC had a higher risk to caries than non-LBC (95% CI =1.26, 2.09).

Conclusions

These findings indicate that parental migration could be a significant risk factor for caries development among 8- to 12-year-old school children in rural China.

Electronic supplementary material

The online version of this article (10.1186/s12903-018-0683-3) contains supplementary material, which is available to authorized users.

Barriers and facilitators of dental service utilization by children aged 8 to 11 years in Enugu State, Nigeria

BACKGROUND

Multiple factors influence a child's ability to access oral health care. The aim of this study was to identify factors that facilitated and served as barriers to children's utilization of oral health care services in Enugu, Nigeria.

METHODS

The study recruited 1406 primary school pupils aged 8 to 11 years. All the children received oral health education, with the aid of an oral health education curriculum appropriate for their age. After this, referral letters were given to the children. Twelve months later, the study participants were revisited in their schools to obtain information on their reasons for utilizing, or not utilizing an oral health care service in the last 12 months. The association between socio-economic status; form of parenthood; number of siblings, birth rank and reasons for utilization and non-utilization of dental services were assessed. Influence on the child's predisposition to oral health service utilization on dental visit was also assessed.

RESULTS

Only 116 (14.7 %) of the 791 children accessible during the 12 months follow-up visit had visited the dental clinic and the main reason for utilization was the desire to fulfill the dentist's request for dental visit (41.9 %) while parents' inability to make out time for a dental visit (43.3 %) was the main reason for non-utilization. The odds of utilizing oral health care services for study participants from the middle (AOR: 0.50; CI: 0.31-0.79; P = 0.003) and low (AOR: 0.24; CI: 0.13-0.45; p = <0.001) socioeconomic strata, and those living with guardians/relatives (AOR: 0.08; CI: 0.01-0.60; p = 0.01) were decreased when compared to those living with both parents, respectively. Respondents with positive perception about dental service utilization had increased odds of utilizing oral health care (AOR: 2.96; CI: 1.48-5.90; p = 0.002).

CONCLUSION

Dentists can be strong motivators for children to utilize oral health care. Time is a significant barrier for the utilization of dental services. The programs designed to address barriers to oral health care utilization for children should be geared towards overcoming the possible threats that socio-economic status and type of parents they have may pose, to reduce inequity in dental service utilization.

Neighborhood and family social capital and parent-reported oral health of children in Iowa

OBJECTIVES

A growing body of evidence supports the impact of social factors on oral health disparities in children in the United States. The goal of this study was to examine the relationship between two types of social capital-family and neighborhood-and the parent-reported oral health of Iowa's children.

METHODS

We analyzed results from a 2010 cross-sectional statewide health survey. The outcome was parent-reported child oral health status, and the five primary independent variables were neighborhood social capital and four separate indicators of family social capital. Data were analyzed using a mixed-effects linear regression with a random effect for zip code.

RESULTS

Significant positive associations were found between child oral health status and neighborhood social capital (P = 0.005) and one indicator of family social capital, family frequency of eating meals together (P = 0.02), after adjusting for covariates.

CONCLUSIONS

This study adds to the growing body of literature around the social determinants of oral health. Our findings indicate that the oral health of children may be influenced by broad social factors such as neighborhood and family social capital.

Association between energy-dense food consumption at 2 years of age and diet quality at 4 years of age

