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Durey A, Ward P, Haynes E, Baker SR, Calache H, Slack-Smith L. Applying Social Practice Theory to Explore Australian Preschool Children's Oral Health. JDR Clin Trans Res 2024; 9:346-357. [PMID: 38623874 PMCID: PMC11406822 DOI: 10.1177/23800844241235615] [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] [Indexed: 04/17/2024] Open
Abstract
INTRODUCTION Despite substantial research and provision of dental care, significant morbidity remains for children's oral health. Guided by social practice theory (SPT), this research moves away from the often-ineffective focus on changing individual behavior to rethinking the centrality of the social world in promoting or undermining oral health outcomes. We define social practice as a routinized relational activity linking and integrating certain elements (competence, materials, and meanings) into the performance of a practice that is reproduced across time and space. OBJECTIVE To investigate oral health in preschool children in Perth, Western Australia, using social practice theory. METHODS With no definitive methodology for investigating SPT, we chose focused ethnography as a problem-focused, context-specific approach using mainly interviews to investigate participants' experience caring for their children's oral health. The focus of analysis was the practice of oral health care, not individual behavior, where themes identified from participants' transcripts were organized into categories of elements and performance. RESULTS Eleven parents, all of whom were married or partnered, were interviewed in 2021. Findings identified social practices relevant to oral health within parenting and family relations linked to routine daily activities, including shopping, consumption of food and beverages, and toothbrushing. Oral health literacy was reflected in integrating competence, materials, and meanings into performing oral health care, notably preferences for children to drink water over sugary beverages and information often being sourced from social media and mothers' groups rather than health providers. CONCLUSION Focusing on social practices as the unit of analysis offers a more layered understanding of elements in young children's oral health care that can indicate where the problem may lie. Findings provide an opportunity to consider future research and policy directions in children's oral health. KNOWLEDGE TRANSFER STATEMENT Examining social practices related to young children's oral health care identifies parents/carers' knowledge about, for example, toothbrushing, the resources required, and why toothbrushing is important. Analyzing these separate elements can reveal both enablers and barriers to oral health care. This provides researchers, clinicians and policymakers an opportunity to focus on not changing individual behavior but understanding how social context impacts parents/carers' capacity to make optimum decisions around young children's oral health.
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Affiliation(s)
- A Durey
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - P Ward
- Research Centre for Public Health, Equity and Human Flourishing, Torrens University, Adelaide, SA, Australia
| | - E Haynes
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - S R Baker
- School of Clinical Dentistry, Sheffield University, Sheffield, UK
| | - H Calache
- La Trobe University, Department of Clinical Sciences, La Trobe Rural Health School, Bendigo, VIC, Australia
| | - L Slack-Smith
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
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Durey A, Naylor N, Slack-Smith L. Inequalities between Aboriginal and non-Aboriginal Australians seen through the lens of oral health: time to change focus. Philos Trans R Soc Lond B Biol Sci 2023; 378:20220294. [PMID: 37381845 PMCID: PMC10291420 DOI: 10.1098/rstb.2022.0294] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 02/21/2023] [Indexed: 06/30/2023] Open
Abstract
Inequitable social environments can illustrate changes needed in the social structure to generate more equitable social relations and behaviour. In Australia, British colonization left an intergenerational legacy of racism against Aboriginal people, who are disadvantaged across various social indicators including oral health. Aboriginal Australian children have poorer health outcomes with twice the rate of dental caries as non-Aboriginal children. Our research suggests structural factors outside individual control, including access to and cost of dental services and discrimination from service providers, prevent many Aboriginal families from making optimum oral health decisions, including returning to services. Nader's concept of 'studying up' redirects the lens onto powerful institutions and governing bodies to account for their role in undermining good health outcomes, indicating changes needed in the social structure to improve equality. Policymakers and health providers can critically reflect on structural advantages accorded to whiteness in a colonized country, where power and privilege that often go unnoticed and unexamined by those who benefit incur disadvantages to Aboriginal Australians, as reflected in inequitable oral health outcomes. This approach disrupts the discourse placing Aboriginal people at the centre of the problem. Instead, refocusing the lens onto structural factors will show how those factors can compromise rather than improve health outcomes. This article is part of the theme issue 'Evolutionary ecology of inequality'.
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Affiliation(s)
- Angela Durey
- School of Population and Global Health, University of Western Australia, Perth, Western Australia 6009, Australia
| | - Nola Naylor
- Aboriginal Health Strategy, Clinical Service Planning & Population Health, Fiona Stanley Hospital, Murdoch, WA 6150, Australia
| | - Linda Slack-Smith
- School of Population and Global Health, University of Western Australia, Perth, Western Australia 6009, Australia
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Callander EJ, Bull C, Lain S, Wakefield CE, Lingam R, Marshall GM, Wake M, Nassar N. Inequality in early childhood chronic health conditions requiring hospitalisation: A data linkage study of health service utilisation and costs. Paediatr Perinat Epidemiol 2022; 36:156-166. [PMID: 34806212 DOI: 10.1111/ppe.12818] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 08/27/2021] [Accepted: 09/02/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND The cost of socioeconomic inequality in health service use among Australian children with chronic health conditions is poorly understood. OBJECTIVES To quantify the cost of socioeconomic inequality in health service use among Australian children with chronic health conditions. METHODS Cohort study using a whole-of-population linked administrative data for all births in Queensland, Australia, between July 2015 and July 2018. Socioeconomic status was defined by an areas-based measure, grouping children into quintiles from most disadvantaged (Q1) to least disadvantaged (Q5) based on their postcode at birth. Study outcomes included health service utilisation (inpatient, emergency department, outpatient, general practitioner, specialist, pathology and diagnostic imaging services) and healthcare costs. RESULTS Of the 238,600 children included in the analysis, 10.4% had at least one chronic health condition. Children with chronic health conditions in Q1 had higher rates of inpatient (6.6, 95% confidence interval [CI] 6.4, 6.7), emergency department (7.2, 95% CI 7.0, 7.5) and outpatient (20.3, 95% CI 19.4, 21.3) service use compared to children with chronic health conditions in Q5. They also had lower rates of general practitioner (37.5, 95% CI 36.7, 38.4), specialist (8.9, 95% CI 8.5, 9.3), pathology (10.7, 95% CI 10.2, 11.3), and diagnostic imaging (4.3, 95% CI 4.2,4.5) service use. Children with any chronic health condition in Q1 incurred lower median out-of-pocket fees than children in Q5 ($0 vs $741, respectively), lower median Medicare funding ($2710, vs $3408, respectively), and higher median public hospital funding ($31, 052 vs $23, 017, respectively). CONCLUSIONS Children of most disadvantage are more likely to access public hospital provided services, which are accessible free of charge to patients. These children are less likely to access general practitioner, specialist, pathology and diagnostic imaging services; all of which are critical to the ongoing management of chronic health conditions, but often attract an out-of-pocket fee.
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Affiliation(s)
- Emily J Callander
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Claudia Bull
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Samantha Lain
- Child Population and Translational Health Research, Children's Hospital at Westmead Clinical School, The University of Sydney, Sydney, Australia
| | - Claire E Wakefield
- School of Women's and Children's Health, Faculty of Medicine, UNSW Sydney, Sydney, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia
| | - Raghu Lingam
- Population Child Health Research Group, School of Women and Children's Health, UNSW Sydney, Sydney, Australia
| | - Glenn M Marshall
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia
- Children's Cancer Institute, Lowy Centre, UNSW Sydney, Sydney, Australia
- School of Women and Children's Health, UNSW Sydney, Sydney, Australia
| | - Melissa Wake
- Murdoch Children's Research Institute, Melbourne, Australia
| | - Natasha Nassar
- Child Population and Translational Health Research, Children's Hospital at Westmead Clinical School, The University of Sydney, Sydney, Australia
- Menzies Centre for Health Policy, Sydney School of Public Health, The University of Sydney, Sydney, Australia
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Durey A, Hearn L, Lund S, O'Grady M, Slack-Smith L. Dental professionals' perspectives working with Aboriginal children in Western Australia: a qualitative study. Aust Dent J 2021; 66:246-253. [PMID: 33428775 DOI: 10.1111/adj.12819] [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] [Accepted: 01/04/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND The disproportionate burden of oral disease in Aboriginal children and the issues in accessing mainstream dental services are well documented. Yet little is known about dental professionals' perspectives in providing oral care for Aboriginal children. This paper presents findings from a study exploring such perspectives. METHODS Semi-structured interviews were carried out in Western Australia following purposive sampling of non-Aboriginal dentists, dental clinic assistants (dental nurses) and oral health therapists/dental hygienists. Interviews were recorded, transcribed and analysed guided by grounded theory for key themes related to the topic. RESULTS Findings included a service delivery model sometimes unresponsive to Aboriginal families' needs; dental professionals' limited education and training to work with confidence and cultural sensitivity with Aboriginal patients and socioeconomic influences on Aboriginal children's poor oral health considered outside dental professionals' remit of care. DISCUSSION Findings suggest oral health policies and practices and dental professionals' education and training need reviewing for how well such policies support dental professionals in an Aboriginal context. This includes engaging with Aboriginal stakeholders, working effectively with Aboriginal families, and developing shared understandings about what is needed to increase access to care and improve oral health outcomes for Aboriginal children.
