The Impact of Socioeconomic Factors on Pediatric Oral Health: A Review

This narrative review examines the impact of socioeconomic status (SES) on pediatric oral health, emphasizing disparities in dental caries prevalence and oral health-related quality of life (OHRQoL) among children from different socioeconomic backgrounds. Utilizing an extensive literature search through PubMed, Google Scholar, and the chat.consensus.app plugin, we synthesized findings from studies published up to December 2023. The review highlights a consistent association between lower SES and adverse pediatric oral health outcomes, influenced by parental education, household income, food security, and neighborhood conditions. It also underscores the importance of the life-course perspective, showing how early-life socioeconomic disadvantages can have long-lasting effects on oral health. Furthermore, the review points to the critical role of school-based oral health education programs and the complex interplay between mental health, SES, and pediatric oral health. By examining the impact of socioeconomic factors across different childhood stages and the effectiveness of educational interventions, this review calls for targeted interventions and policy initiatives aimed at reducing socioeconomic inequalities in pediatric oral health. The findings advocate for a multifaceted approach to improve oral health outcomes for children across socioeconomic backgrounds, ensuring equitable access to oral health care and promoting overall well-being.

Interrelationship Between Intelligence Quotient and Space Maintainers Among Children: A Cross-Sectional Comparative Study

Introduction Intelligence quotient (IQ) is an indicator to measure a child's cognitive ability to learn or understand and to deal with new situations with their logical and analytical skills. Children with better IQ exhibit increased cooperation when undergoing dental treatments, leading to a positive attitude toward dental care. The primary aim of the study was to assess the interrelationship between the IQ of children, space maintainer therapy, and the behavior of children aged 6-10 years. Materials and methods A total of 104 children were divided into two groups: group 1 included children undergoing space maintainer therapy and group 2 included children who did not undergo space maintainer therapy. Their IQ scores were assessed using Raven's Coloured Progressive Matrices and behavior and the Frankl behavior rating scale. The data were analyzed by SPSS Version 23 (IBM Corp., Armonk, NY). Independent t-tests were used to evaluate the differences between IQ and children with space maintainers, and Mann-Whitney U tests were used to assess the differences between behavior and space maintainers. Results The mean age of the participants was approximately 8.28 years. The mean IQ score of the group of children undergoing the space maintainer therapy was 90.69 ± 7.65 and that of the control group was 105.59±10.71. Based on the Frankl behavior rating scale, the mean score in the space maintainer group was 35.44 and that of the control group was 69.56. There was a significant association between IQ, behavior, and the presence of space maintainers. Conclusion The group of children undergoing space maintainer therapy demonstrated comparatively lesser IQ, and the majority of children exhibited negative behavior. Also, children wearing space maintainers had undergone one or multiple extractions, which is traumatic for children and may lead to them likely exhibiting a negative behavior than children in the control group. Hence, it may be concluded that intelligence, behavior, and space maintainers are all significantly associated with each other.

Assessing Risks of Early Childhood Caries in Primary Care Practice Using Electronic Health Records and Neighborhood Data

CONTEXT

Early childhood caries (ECC) is a persistent public health challenge, affecting more than 56% of US toddlers and preschool-aged children. Despite this, ECC is largely preventable with routine oral hygiene practices, diet, and application of topical fluoride.

OBJECTIVE

This study assessed the utilization of preventive oral health care in primary care practices and evaluated the variation in patient characteristic and geographic disparities.

DESIGN

We conducted a retrospective study using electronic health records (EHRs) over a 2-year period. Patients' home addresses were geocoded and linked to census-based neighborhood statistics and fluoridated water accessibility. Multiple logistic regression modeling was used to assess the risk of ECC in patients with fluoride preventive care, controlled for demographics, comorbid conditions, and neighborhood risk factors.

PARTICIPANTS

Patients aged 6 to 71 months who had primary care providers at family medicine and general pediatric clinics in a large academic medical center.

MAIN OUTCOME MEASURE

The presence of dental caries based on diagnoses in EHRs.

RESULTS

The study consisted of 10 836 patients: 17% treated with topical fluoride varnish (TFV), 12% prescribed oral fluoride supplement, 6.1% with both TFV and supplement, and 64% without fluoride treatment. Patients with fluoride treatment were 24% to 53% less likely to have ECC. Children living in rural and nonfluoridated water communities had 1.7 to 1.8 times greater risk of developing ECC. Minority, under/uninsured, and low-income patients also were at an increased risk of ECC.

CONCLUSION

Despite continuing efforts to improve access to dental care for vulnerable populations, substantial disparities remain among socioeconomically disadvantaged children. To address dental care shortage, primary care clinicians should serve as the safety net to care for vulnerable and underserved children who have no or limited access to oral health services. Future research into the collaboration between primary care and dental providers at the level of both practice and professional education should be considered.