The present study aimed to evaluate the association between the consumption of energy-dense foods at 2 years of age and the consumption of foods and diet quality at 4 years of age. The sample included 705 children evaluated at 2 and 4 years of age, as part of the population-based birth cohort Generation XXI (Porto, Portugal). Data on sociodemographic and lifestyle factors of both children and mothers were collected by face-to-face interviews. The weight and height of children were measured by trained professionals. Based on FFQ, four energy-dense food groups were defined: soft drinks; sweets; cakes; salty snacks. A healthy eating index was developed using the WHO dietary recommendations for children (2006) aged 4 years. The associations were evaluated through Poisson regression models. After adjustment for maternal age and education, child's carer, child's siblings and child's BMI, higher consumption of energy-dense foods at 2 years of age was found to be associated with higher consumption of the same foods 2 years later. An inverse association was found between the intake ( ≥ median) of soft drinks (incidence rate ratio (IRR) = 0·74, 95 % CI 0·58, 0·95), salty snacks (IRR = 0·80, 95 % CI 0·65, 1·00) and sweets (IRR = 0·73, 95 % CI 0·58, 0·91) at 2 years of age and the consumption of fruit and vegetables at 4 years of age ( ≥ 5 times/d). Weekly and daily consumption of energy-dense foods at 2 years of age was associated with a lower healthy eating score at 4 years of age (IRR = 0·75, 95 % CI 0·58, 0·96; IRR = 0·56, 95 % CI 0·41, 0·77, respectively). The consumption of energy-dense foods at young ages is negatively associated with the diet quality of children a few years later.

Family structure, socioeconomic position and utilization of oral health services among Nigerian senior secondary school pupils

OBJECTIVE

To test the relationship between socioeconomic position (SEP), family composition, number of siblings, and birth position in the family, and the utilization of oral health services by senior secondary school pupils in Ile-Ife, Nigeria.

METHODS

A cross-sectional study design included senior secondary school pupils in the Central Local Government Area of Ile-Ife during 2007/2008. Sample size calculation was performed and 1,200 pupils were invited to participate. A multistage, stratified sampling technique was used. Data collection included a self-administered questionnaire. Data were analyzed using logistic regression.

RESULTS

The response rate was 76 percent (n=1043). The mean age was 15.8 (standard deviation=1.9) and 49 percent were males. Only 22.5 percent of pupils had ever visited a dentist in their lives. Results from multivariate analyses showed that pupils attending free schools, those paying 1 to 10,000 naira (equivalent to US$ 63.31) and 10,000 to 19,000 naira (equivalent to US$ 120.29) were respectively 1.93, 1.87, and 2.74 times less likely to have attended a dentist in the past than pupils in more expensive schools. Pupils living with single mothers or without a parent were unlikely to have visited the dentist. Number of siblings and birth position in the family were not associated with utilization of oral health services.

CONCLUSIONS

Adolescents from families with a low SEP growing up without their parents may need extra incentives to visit dentist.

Parenting style, parenting stress, and children's health-related behaviors

OBJECTIVE

Parental guidance is critical to the development of children's health-related behaviors. The purpose of this study was to look at the relationship between parenting factors, including parenting style and parenting stress, and children's health-related behaviors.

METHODS

In this descriptive, correlational study, 284 parents of preschool children were interviewed using the Child Rearing Questionnaire and the Korean Parenting Stress Index-Short Form.

RESULTS

Parent distress, authoritative and permissive parenting styles, family income, and mother's education were significantly associated with children's health-related behaviors.

CONCLUSIONS

These findings suggest that higher levels of warmth, characteristics of both parenting styles, may be a critical factor in the development of health-related behaviors.

Review and recommendations for zero-inflated count regression modeling of dental caries indices in epidemiological studies

Over the past 5-10 years, zero-inflated (ZI) count regression models have been increasingly applied to the analysis of dental caries indices (e.g. DMFT, dfms). The main reason for that is linked to the broad decline in children's caries experience, such that dmf and DMF indices more frequently generate low or even zero counts. This article specifically reviews the application of ZI Poisson and ZI negative binomial regression models to dental caries, with emphasis on the description of the models and the interpretation of fitted model results given the study goals. The review finds that interpretations provided in the published caries research are often imprecise or inadvertently misleading, particularly with respect to failing to discriminate between inference for the class of susceptible persons defined by such models and inference for the sampled population in terms of overall exposure effects. Recommendations are provided to enhance the use as well as the interpretation and reporting of results of count regression models when applied to epidemiological studies of dental caries.