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Affiliation(s)
- A Durey
- School of Population and Global Health, University of Western Australia, Nedlands, WA, Australia
| | - L Hearn
- Edith Cowan University, Joondalup, WA, Australia
| | - S Lund
- School of Allied Health, University of Western Australia, Nedlands, WA, Australia
| | - M O'Grady
- Dental School, University of Western Australia, Nedlands, WA, Australia
| | - L Slack-Smith
- School of Population and Global Health, University of Western Australia, Nedlands, WA, Australia
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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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Durey A, Gibson BJ, Ward PR, Calache H, Slack-Smith L. Social practice theory: An innovative approach to considering preschool children's poor oral health. Community Dent Oral Epidemiol 2021; 49:309-313. [PMID: 33987862 DOI: 10.1111/cdoe.12659] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/23/2021] [Indexed: 11/30/2022]
Abstract
Oral disease in early childhood is highly prevalent and costly and impacts on the child and family with significant societal costs. Current approaches have largely failed to improve young children's oral health. This paper proposes a different approach to conceptualize poor oral health in preschool children (0-5 years) using social practices. Social practice theory offers an innovative perspective to understanding oral health by shifting emphasis away from the individual and onto how practical, social and material arrangements around the oral health of preschool children exist, change or become embedded in the social structures they inhabit. This novel approach contributes to the growing theoretical understanding in this area and has the potential to offer insights into the problem and ways it might be addressed.
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Affiliation(s)
- Angela Durey
- School of Population and Global Health, University of Western Australia, Perth, WA, Australia
| | - Barry J Gibson
- School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Paul R Ward
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Hanny Calache
- La Trobe Rural Health School, Dentistry and Oral Health, La Trobe University, Bendigo, Vic., Australia
| | - Linda Slack-Smith
- School of Population and Global Health, University of Western Australia, Perth, WA, Australia
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7
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Guarnizo-Herreño CC, Scholes S, Heilmann A, O'Connor R, Fuller E, Shen J, Watt RG, Morris S, Wildman J, Tsakos G. Dental attendance and behavioural pathways to adult oral health inequalities. J Epidemiol Community Health 2021; 75:1063-1069. [PMID: 33893184 DOI: 10.1136/jech-2020-216072] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 03/22/2021] [Accepted: 04/13/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND While inequalities in oral health are documented, little is known about the extent to which they are attributable to potentially modifiable factors. We examined the role of behavioural and dental attendance pathways in explaining oral health inequalities among adults in England, Wales and Northern Ireland. METHODS Using nationally representative data, we analysed inequalities in self-rated oral health and number of natural teeth. Highest educational attainment, equivalised household income and occupational social class were used to derive a latent socioeconomic position (SEP) variable. Pathways were dental attendance and behaviours (smoking and oral hygiene). We used structural equation modelling to test the hypothesis that SEP influences oral health directly and also indirectly via dental attendance and behavioural pathways. RESULTS Lower SEP was directly associated with fewer natural teeth and worse self-rated oral health (standardised path coefficients, -0.21 (SE=0.01) and -0.10 (SE=0.01), respectively). We also found significant indirect effects via behavioural factors for both outcomes and via dental attendance primarily for self-rated oral health. While the standardised parameters of total effects were similar between the two outcomes, for number of teeth, the estimated effect of SEP was mostly direct while for self-rated oral health, it was almost equally split between direct and indirect effects. CONCLUSION Reducing inequalities in dental attendance and health behaviours is necessary but not sufficient to tackle socioeconomic inequalities in oral health.
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Affiliation(s)
- Carol C Guarnizo-Herreño
- Departamento de Salud Colectiva, Facultad de Odontología, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Shaun Scholes
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Anja Heilmann
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Rhiannon O'Connor
- School of Dental Sciences and Centre for Oral Health Research, Newcastle University, Newcastle upon Tyne, UK
| | | | - Jing Shen
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.,GlaxoSmithKline, Wavre, Belgium (Although Jing Shen works now for GSK, the work associated with the paper was conducted during her time at Newcastle University)
| | - Richard G Watt
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Steve Morris
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - John Wildman
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Georgios Tsakos
- Department of Epidemiology and Public Health, University College London, London, UK
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Do LG, Ha DH, Bell LK, Devenish G, Golley RK, Leary SD, Manton DJ, Thomson WM, Scott JA, Spencer AJ. Study of Mothers' and Infants' Life Events Affecting Oral Health (SMILE) birth cohort study: cohort profile. BMJ Open 2020; 10:e041185. [PMID: 33099500 PMCID: PMC7590353 DOI: 10.1136/bmjopen-2020-041185] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
PURPOSE The long-term goal of the Study of Mothers' and Infants' Life Events Affecting Oral Health (SMILE) birth cohort study is to identify and evaluate the relative importance and timing of critical factors that shape the oral health of young children. It will then evaluate those factors in their inter-relationship with socioeconomic influences. PARTICIPANTS SMILE is a single-centre study conducted in Adelaide, Australia. All newborns at the main three public hospitals between July 2013 and August 2014 were eligible for inclusion. The final recruited sample at birth was 2181 mother/infant dyads. Participants were followed up with questionnaires when the child was 3 and 6 months of age, and 1, 2 and 5 years of age. Oral epidemiological examinations and anthropometric assessments were conducted at age 2 and 5 years. FINDINGS TO DATE SMILE has contributed comprehensive data on dietary patterns of young children. Intakes of free sugars, core and discretionary foods and drinks have been detailed. There was a sharp increase in free sugars intake with age. Determinants of dietary patterns, oral health status and body weight during the first 5 years of life have been evaluated. Socioeconomic characteristics such as maternal education and household income and area-level socioeconomic profile influenced dietary patterns and oral health behaviours and status. FUTURE PLAN Funding has been obtained to conduct oral epidemiological examinations and anthropometric assessments at age 7-8 years. Plans are being developed to follow the cohort into adolescent years.
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Affiliation(s)
- Loc G Do
- Australian Research Centre for Population Oral Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Diep H Ha
- Australian Research Centre for Population Oral Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Lucinda K Bell
- Nutrition, Flinders University Faculty of Medicine Nursing and Health Sciences, Adelaide, South Australia, Australia
| | - Gemma Devenish
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Rebecca K Golley
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | | | - David J Manton
- Centrum voor Tandheelkunde en Mondzorgkunde, UMCG, Groningen, The Netherlands
| | | | - Jane A Scott
- Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - A John Spencer
- University of Adelaide, Adelaide, South Australia, Australia
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Esa R, Jamaludin M, Yusof ZYM. Impact of maternal and child dental anxiety on oral health-related quality of life of 5-6-year-old preschool children. Health Qual Life Outcomes 2020; 18:319. [PMID: 32993663 PMCID: PMC7526362 DOI: 10.1186/s12955-020-01565-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 09/16/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND There is a lack of evidence with regards to the association between both maternal and child dental anxiety and the mother's perception of her child's oral health-related quality of life (COHRQoL). The aim of this study was to investigate the association of maternal and child dental anxiety with COHRQoL and the effect of demographic factors as moderators in this relationship. In addition, the association between child's dental caries experience and the COHRQoL was also assessed. METHODS A cross-sectional study was conducted involving 1150, 5-6 year-old preschool children in Selangor, Malaysia. Mothers answered a questionnaire on socio-economic status, the Malay-Modified Dental Anxiety Scale to assess maternal dental anxiety, and the Malay-Early Childhood Oral Health Impact Scale to assess COHRQoL. Child's dental anxiety was assessed using the Malay-Modified Child Dental Anxiety Scale via a face-to-face interview prior to oral examination to assess dental caries. Data were analysed using structural equation modelling to assess the relationship between maternal and child dental anxiety and COHRQoL. RESULTS Overall, complete data on 842 mother-child dyads were analysed. The mean scores of total ECOHIS, the child impacts section (CIS), and the family impacts section (FIS) were 17.7 (SD = 4.9), 12.6 (SD = 3.7), and 5.1 (SD = 1.9), respectively. The mean dental anxiety scores for mothers and children were 11.8 (SD = 4.5) and 16.9 (SD = 4.3), respectively. Maternal dental anxiety was associated with the CIS (b = 0.08, p < 0.001), the FIS (b = 0.01, p = 0.001), and the total ECOHIS (b = 0.14, p < 0.001). Maternal education level, income, urban/rural location, and kindergarten type were moderators to the relationship. In addition, there was also a significant relationship between child's dental caries experience and COHRQoL (p < 0.001). CONCLUSIONS Maternal dental anxiety and child's dental caries experience have significantly impacted the COHRQoL, the CIS, and the FIS domains. Demographic factors such as maternal education, income, urban/rural location, and kindergarten type acted as moderators that can strengthen or weaken the relationship between maternal dental anxiety and COHRQoL of 5-6-year-old preschool children.
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Affiliation(s)
- Rashidah Esa
- Department of Dental Public Health, Faculty of Dentistry, MAHSA University, Bandar Saujana Putra, 42610, Jenjarom, Selangor, Malaysia.,Department of Community Oral Health and Clinical Prevention, Faculty of Dentistry, University of Malaya, 50603, Kuala Lumpur, Malaysia.,Community Oral Health Research Group, Faculty of Dentistry, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Marhazlinda Jamaludin
- Department of Community Oral Health and Clinical Prevention, Faculty of Dentistry, University of Malaya, 50603, Kuala Lumpur, Malaysia.,Community Oral Health Research Group, Faculty of Dentistry, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Zamros Yuzadi Mohd Yusof
- Department of Community Oral Health and Clinical Prevention, Faculty of Dentistry, University of Malaya, 50603, Kuala Lumpur, Malaysia. .,Community Oral Health Research Group, Faculty of Dentistry, University of Malaya, 50603, Kuala Lumpur, Malaysia.
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10
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Freire MC, Jordão LM, Peres MA, Abreu MH. Six‐year trends in dental pain and maternal education inequalities among Brazilian adolescents. Community Dent Oral Epidemiol 2019; 47:454-460. [DOI: 10.1111/cdoe.12483] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 05/14/2019] [Accepted: 06/11/2019] [Indexed: 12/01/2022]
Affiliation(s)
| | | | - Marco A. Peres
- Menzies Health Institute Queensland and School of Dentistry and Oral Health Griffith University Gold Coast‐QLD Queensland Australia
| | - Mauro H.N.G. Abreu
- School of Dentistry Federal University of Minas Gerais Belo Horizonte‐MG Brazil
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11
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Stormon N, Ford PJ, Lalloo R. Oral health in the Longitudinal Study of Australian Children: An age, period, and cohort analysis. Int J Paediatr Dent 2019; 29:404-412. [PMID: 30805983 DOI: 10.1111/ipd.12485] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 01/07/2019] [Accepted: 02/20/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Oral health policy and funding must be informed by well-designed studies which monitor oral health and the factors which influence it. AIM This study aimed to analyse the oral health of the Longitudinal Study of Australia Children (LSAC). DESIGN The LSAC is a dual-cohort cross-sequential study run biennially since 2004. Carer-report measures for oral health were measured across six biennial waves and included frequency of tooth brushing, dental service use, and dental problems since the previous wave. RESULTS A total of 10 090 Australian children participated at baseline (birth [B] n = 5017 and kindergarten [K] n = 4983). Most carers reported that children brushed daily and had regular access to dental care. Increasing age was a significant predictor of dental caries, whereas no differences were observed between time periods and cohorts. Dental caries was more frequently reported than dental injuries. Caries was highest at age eight for the B (n = 1234, 30.5%) and K (n = 1355, 31.5%) cohorts. CONCLUSIONS By the age of six, caries prevalence had already begun to climb despite the majority of carers reporting good oral health behaviours for their children. Early intervention in the prevention of dental caries is essential, as children appear to attend dental services when caries is already occurring.
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Affiliation(s)
- Nicole Stormon
- School of Dentistry, UQ Oral Health Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Pauline J Ford
- School of Dentistry, UQ Oral Health Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Ratilal Lalloo
- School of Dentistry, UQ Oral Health Centre, The University of Queensland, Brisbane, Queensland, Australia
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12
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Singh A, Peres MA, Watt RG. The Relationship between Income and Oral Health: A Critical Review. J Dent Res 2019; 98:853-860. [PMID: 31091113 DOI: 10.1177/0022034519849557] [Citation(s) in RCA: 102] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
In this critical review, we summarized the evidence on associations between individual/household income and oral health, between income inequality and oral health, and income-related inequalities in oral health. Meta-analyses of mainly cross-sectional studies confirm that low individual/household income is associated with oral cancer (odds ratio, 2.41; 95% confidence interval [CI], 1.59-3.65), dental caries prevalence (prevalence ratio, 1.29; 95% CI, 1.18-1.41), any caries experience (odds ratio, 1.40; 95% CI, 1.19-1.65), tooth loss (odds ratio, 1.66; 95% CI, 1.48-1.86), and traumatic dental injuries (odds ratio, 0.76; 95% CI, 0.65-0.89). Reviews also confirm qualitatively that low income is associated with periodontal disease and poor oral health-related quality of life. Limited evidence from the United States shows that psychosocial and behavioral explanations only partially explain associations between low individual/household income and oral health. Few country-level studies and a handful of subnational studies from the United States, Japan, and Brazil show associations between area-level income inequality and poor oral health. However, this evidence is conflicting given that the association between area-level income inequality and oral health outcomes varies considerably by contexts and by oral health outcomes. Evidence also shows cross-national variations in income-related inequalities in oral health outcomes of self-rated oral health, dental care, oral health-related quality of life, outcomes of dental caries, and outcomes of tooth loss. There is a lack of discussion in oral health literature about limitations of using income as a measure of social position. Future studies on the relationship between income and oral health can benefit substantially from recent theoretical and methodological advancements in social epidemiology that include application of an intersectionality framework, improvements in reporting of inequality, and causal modeling approaches. Theoretically well-informed studies that apply robust epidemiological methods are required to address knowledge gaps for designing relevant policy interventions to reduce income-related inequalities in oral health.
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Affiliation(s)
- A Singh
- 1 Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - M A Peres
- 2 Menzies Health Institute Queensland and School of Dentistry and Oral Health, Griffith University, Gold Coast, Queensland, Australia
| | - R G Watt
- 3 Research Department of Epidemiology and Public Health, University College London, London, UK
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Fernando S, Tadakamadla SK, Bakr M, Scuffham PA, Johnson NW. Indicators of Risk for Dental Caries in Children: A Holistic Approach. JDR Clin Trans Res 2019; 4:333-341. [PMID: 31039050 DOI: 10.1177/2380084419834236] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Dental caries in children is a major public health problem worldwide, with a multitude of determinants acting upon children to different degrees in different communities. The objective of this study was to determine maternal, environmental, and intraoral indicators of dental caries experience in a sample of 6- to 7-y-old children in South East Queensland, Australia. METHODS A total of 174 mother-child dyads were recruited for this cross-sectional study from the Griffith University Environments for Healthy Living birth cohort study. Maternal education, employment status, and prepregnancy body mass index were maternal indicators, and annual household income was taken as a proxy for environmental indicators. These were collected as baseline data of the study. Clinical data on children's dental caries experience, saliva characteristics of buffering capacity, stimulated flow rate, and colony-forming units per milliliter of salivary mutans streptococci were collected for the oral health substudy. Univariate analysis was performed with 1-way analysis of variance and chi-square tests. Caries experience was the outcome, which was classified into 4 categories based on the number of carious tooth surfaces. Ordinal logistic regression was used to explore the association of risk indicators with caries experience. RESULTS Age (P = 0.021), low salivary buffering capacity (P = 0.001), reduced levels of salivary flow rate (P = 0.011), past caries experience (P = 0.001), low annual household income; <$30,000 (P = 0.050) and <$60,000 (P = 0.033) and maternal employment status (P = 0.043) were associated with high levels of dental caries. CONCLUSION These data support the evidence of associations between maternal, environmental, and children's intraoral characteristics and caries experience among children in a typical Western industrialized country. All of these need to be considered in preventative strategies within families and communities. KNOWLEDGE TRANSFER STATEMENT The results of this study can be used by clinicians, epidemiologists, and policy makers to identify children who are at risk of developing dental caries. With consideration of costs for treatment for the disease, this information could be used to plan cost-effective and patient-centered preventive care.
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Affiliation(s)
- S Fernando
- Menzies Health Institute Queensland, Griffith University, Queensland, Australia.,School of Dentistry and Oral Health, Griffith University, Queensland, Australia
| | - S K Tadakamadla
- School of Human Services and Social Work, Griffith University, Queensland, Australia
| | - M Bakr
- Menzies Health Institute Queensland, Griffith University, Queensland, Australia.,School of Dentistry and Oral Health, Griffith University, Queensland, Australia
| | - P A Scuffham
- Menzies Health Institute Queensland, Griffith University, Queensland, Australia.,School of Medicine, Griffith University, Queensland, Australia
| | - N W Johnson
- Menzies Health Institute Queensland, Griffith University, Queensland, Australia.,School of Dentistry and Oral Health, Griffith University, Queensland, Australia.,Dental Institute, King's College London, London, UK
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14
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Devenish G, Ytterstad E, Begley A, Do L, Scott J. Intake, sources, and determinants of free sugars intake in Australian children aged 12-14 months. MATERNAL AND CHILD NUTRITION 2018; 15:e12692. [PMID: 30225982 DOI: 10.1111/mcn.12692] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 08/14/2018] [Accepted: 09/10/2018] [Indexed: 12/21/2022]
Abstract
The consumption of free sugars is directly associated with adiposity and dental caries in early childhood; however, intake data in the first 2 years of life are limited. This cross-sectional analysis aims to identify major food sources of free sugars for Australian children aged 12-14 months and investigate factors associated with meeting the World Health Organisation (WHO) Guideline for sugars intake. Three days of nonconsecutive dietary data were collected via a 24-hr recall and 2-day food record for 828 participants. Usual intake of energy, total sugars, and free sugars were estimated, along with food group contributions to free sugars. Multiple logistic regression analysis was used to investigate factors associated with exceeding the WHO conservative recommendation that <5% of energy should come from free sugars. Mean free sugars intake was 8.8 (SD 7.7, IQR 3.7-11.6) g/day, contributing 3.6% (SD 2.8, IQR 1.6-4.8) of energy. Only 2.4% of participants exceeded the WHO recommendation that <10% of energy should come from free sugars, with 22.8% of participants exceeding the <5% recommendation. Children from households with greater socio-economic disadvantage (IRSAD <5, OR = 1.94) and in the lowest income bracket (OR = 2.10) were more likely to have intakes ≥5% of energy. Major food sources of free sugars were commercial infant foods (26.6%), cereal-based products (19.7%), namely, sweet biscuits (8.3%) and cakes (7.6%), followed by yoghurt (9.6%), and fruit and vegetable beverages (7.4%). These findings highlight the substantial contribution of infant foods to free sugars intakes and provide further evidence that dietary intakes are influenced by social determinants.
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Affiliation(s)
- Gemma Devenish
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Elinor Ytterstad
- Department of Mathematics and Statistics, UiT The Arctic University of Norway, Tromsø, Norway
| | - Andrea Begley
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Loc Do
- Australian Research Centre for Population Oral Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Jane Scott
- School of Public Health, Curtin University, Perth, Western Australia, Australia
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15
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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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16
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Shen J, Listl S. Investigating social inequalities in older adults' dentition and the role of dental service use in 14 European countries. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2018; 19:45-57. [PMID: 28064379 PMCID: PMC5773639 DOI: 10.1007/s10198-016-0866-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 12/13/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Oral disease, despite being largely preventable, remains the most common chronic disease worldwide and has a significant negative impact on quality of life, particularly among older adults. OBJECTIVE This study is the first to comprehensively and at a large scale (14 European countries) measure the social inequalities in the number of natural teeth (an informative oral health marker) in the over 50-year-old population and to investigate the extent to which such inequalities are attributable to dental service use. METHODS Using Wave 5 of the Survey of Health, Ageing and Retirement in Europe, which included internationally harmonized information on over 50,000 individuals across 14 European countries, we calculated Gini and Concentration indices (CI) as well as the decompositions of CIs by socioeconomic factors. RESULTS Sweden consistently performed the best with the lowest inequalities as measured by Gini (0.1078), CI by income (0.0392), CI by education (0.0407), and CI by wealth (0.0296). No country performed the worst in all inequality measures. However, unexpectedly, some wealthier countries (e.g., the Netherlands and Denmark) had higher degrees of inequalities than less-wealthy countries (e.g., Estonia and Slovenia). Decomposition analysis showed that income, education, and wealth contributed substantially to the inequalities, and dental service use was an important contributor even after controlling for income and wealth. CONCLUSIONS The study highlighted the importance of comprehensively investigating oral health inequalities. The results are informative to policymakers to derive country-specific health policy recommendations to reduce oral health inequalities in the older population and also have implications for oral health improvement of the future generations.
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Affiliation(s)
- Jing Shen
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.
| | - Stefan Listl
- Quality and Safety of Oral Care, Radboud University, Nijmegen, The Netherlands
- Translational Health Economics, Heidelberg University, Heidelberg, Germany
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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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18
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Kim HN, Kim JH, Kim SY, Kim JB. Associations of Community Water Fluoridation with Caries Prevalence and Oral Health Inequality in Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14060631. [PMID: 28608827 PMCID: PMC5486317 DOI: 10.3390/ijerph14060631] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 05/22/2017] [Accepted: 06/06/2017] [Indexed: 11/16/2022]
Abstract
This study aimed to confirm the association between the community water fluoridation (CWF) programme and dental caries prevention on permanent teeth, comparing to a control area, neighbouring population without the programme, and verifying whether the programme can reduce the socio-economic inequality related to the oral health of children in Korea. Evaluation surveys were conducted among 6-, 8-, and 11-year-old children living in Okcheon (CWF) and neighbouring Yeongdong (non-CWF, control area) towns in South Korea. Data on monthly family income, caregiver educational level, and Family Affluence Scale scores were evaluated using questionnaires that were distributed to the parents. The effectiveness of CWF in caries reduction was calculated based on the differences in decayed, missing, and filled teeth and decayed, missing, and filled tooth surfaces indices between the two towns. The data were analysed using logistic regression and univariate analysis of variance. Both 8- and 11-year-old children living in the CWF area had lower dental caries prevalence than those living in the non-CWF community. Differences in dental caries prevalence based on educational level were found in the control area but not in the CWF area. Socio-economic factor-related inequality in oral health were observed in the non-CWF community. Additionally, 8- and 11-year-old children living in the CWF area displayed lower dental caries prevalence in the pit-and-fissure and smooth surfaces than those living in the non-CWF community. These results suggest that CWF programmes are effective in the prevention of caries on permanent teeth and can reduce oral health inequalities among children. The implementation of CWF programmes should be sustained to overcome oral health inequalities due to socio-economic factors and improve children's overall oral health.
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Affiliation(s)
- Han-Na Kim
- Department of Dental Hygiene, College of Health Sciences, Cheongju University, 298, Daesung-ro, Cheongwon-gu, Cheongju 28503, Korea.
| | - Jeong-Hee Kim
- Department of Preventive and Community Dentistry, School of Dentistry, Pusan National University, 49, Busandaehak-ro, Mulgeum-eup, Yangsan, Gyeongsangnam-do 50612, Korea.
| | - Se-Yeon Kim
- Department of Preventive and Community Dentistry, School of Dentistry, Pusan National University, 49, Busandaehak-ro, Mulgeum-eup, Yangsan, Gyeongsangnam-do 50612, Korea.
- BK 21 PLUS Project, School of Dentistry, Pusan National University, Yangsan 50612, Korea.
| | - Jin-Bom Kim
- Department of Preventive and Community Dentistry, School of Dentistry, Pusan National University, 49, Busandaehak-ro, Mulgeum-eup, Yangsan, Gyeongsangnam-do 50612, Korea.
- BK 21 PLUS Project, School of Dentistry, Pusan National University, Yangsan 50612, Korea.
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19
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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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20
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Safiri S, Kelishadi R, Heshmat R, Rahimi A, Djalalinia S, Ghasemian A, Sheidaei A, Motlagh ME, Ardalan G, Mansourian M, Asayesh H, Sepidarkish M, Qorbani M. Socioeconomic inequality in oral health behavior in Iranian children and adolescents by the Oaxaca-Blinder decomposition method: the CASPIAN- IV study. Int J Equity Health 2016; 15:143. [PMID: 27628496 PMCID: PMC5024445 DOI: 10.1186/s12939-016-0423-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 08/17/2016] [Indexed: 12/03/2022] Open
Abstract
Background The present study set to describe the socioeconomic inequality associated with oral hygiene behavior among Iranian pediatric population. Methods A representative sample of 13486 school students aged 6–18 years was selected through multistage random cluster sampling method from urban and rural areas of 30 provinces in Iran. Principle Component Analyses (PCA) correlated variables summarized as socioeconomic status (SES). Association of independent variables with tooth brushing was assessed through logistic regression analysis. Decomposition of the gap in tooth brushing between the first and fifth SES quintiles was assessed using the counterfactual decomposition technique. To assess the relation between tooth brushing and each socioeconomic category, Concentration Index (C) and the slope index of inequality (SII) were used, representing the linear regression coefficient. Results The participation rate was 90.6 % (50.7 % boys and 75.6 % urban inhabitants). The mean age of participants was 12.47 ± 3.36 years. The frequency of tooth brushing increased across SES quintiles, prevalence of tooth brushing between the first and fifth quintile, under 20 % difference, increased from 58.22 (95 % CI: 56.24,60.20) to 78.61 (95 % CI: 77.00,80.24). Only 3 % of the difference is explained by the factors considered in the study, and 17 % remained unknown. Residence area, family size, and smoking status made a significant contribution to the gap between the first and last SE groups. Residence area [ −2.01 (95 % CI: −3.46, −0.55)] was along the maximum levels of gaps between SE categories. Conclusions The findings revealed a socio-economic inequality in oral health behavior in Iranian children and adolescents. Also, factors influencing oral health are addressed to develop and implement complementary public health actions.
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Affiliation(s)
- Saeid Safiri
- Managerial Epidemiology Research Center, Department of Public Health, School of Nursing and Midwifery, Maragheh University of Medical Sciences, Maragheh, Iran.,Road Traffic Injury Research Center, Department of Statistics & Epidemiology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Roya Kelishadi
- Child Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ramin Heshmat
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Rahimi
- School of Humanities and Tourism Management, Bangkok University, Bangkok, Thailand
| | - Shirin Djalalinia
- Development of Research & Technology Center, Deputy of Research and Technology, Ministry of Health and Medical Education, Tehran, Iran
| | | | - Ali Sheidaei
- Department of Epidemiology and Biostatistics, Shahid Beheshti University of Medical Science, Tehran, Iran
| | | | - Gelayol Ardalan
- Development of Research & Technology Center, Deputy of Research and Technology, Ministry of Health and Medical Education, Tehran, Iran
| | - Morteza Mansourian
- Department of Health Education, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Hamid Asayesh
- Department of Medical Emergencies, Qom University of Medical Sciences, Qom, Iran
| | - Mahdi Sepidarkish
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Centre, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Mostafa Qorbani
- Department of Community Medicine, School of Medicine, Alborz University of Medical Science, Karaj, Iran. .,Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
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21
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Ha DH, Xiangqun J, Cecilia MG, Jason A, Do LG, Jamieson LM. Social inequality in dental caries and changes over time among Indigenous and non-Indigenous Australian children. Aust N Z J Public Health 2016; 40:542-547. [DOI: 10.1111/1753-6405.12566] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 03/01/2015] [Accepted: 04/01/2015] [Indexed: 11/29/2022] Open
Affiliation(s)
- Diep Hong Ha
- Australian Research Centre for Population Oral Health (ARCPOH), School of Dentistry; The University of Adelaide; South Australia
| | - Ju Xiangqun
- Australian Research Centre for Population Oral Health (ARCPOH), School of Dentistry; The University of Adelaide; South Australia
| | - Mejia Gloria Cecilia
- Australian Research Centre for Population Oral Health (ARCPOH), School of Dentistry; The University of Adelaide; South Australia
- School of Dental Medicine; East Carolina University; USA
| | - Armfield Jason
- Australian Research Centre for Population Oral Health (ARCPOH), School of Dentistry; The University of Adelaide; South Australia
| | - Loc G. Do
- Australian Research Centre for Population Oral Health (ARCPOH), School of Dentistry; The University of Adelaide; South Australia
| | - Lisa M Jamieson
- Australian Research Centre for Population Oral Health (ARCPOH), School of Dentistry; The University of Adelaide; South Australia
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22
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McLaren L, McNeil DA, Potestio M, Patterson S, Thawer S, Faris P, Shi C, Shwart L. Equity in children's dental caries before and after cessation of community water fluoridation: differential impact by dental insurance status and geographic material deprivation. Int J Equity Health 2016; 15:24. [PMID: 26864565 PMCID: PMC4750250 DOI: 10.1186/s12939-016-0312-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 02/01/2016] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND One of the main arguments made in favor of community water fluoridation is that it is equitable in its impact on dental caries (i.e., helps to offset inequities in dental caries). Although an equitable effect of fluoridation has been demonstrated in cross-sectional studies, it has not been studied in the context of cessation of community water fluoridation (CWF). The objective of this study was to compare the socio-economic patterns of children's dental caries (tooth decay) in Calgary, Canada, in 2009/10 when CWF was in place, and in 2013/14, after it had been discontinued. METHODS We analyzed data from population-based samples of schoolchildren (grade 2) in 2009/10 and 2013/14. Data on dental caries (decayed, missing, and filled primary and permanent teeth) were gathered via open mouth exams conducted in schools by registered dental hygienists. We examined the association between dental caries and 1) presence/absence of dental insurance and 2) small area index of material deprivation, using Poisson (zero-inflated) and logistic regression, for both time points separately. For small-area material deprivation at each time point, we also computed the concentration index of inequality for each outcome variable. RESULTS Statistically significant inequities by dental insurance status and by small area material deprivation were more apparent in 2013/14 than in 2009/10. CONCLUSIONS Results are consistent with increasing inequities in dental caries following cessation of CWF. However, further research is needed to 1) confirm the effects in a study that includes a comparison community, and 2) explore possible alternative reasons for the findings, including changes in treatment and preventive programming.
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Affiliation(s)
- Lindsay McLaren
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
| | - Deborah A McNeil
- Research and Innovation, Population, Public and Aboriginal Health, Alberta Health Services, Calgary, AB, Canada.
| | - Melissa Potestio
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
- Alberta Cancer Prevention Legacy Fund, Population Public and Aboriginal Health, Alberta Health Services, Calgary, AB, Canada.
| | - Steve Patterson
- Faculty of Medicine and Dentistry, School of Dentistry, University of Alberta, Edmonton, AB, Canada.
| | - Salima Thawer
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
| | - Peter Faris
- Research Facilitation, Priorities, and Implementation, Alberta Health Services, Calgary, AB, Canada.
| | - Congshi Shi
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
| | - Luke Shwart
- Provincial Oral Health Office, Population, Public and Aboriginal Health, Alberta Health Services, Calgary, AB, Canada
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Kumar S, Tadakamadla J, Kroon J, Johnson NW. Impact of parent-related factors on dental caries in the permanent dentition of 6-12-year-old children: A systematic review. J Dent 2015; 46:1-11. [PMID: 26747024 DOI: 10.1016/j.jdent.2015.12.007] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 11/27/2015] [Accepted: 12/26/2015] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To synthesise data from the literature on the effects of various parent-related characteristics (socio-demographic, behavioural and family environment) on dental caries in the permanent dentition of children. DATA Available studies in which the effects of parent-related characteristics on dental caries experience in the permanent dentition of children aged 6-12 years were evaluated. SOURCES PubMed, Medline via OVID and CINAHL Plus via EBSCO, restricted to scientific articles, were searched in April 2015. English language and time filters (articles published from 2000) were used. STUDY SELECTION A total of 4162 titles were retrieved, of which 2578 remained after duplicates were removed. After review of titles and their abstracts by two independent reviewers, 114 articles were considered relevant for full text review. Of these, 48 were considered for final inclusion. Data extraction was performed by two authors using piloted data extraction sheets. CONCLUSIONS Most of the literature on determinants of dental caries has been limited to socio-economic and behavioural aspects: we found few studies evaluating the effects of family environment and parental oral hygiene behaviour. Children belonging to lower socio-economic classes experienced more caries. In more than half the studies, children of highly educated, professional and high income parents were at lower risk for dental caries. There were conflicting results from studies on the effect of variables related to family environment, parents' oral hygiene behaviour and parent's disease status on dental caries in their children.
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Affiliation(s)
- Santhosh Kumar
- Population and Social Health Research Programme, Menzies Health Institute Queensland and School of Dentistry and Oral Health, Griffith University, Queensland, Australia.
| | - Jyothi Tadakamadla
- Population and Social Health Research Programme, Menzies Health Institute Queensland and School of Dentistry and Oral Health, Griffith University, Queensland, Australia
| | - Jeroen Kroon
- Population and Social Health Research Programme, Menzies Health Institute Queensland and School of Dentistry and Oral Health, Griffith University, Queensland, Australia
| | - Newell W Johnson
- Dental Research, Population and Social Health Research Programme, Menzies Health Institute Queensland, Griffith University, Queensland, Australia
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Kramer PF, Chaffee BW, Bertelli AE, Ferreira SH, Béria JU, Feldens CA. Gains in children's dental health differ by socioeconomic position: evidence of widening inequalities in southern Brazil. Int J Paediatr Dent 2015; 25:383-92. [PMID: 25323949 PMCID: PMC4401627 DOI: 10.1111/ipd.12140] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
UNLABELLED Oral health inequalities are the measures by which equity in oral health is tracked. Despite widespread improvement in children's dental health globally, substantial socio-economic disparities persist and may be worsening. OBJECTIVES Quantify 10-year changes in child caries occurrence by socio-economic position in a Southern Brazilian city and compare oral health inequalities over time. METHODS Representative surveys of dental caries in children (age <6 years) in Canoas, Brazil, were conducted in 2000 and 2010 following standardized methods. For each survey year, we calculated disparities by socio-economic position (maternal education and family income) in age- and sex-standardized caries occurrence (prevalence: dmft > 0; severity: mean dmft) using absolute measures (difference and Slope Index of Inequality) and relative measures (ratio and Relative Index of Inequality). RESULTS Comparing 2010 to 2000, caries occurrence was lower in all socio-economic strata. However, reductions were more pronounced among socio-economically advantaged groups, yielding no improvement in children's oral health disparities. Some disparity indicators were consistent with increasing inequality. CONCLUSIONS Overall, dental caries levels among children in Canoas improved, but inequalities in disease distribution endured. Concerted public health efforts targeting socio-economically disadvantaged groups are needed to achieve greater equity in children's oral health.
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Affiliation(s)
| | - Benjamin W. Chaffee
- Department of Preventive and Restorative Dental Sciences, University of California San Francisco, San Francisco, United States
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Holstein BE, Bast LS, Brixval CS, Damsgaard MT. Trends in Social Inequality in Tooth Brushing among Adolescents: 1991-2014. Caries Res 2015; 49:595-9. [DOI: 10.1159/000441196] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Accepted: 09/11/2015] [Indexed: 11/19/2022] Open
Abstract
This study examines whether social inequality in tooth brushing frequency among adolescents changed from 1991 to 2014. The data material was seven comparable cross-sectional studies of nationally representative samples of 11- to 15-year-olds in Denmark with data about frequency of tooth brushing and occupation of parents. The total number of participants was 31,464, of whom 21.7% brushed their teeth less than the recommended 2 times a day. The absolute social inequality measured as prevalence difference between low and high social class increased from 7.7% in 1991 to 14.6% in 2014. The relative social inequality assessed by odds ratios for infrequent tooth brushing also increased from 1991 to 2014.
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Validation of the child oral health impact profile (COHIP) french questionnaire among 12 years-old children in New Caledonia. Health Qual Life Outcomes 2015; 13:176. [PMID: 26518886 PMCID: PMC4628352 DOI: 10.1186/s12955-015-0371-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 10/20/2015] [Indexed: 11/17/2022] Open
Abstract
Background The Child Oral Health Impact Profile (COHIP) is an Oral Health Related Quality of Life (OHRQOL) tool that assesses the impact of oral diseases on quality of life in children. This study aimed to assess the validity of the COHIP French questionnaire (45 items) and to evaluate the OHRQOL of 12-years children in New Caledonia. Methods After cultural adaptation of the COHIP questionnaire, data were collected from clinical oral examinations and self-administered questionnaires in a representative sample of children aged 12 years in New Caledonia. Questions related to socio-demographic status or children’s perception of their oral and general health were added to the COHIP questionnaire. Studying the association between COHIP scores and health subjective perceptions or dental status indicators assessed concurrent and discriminant validity. The items of the COHIP were subjected to principal components analysis. Finally, reproducibility and reliability were evaluated using Intraclass Correlation Coefficients (ICC) and Cronbach’s alpha coefficient. Results Two hundred and thirty-six children participated in the main study; mean age was 12.6 ± 0.31 years, 55.1 % were girls and diverse ethnic groups were represented. A preliminary reliability analysis has led to calculate COHIP scores with 34 items as in the English version, scores ranged from 35 to 131 (mean ± SD, 101.9 ± 16.84). Lower COHIP scores were significantly associated with the self-perception of poor general or oral health. COHIP was able to discriminate between participants according to gender, ethnic group, oral hygiene, dental attendance, dental fear and the presence of oral diseases. Test–retest reliability and scale reliability were excellent (ICC = 0.904; Cronbach’s alpha coefficient = 0.880). Four components were identified from the factor analysis. Conclusion The French 34-items COHIP showed excellent psychometric properties. Further testing will examine the structure and utility of the instrument in both clinical and epidemiological samples.
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Capurro DA, Iafolla T, Kingman A, Chattopadhyay A, Garcia I. Trends in income-related inequality in untreated caries among children in the United States: findings from NHANES I, NHANES III, and NHANES 1999-2004. Community Dent Oral Epidemiol 2015; 43:500-10. [PMID: 26037290 DOI: 10.1111/cdoe.12174] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 05/08/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The goal of this analysis was to describe income-related inequality in untreated caries among children in the United States over time. METHODS The analysis focuses on children ages 2-12 years in three nationally representative U.S. surveys: the National Health and Nutrition Examination Survey (NHANES) 1971-1974, NHANES 1988-1994, and NHANES 1999-2004. The outcome of interest is untreated dental caries. Various methods are employed to measure absolute and relative inequality within each survey such as pair-wise comparisons, measures of association (odds ratios), and three summary measures of overall inequality: the slope index of inequality, the relative index of inequality, and the concentration index. Inequality trends are then assessed by comparing these estimates across the three surveys. RESULTS Inequality was present in each of the three surveys analyzed. Whether measured on an absolute or relative scale, untreated caries disproportionately affected those with lower income. Trend analysis shows that, despite population-wide reductions in untreated caries between NHANES I and NHANES III, overall absolute inequality slightly increased, while overall relative inequality significantly increased. Between NHANES III and NHANES 1999-2004, both absolute and relative inequality tended to decrease; however, these changes were not statistically significant. CONCLUSIONS Socioeconomic inequality in oral health is an important measure of progress in overall population health and a key input to inform health policies. This analysis shows the presence of socioeconomic inequality in oral health in the American child population, as well as changes in its magnitude over time. Further research is needed to determine the factors related to these changes and their relative contribution to inequality trends.
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Affiliation(s)
| | - Timothy Iafolla
- National Institute of Dental and Craniofacial Research, National Institutes of Health (NIDCR/NIH), Bethesda, MD, USA
| | - Albert Kingman
- National Institute of Dental and Craniofacial Research, National Institutes of Health (NIDCR/NIH), Bethesda, MD, USA
| | - Amit Chattopadhyay
- Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Isabel Garcia
- College of Dentistry, University of Florida, Gainesville, FL, USA
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Poon BT, Holley PC, Louie AM, Springinotic CM. Dental caries disparities in early childhood: A study of kindergarten children in British Columbia. Canadian Journal of Public Health 2015; 106:e308-14. [PMID: 26451993 DOI: 10.17269/cjph.106.4918] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 06/25/2015] [Accepted: 05/02/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The objective of this paper was to describe results of a public health-administered, provincial dental survey of children aged 4-6 years old in British Columbia, and assess the changes in rates of dental caries geographically and by neighbourhood socio-economic status between baseline (2006/07) and follow-up data collection (2009/10). METHOD The study design involved two retrospective cohorts of kindergarten children who received a public health-administered dental assessment in the years 2006/07 and 2009/10. Neighbourhood socio-economic status was measured by an index created from Canadian Census and Tax Filer data sets. The dental outcomes included previous decay experience, untreated visible decay, and urgent treatment needs. RESULTS The analysis comprised dental outcomes for 35,602 kindergarten children in 2006/07 and 35,215 children in 2009/10. There was a modest decrease in dental decay rates between surveys, with rates of decay experience - previous and untreated - of 38.9% and 36.7% respectively. However, there were disparities, with almost 50% of children with dental decay in the most socio-economically disadvantaged neighbourhoods, and approximately 30% with dental decay in the least disadvantaged areas. CONCLUSION The kindergarten dental survey had extensive coverage, was at the population level, and enabled analysis of change in early childhood dental decay rates over time and by geography. Although overall rates improved, dental health inequalities persisted in both survey years at both regional and neighbourhood levels.
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Affiliation(s)
- Brenda T Poon
- Human Early Learning Partnership University of British Columbia.
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Calzón Fernández S, Fernández Ajuria A, Martín JJ, Murphy MJ. The impact of the economic crisis on unmet dental care needs in Spain. J Epidemiol Community Health 2015; 69:880-5. [DOI: 10.1136/jech-2014-204493] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 03/02/2015] [Indexed: 01/08/2023]
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Roncalli AG, Sheiham A, Tsakos G, Watt RG. Socially unequal improvements in dental caries levels in Brazilian adolescents between 2003 and 2010. Community Dent Oral Epidemiol 2015; 43:317-24. [DOI: 10.1111/cdoe.12156] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 01/13/2015] [Indexed: 01/28/2023]
Affiliation(s)
- Angelo G. Roncalli
- Department of Dentistry; Federal University of Rio Grande do Norte; Natal RN Brazil
- Department of Epidemiology and Public Health; University College London; London UK
| | - Aubrey Sheiham
- Department of Epidemiology and Public Health; University College London; London UK
| | - Georgios Tsakos
- Department of Epidemiology and Public Health; University College London; London UK
| | - Richard G. Watt
- Department of Epidemiology and Public Health; University College London; London UK
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Sgan-Cohen H, Livny A, Listl S. Dental health among older Israeli adults: is this a reflection of a medical care model inadequately addressing oral health? Int Dent J 2014; 65:49-56. [PMID: 25345406 DOI: 10.1111/idj.12135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES Israel's health-care system is considered as one of the most efficient worldwide. The purpose of the present study was to assess oral health outcomes, dental care use and respective social inequalities among the older segment of the Israeli population. METHODS Secondary analyses were conducted of recently available data from the Survey of Health, Ageing, and Retirement in Europe (SHARE Israel, wave 2), which specifically includes information on chewing ability, denture wearing and dental care use obtained from more than 2,400 Israeli people, 50+ years of age. Multivariate logistic regressions and concentration indices were used to analyse determinants of oral health and dental care use. RESULTS Seventy per cent of respondents reported being able to bite/chew on hard foods and 49% of respondents reported wearing dentures. Forty-three per cent of respondents had visited a dentist within the past 12 months, with about half of all dental visits being made for solely nonpreventive reasons. Significant income-related inequalities were identified, with higher income being associated with greater dental care use (particularly preventive dental visits), better chewing ability and less denture wearing. CONCLUSIONS For the older segment of the Israeli population and compared with other countries, the findings of the present study suggest a relatively low level of chewing ability, a high extent of nonpreventive dental visiting, as well as considerable inequalities in oral health and care. It seems that the Israeli health-care system may be improved even further by more comprehensive inclusion of dental care into universal health coverage.
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Affiliation(s)
- Harold Sgan-Cohen
- Department of Community Dentistry, Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel
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Arora A, Lam ASF, Karami Z, Do LG, Harris MF. How readable are Australian paediatric oral health education materials? BMC Oral Health 2014; 14:111. [PMID: 25183234 PMCID: PMC4236645 DOI: 10.1186/1472-6831-14-111] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 08/29/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The objective of this study was to analyse the readability of paediatric oral health education leaflets available in Australia. METHODS Forty paediatric oral health education materials were analysed for general readability according to the following parameters: Thoroughness; Textual framework; Terminology; and Readability (Flesch-Kincaid grade level (FKGL), Gunning Fog index (Fog) and Simplified Measure of Gobbledygook (SMOG)). RESULTS Leaflets produced by the industry were among the hardest to read with an average readability at the 8th grade (8.4 ± 0.1). The readability of leaflets produced by the commercial sector was at the 7th grade (7.1 ± 1.7) and the government at the 6th grade (6.3 ± 1.9). The FKGL consistently yielded readabilities 2 grades below the Fog and SMOG indexes. In the content analyses, 14 essential paediatric oral health topics were noted and Early Childhood Caries (ECC) was identified as the most commonly used jargon term. CONCLUSION Paediatric oral health education materials are readily available, yet their quality and readability vary widely and may be difficult to read for disadvantaged populations in Australia. A redesign of these leaflets while taking literacy into consideration is suggested.
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Affiliation(s)
- Amit Arora
- Centre for Primary Health Care and Equity, Faculty of Medicine, UNSW Australia, Room 345, Level 3, AGSM Building, Gate 11, Botany Street, Randwick NSW 2052, Australia
- Faculty of Dentistry, University of Sydney, Westmead, NSW, Australia
- Sydney and Sydney South West Local Health District, Sydney, NSW, Australia
| | - Andy SF Lam
- Faculty of Dentistry, University of Sydney, Westmead, NSW, Australia
| | - Zahra Karami
- Faculty of Dentistry, University of Sydney, Westmead, NSW, Australia
| | - Loc Giang Do
- Australian Research Centre for Population Oral Health, University of Adelaide, Adelaide, SA, Australia
| | - Mark Fort Harris
- Centre for Primary Health Care and Equity, Faculty of Medicine, UNSW Australia, Room 345, Level 3, AGSM Building, Gate 11, Botany Street, Randwick NSW 2052, Australia
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Frazão P, Benicio MHD, Narvai PC, Cardoso MA. Food insecurity and dental caries in schoolchildren: a cross-sectional survey in the western Brazilian Amazon. Eur J Oral Sci 2014; 122:210-5. [DOI: 10.1111/eos.12124] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2014] [Indexed: 12/21/2022]
Affiliation(s)
- Paulo Frazão
- Department of Public Health Practice; School of Public Health; University of São Paulo; São Paulo Brazil
| | - Maria H. D. Benicio
- Department of Nutrition; School of Public Health; University of São Paulo; São Paulo Brazil
| | - Paulo C. Narvai
- Department of Public Health Practice; School of Public Health; University of São Paulo; São Paulo Brazil
| | - Marly A. Cardoso
- Department of Nutrition; School of Public Health; University of São Paulo; São Paulo Brazil
- David Rockefeller Center for Latin American Studies; Harvard University; Cambridge MA USA
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Shen J, Wildman J, Steele J. Measuring and decomposing oral health inequalities in an UK population. Community Dent Oral Epidemiol 2013; 41:481-9. [PMID: 23992442 PMCID: PMC3812409 DOI: 10.1111/cdoe.12071] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Accepted: 07/27/2013] [Indexed: 12/03/2022]
Abstract
Objectives With health inequalities high on the policy agenda, this study measures oral health inequalities in the UK. Methods We compare an objective clinical measure of oral health (number of natural teeth) with a self-reported measure of the impact of oral health (the Oral Health Impact Profile, OHIP) to establish whether the type of measure affects the scale of inequality measured. Gini coefficients and Concentration Indices (CIs) are calculated with subsequent decompositions using data from the 1998 UK Adult Dental Health Survey. Because the information on OHIP is only available on dentate individuals, analyses on the number of natural teeth are conducted for two samples – the entire sample and the sample with dentate individuals only, the latter to allow direct comparison with OHIP. Results We find considerable overall pure oral health inequalities (number of teeth: Gini = 0.68 (including edentate), Gini = 0.40 (excluding edentate); OHIP: Gini = 0.33) and income-related inequalities for both measures (number of teeth: CI = 0.35 (including edentate), CI = 0.15 (excluding edentate); OHIP: CI = 0.03), and the CI is generally higher for the number of teeth than for OHIP. There are differences across age groups, with CI increasing with age for the number of teeth (excluding edentate: 16–30 years: CI = 0.01, 65 + years: CI = 0.11; including edentate: 16–30 years: CI = 0.01, 65 + years: CI = 0.19). However, inequalities for OHIP were highest in the youngest age group (CI = 0.05). Number of teeth reflects the accumulation of damage over a lifetime, while OHIP records more immediate concerns. Conclusions There are considerable pure oral health inequalities and income-related oral health inequalities in the UK. Using sophisticated methods to measure oral health inequality, we have been able to compare inequality in oral health with inequality in general health. The results provide a benchmark for future comparisons but also indicate that the type of health measure may be of considerable significance in how we think about and measure oral health inequalities.
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Affiliation(s)
- Jing Shen
- Institute of Health & Society, Newcastle University, Newcastle Upon Tyne, UK
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Moysés SJ. Inequalities in oral health and oral health promotion. Braz Oral Res 2013; 26 Suppl 1:86-93. [PMID: 23318749 DOI: 10.1590/s1806-83242012000700013] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2012] [Accepted: 09/03/2012] [Indexed: 11/22/2022] Open
Abstract
This article offers a critical review of the problem of inequalities in oral health and discusses strategies for disease prevention and oral health promotion. It shows that oral health is not merely a result of individual biological, psychological, and behavioral factors; rather, it is the sum of collective social conditions created when people interact with the social environment. Oral health status is directly related to socioeconomic position across the socioeconomic gradient in almost all populations. The main priority for dental interventions is that they be integrated collaboratively and enable research and policies that address the main proximal determinants of oral diseases, i.e., sugars, smoking, hygiene, and risk behaviors. Adopting a mixed approach, these interventions should also reduce inequality, focusing on the socioeconomic determinants, to change the slope of the social gradient. The cornerstone of this approach is the Integrated Common Risk Factor Approach (CRFA).
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Affiliation(s)
- Samuel Jorge Moysés
- School of Health and Biosciences, Pontifical Catholic University of Paraná, Curitiba, PR, Brazil.
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Rogers J. Building the links between surveillance, research, and policy and practice--dental public health experiences in Australia. Community Dent Oral Epidemiol 2013; 40 Suppl 2:82-9. [PMID: 22998310 DOI: 10.1111/j.1600-0528.2012.00725.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To identify how to translate dental public health surveillance and broader research into policy and practice. METHODS Via a literature review to identify both the potential uses of surveillance data and key elements in the policy making process. Then through a consideration of Australian dental public health examples to identify ways to build links between this research and policy making. RESULTS The development of dental public health policy can be complex. Different notions of evidence are held by researchers and policy makers. A cultural gap divides these two groups. Translation of research into policy is more likely if an issue is moved up the policy agenda through judicial articulation of the problem with an associated policy proposal and where political factors are positive. If these elements exist, a policy outcome is more possible when a 'policy window' opens. Five ways to build the links between surveillance, research and policy and practice are to communicate across the cultural gap; be prepared for chance opportunities to transfer knowledge; undertake policy relevant research; don't abuse research evidence by making exaggerated claims; and provide timely dissemination of surveillance and research findings. Structural barriers to academics having greater engagement with policy agencies also need to be addressed. CONCLUSION Translating surveillance and broader research evidence into policy requires active management rather than expecting passive diffusion. Researchers need to understand and act on the external factors that are likely to affect the uptake of their research if they want their research to influence policy and practice.
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Affiliation(s)
- John Rogers
- Melbourne Dental School, The University of Melbourne, Melbourne, Victoria, Australia.
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Blair YI, McMahon AD, Macpherson LMD. Comparison and relative utility of inequality measurements: as applied to Scotland's child dental health. PLoS One 2013; 8:e58593. [PMID: 23520524 PMCID: PMC3592808 DOI: 10.1371/journal.pone.0058593] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Accepted: 02/07/2013] [Indexed: 11/18/2022] Open
Abstract
This study compared and assessed the utility of tests of inequality on a series of very large population caries datasets. National cross-sectional caries datasets for Scotland's 5-year-olds in 1993/94 (n = 5,078); 1995/96 (n = 6,240); 1997/98 (n = 6,584); 1999/00 (n = 6,781); 2002/03 (n = 9,747); 2003/04 (n = 10,956); 2005/06 (n = 10,945) and 2007/08 (n = 12,067) were obtained. Outcomes were based on the d3mft metric (i.e. the number of decayed, missing and filled teeth). An area-based deprivation category (DepCat) measured the subjects' socioeconomic status (SES). Simple absolute and relative inequality, Odds Ratios and the Significant Caries Index (SIC) as advocated by the World Health Organization were calculated. The measures of complex inequality applied to data were: the Slope Index of Inequality (absolute) and a variety of relative inequality tests i.e. Gini coefficient; Relative Index of Inequality; concentration curve; Koolman & Doorslaer's transformed Concentration Index; Receiver Operator Curve and Population Attributable Risk (PAR). Additional tests used were plots of SIC deciles (SIC(10)) and a Scottish Caries Inequality Metric (SCIM(10)). Over the period, mean d3mft improved from 3.1(95%CI 3.0-3.2) to 1.9(95%CI 1.8-1.9) and d3mft = 0% from 41.1(95%CI 39.8-42.3) to 58.3(95%CI 57.8-59.7). Absolute simple and complex inequality decreased. Relative simple and complex inequality remained comparatively stable. Our results support the use of the SII and RII to measure complex absolute and relative SES inequalities alongside additional tests of complex relative inequality such as PAR and Koolman and Doorslaer's transformed CI. The latter two have clear interpretations which may influence policy makers. Specialised dental metrics (i.e. SIC, SIC(10) and SCIM(10)) permit the exploration of other important inequalities not determined by SES, and could be applied to many other types of disease where ranking of morbidity is possible e.g. obesity. More generally, the approaches described may be applied to study patterns of health inequality affecting worldwide populations.
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Affiliation(s)
- Yvonne I Blair
- Dental Public Health, Oral Health Directorate, Clutha House, Glasgow, Scotland, United Kingdom.
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Jagger DC, Sherriff A, Macpherson LM. Measuring socio-economic inequalities in edentate Scottish adults--cross-sectional analyses using Scottish Health Surveys 1995-2008/09. Community Dent Oral Epidemiol 2013; 41:499-508. [PMID: 23398352 DOI: 10.1111/cdoe.12040] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Accepted: 01/13/2013] [Indexed: 01/04/2023]
Abstract
OBJECTIVES To investigate the appropriateness of different measures of socio-economic inequalities, in relation to adult oral health in Scotland, utilizing data from a series of large, representative population surveys. METHODS The Scottish Health Surveys (SHeS) (1995; 1998; 2003; 2008/09) are cross-sectional national population-based surveys used to monitor health status in those living in private households. The age groups included in this study are as follows: 45-54; 55-64 years: all survey years; 65-74: 1998 onwards; 75+: 2003 onwards. Primary outcome was no natural teeth (edentulism). Three measures of socio-economic position: Occupational social class, Education, Carstairs deprivation score (2001) were used. Simple (absolute/relative differences) and complex measures (Slope Index, Relative Index, Concentration Index and c-index) of inequality were produced for each age group across all four surveys. RESULTS Simple and complex (absolute) measures of inequality have both demonstrated narrowing disparities in edentulism over time in the 45- to 64-year-old group, a levelling off in those aged 65 and above, and a rise in those aged 75+. Complex relative measures (RII, Concentration Index and c-index), however, show an increasing trend in inequalities over time for all age groups, suggesting that rates of improvement in edentulism rates are not uniform across all social groups. CONCLUSIONS Simple absolute inequality provides a quick and easy indication of the extent of disparities between extreme groups, whereas complex measures (absolute and relative) consider the gradient in health across all social groups. We have demonstrated that both are useful measures of inequality and should be considered complementary to one another. The appropriate choice of complex measure of inequality will depend on the audience to whom the results are to be communicated. This methodological approach is not confined to oral health but is applicable to other health outcomes that are socially patterned.
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Affiliation(s)
- Daryll C Jagger
- Clinical Dentistry, Glasgow Dental Hospital & School, University of Glasgow, Glasgow, UK
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Ravaghi V, Quiñonez C, Allison PJ. The magnitude of oral health inequalities in Canada: findings of the Canadian health measures survey. Community Dent Oral Epidemiol 2013; 41:490-8. [DOI: 10.1111/cdoe.12043] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2012] [Accepted: 01/13/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Vahid Ravaghi
- Oral Health & Society Research Unit; Faculty of Dentistry; McGill University; Montreal QC Canada
| | - Carlos Quiñonez
- Dental Public Health; Faculty of Dentistry; University of Toronto; Toronto ON Canada
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Abstract
The purpose of this study was to identify socio-economic inequalities in regular dental attendance throughout the life-course. The analyses relied on data from SHARE (waves 1 to 3 of the Survey of Health, Ageing, and Retirement in Europe), which includes retrospective information on life-course dental attendance of 26,525 persons currently aged 50 years or greater from 13 European countries (Austria, Poland, Spain, Italy, the Netherlands, Belgium, Greece, the Czech Republic, France, Denmark, Switzerland, Germany, and Sweden). Inequalities in dental attendance were assessed by means of Concentration Indices. Socio-economic disparities in regular dental attendance were identified as early as childhood. Moreover, higher educational attainment resulted in increased probabilities of regular dental attendance throughout subsequent life-years in all nations. In most countries, inequality levels remained relatively inelastic throughout the life-course. These findings suggest that a considerable proportion of inequalities in dental care use is already established at childhood and persists throughout the life-course.
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Affiliation(s)
- S Listl
- Department of Conservative Dentistry, University of Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
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Affiliation(s)
- Kaye Roberts-Thomson
- Australian Research Centre for Population Oral Health (ARCPOH); School of Dentistry; The University of Adelaide; SA; Australia
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Somkotra T. Experience of socioeconomic-related inequality in dental care utilization among Thai elderly under universal coverage. Geriatr Gerontol Int 2012; 13:298-306. [PMID: 22726702 DOI: 10.1111/j.1447-0594.2012.00895.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM To assess the socioeconomic-related inequality in dental care utilization among Thai elderly and to determine factors associated with the observed inequality after the country achieved universal coverage. METHODS The data were taken from the nationally representative Thailand Health & Welfare Survey 2007. Data of 10,096 Thai elderly (aged over 60 years) were selected. Descriptive analyses of the features of dental care utilization among Thai elderly were carried out, in addition to the concentration index (Cindex ) being used to quantify the extent of socioeconomic-related inequality in dental care utilization. Logistic regression was used to determine factors associated with inequality in dental care. RESULTS Socioeconomic-related inequality in dental care utilization among Thai elderly was shown. Also, utilization was more concentrated among wealthier older adults, as shown by the positive value of Cindex (equals 0.244). The poor elderly, however, were more likely to utilize dental care at public facilities, particularly primary care facilities. Multivariate analysis showed that certain demographic, socioeconomic and geographic characteristics were particularly associated with poor-rich differences in dental care utilization among Thai elderly. CONCLUSIONS Although socioeconomic-related inequality in dental care utilization among Thai elderly exists, the pro-poor utilization at public facilities, particularly primary care facilities, substantiates the concerted effort to reducing inequality in dental care utilization for Thai elderly.
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Affiliation(s)
- Tewarit Somkotra
- Department of Community Dentistry, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand.
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Do LG. Distribution of caries in children: variations between and within populations. J Dent Res 2012; 91:536-43. [PMID: 22223436 DOI: 10.1177/0022034511434355] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The rapid changes in social and economic conditions in many populations may have significant impacts on health, including child oral health. Understanding trends and variations between and within countries will assist in the development of effective preventive programs. This review aims (1) to document time-trends in child caries experience of countries with different levels of social and economic development, and (2) to compare factors affecting the caries experience of children in two contrasting countries. A time-trend analytical approach of ecological data from countries with different levels of social and economic development and individual data of the two contrasting Vietnamese and Australian child populations were used. The analysis found a significant decline in caries experience of children, mostly driven by the improvement in populations with high social and economic development. Significant variations in caries experience and in associations with risk factors between and within countries were observed. Socio-economic inequality in child oral health existed within developed countries and between countries with different levels of development. Population programs aimed at improving upstream factors are of priority in further improving child oral health in different populations.
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Affiliation(s)
- L G Do
- The University of Adelaide, Australian Research Centre for Population Oral Health, School of Dentistry, Adelaide, Australia.
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Abstract
BACKGROUND Despite its importance for the planning of future treatment needs and an optimised allocation of health care resources, only little is known about socio-economic inequalities in denture-wearing by late middle-aged and elderly generations. OBJECTIVES To describe income-related inequalities in denture-wearing by elderly populations residing in different European countries. MATERIAL AND METHODS Data from the Survey of Health, Ageing and Retirement in Europe (SHARE Wave 2) were used to assess income-related inequalities in denture-wearing by means of Concentration Indices (CI) for populations aged 50+ from 14 different European countries. RESULTS We could identify a significant disproportionate concentration of denture-wearing amongst the poor elderly populations in Denmark (CI = -0.3534, corresponding to the highest level of inequality), Sweden (CI = -0.3479), Switzerland (CI = -0.2013), Greece (CI = -0.1953), the Netherlands (CI = -0.1413), France (CI = -0.1339), Austria (CI = -0.0974), Czech Republic (CI = -0.0959), Belgium (CI = -0.0947), Germany (CI = -0.0762), Ireland (CI = -0.0575) and Spain (CI = -0.0482, corresponding to the lowest level of pro-poor inequality). Poland became evident as the only country in which individuals from the upper end of the income scale wear more dentures than their peers from the lower end of the income scale (CI = 0.0379). No significant income-related inequalities were observable in Italy. CONCLUSIONS There is considerable income-related inequality in denture-wearing by several elderly populations in Europe. Future resource planning for prosthetic care should, thus, specifically distinguish between the treatment needs of different socio-economic groups within elderly populations.
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Affiliation(s)
- Stefan Listl
- Department of Conservative Dentistry, University of Heidelberg, Heidelberg, Germany.
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Abstract
The purpose of this study was to describe income-related inequalities in dental service utilization by the elderly populations residing in different European countries. We used data from the Survey of Health, Ageing, and Retirement in Europe (SHARE Wave 2), which contains information on utilization of dental services by 33,358 individuals aged 50+ years from 14 different countries. We assessed income-related inequalities in dental attendance and preventive and/or operative dental treatment by means of Concentration Indices (CI) and Slope Indices of Inequality (SII). We could identify a disproportionate concentration of access to treatment among the rich elderly populations in all 14 countries (relative inequality according to CI), as well as significantly higher access to treatment by individuals located in the highest in relation to the lowest income group for all countries except Italy and the Czech Republic (absolute inequality according to SII). Such differential utilization appears mainly attributable to inequalities in preventive dental visits, either alone or in combination with operative treatment. Persons' oral health status explains substantial proportions of absolute but not of relative inequalities. Overall, there is considerable income-related inequality in dental service utilization by several elderly populations residing in Europe. More research is needed to identify the exact causes of such disparities.
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Affiliation(s)
- S Listl
- Department of Conservative Dentistry, University of Heidelberg, Mannheim Research Institute for the Economics of Aging.
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