Prenatal and Pediatric Oral Health Education Among Dental Hygiene Programs in the United States

Purpose: Health care and dental providers must be prepared to address the oral health needs of mothers and children in order to reduce the burden of dental disease in these populations. The purpose of this study was to describe the curriculum and clinical experiences related to prenatal and pediatric oral health in the university and community college dental hygiene programs in the United States (US).Methods: Dental hygiene program directors (PDs) from across the US were invited to participate in a cross-sectional electronic survey regarding the prenatal and pediatric oral health curriculum at their institution. In addition to program characteristics, the survey included items pertaining to curriculum and competencies, content delivery methods and hours spent, locations for clinical experiences, collaboration efforts, and professional policy guidelines. Responses were summarized, and descriptive analyses were conducted to examine program competency and curriculum by program type.Results: A total of 124 PDs responded to the survey for a 37.9% response rate; over half (54%) were based in community colleges. Overall, most PDs indicated prenatal (77.3%) and pediatric oral health (66.1%) as a part of their program's core curriculum. However, prenatal oral health was a core competency for 52% of the respondents and less than half (46%) considered pediatric oral health a core competency. Most programs (>75%) reported teaching professional policies and guidelines. Universities reported more hours for prenatal and didactic and clinical experiences than community colleges. The most common barrier reported for prenatal and pediatric clinical experience was the lack of patients (55% and 35%, respectively).Conclusions: Most dental hygiene programs are utilizing a variety of methodologies to incorporate prenatal and pediatric content into the curriculum and students are being exposed to professional guidelines and recommendations for these populations. However, patient care experiences for prenatal and pediatric patients were low due to lack of patients.

Disparities in Caregiver-Reported Dental Cavities and Toothaches Among Children in the Special Supplemental Nutrition for Women, Infants, and Children (WIC) Program

Purpose: Dental caries is prevalent among low-income and minority children despite oral health promotion programs. The purpose of this study was to examine disparities associated with caregiver-reported cavities and toothaches among children in the United States aged 2-4 years by their eligibility for and participation in the Special Supplemental Nutrition for Women, Infants, and Children (WIC) program.Methods: A secondary data analysis was performed using the 2016 National Survey of Children's Health (NSCH) data on children aged 2-4 years (n=7,719) with complete WIC participation information. Three groups were formed based on WIC eligibility and participation status: WIC participants, income-eligible non-participants, and higher-income non-participants. Caregiver-reported cavities and toothaches were compared by WIC eligibility and participation using chi-square tests and multivariate logistic regression analysis.Results: Among all children in the data set, 2,069 were WIC eligible, 49.8% of whom participated in WIC. Participants in WIC had higher reported cavities and toothaches (10.0% and 5.2%) than income-eligible, or higher-income non- WIC participating children (8.9% and 3.2%; 4.4% and 0.1%, respectively; p < 0.001). However, non-Hispanic, white WIC participants, had a higher proportion of reported cavities (14.0%) and toothaches (8.2%) than income-eligible non-participants (6.7% and 1.9%, respectively; p < 0.05). While non-Hispanic, black WIC participating children, had nearly 3.6 times more reported cavities than income-eligible nonparticipants (9.0% vs. 2.5%, p < 0.05).Conclusion: Caregiver-reported cavities and toothaches varied by sociodemographic characteristics within WIC participation and eligibility groups. These findings suggest that more research is warranted to explore factors that are contributing to oral health disparities associated with WIC eligibility and participation.

Analysis of 100 Most-Viewed YouTube Toothbrushing Videos

Purpose: Parental education regarding the importance of toothbrushing and how to brush children's teeth is a key factor influencing pediatric oral health and You Tube videos have become a popular source of health information. The purpose of this study was to examine the descriptive features of the 100 most frequently viewed English-language YouTube toothbrushing videos and evaluate their usefulness relative to professional guidelines.Methods: A structured YouTube web search identified the 100 most frequently viewed toothbrushing videos during a six-month period (10/1/17 - 4/30/18). Two independent evaluators assessed each video for consistency with professional recommendations using a priori criteria. Each video was also assessed for descriptive characteristics, user engagement, and content. Comparative analyses by video source (health care professionals, commercial, and independent media) were performed, and an exploratory regression model was used to test the relationship between video characteristics and usefulness for parent education.Results: The top 100 YouTube videos were most often posted by independent media outlets (78%), targeted toward children (70%), and less than 2 minutes long (56%). Few videos aligned with professional recommendations regarding toothbrushing frequency (38%), toothbrushing duration (24%), amount of toothpaste (21%), fluoride toothpaste use (19%), post-brushing behavior (10%), toothbrush selection (4%), and toothbrush replacement (3%). A stepwise bidirectional regression model found that videos posted by health care professionals were significantly more likely to contain recommendations consistent with professional recommendations compared with other upload sources.Conclusion: The most frequently viewed toothbrushing videos were not uploaded to the Internet by health care professionals. Videos uploaded by health care professionals contained significantly higher counts of professional recommendations however, they differed in audio and visual format and production style compared to those from commercial and independent media sources.

Influence of Parental Health Literacy on Change over Time in the Oral Health of American Indian Children

In cross-sectional studies, parental health literacy (HL) is associated with children’s oral health. It is unclear, however, whether HL influences pediatric outcomes. We examined the relationship of HL with change over time in parental oral health knowledge, beliefs, and behaviors, as well as pediatric oral health outcomes. We used longitudinal data from a study designed to reduce dental decay in American Indian children (N = 579). At baseline and annually for three years, parents answered questions assessing HL; oral health knowledge, beliefs, and behaviors; and pediatric oral health status. The number of decayed, missing, and filled tooth surfaces (dmfs) was computed based on annual dental evaluations. Linear mixed models showed that HL was significantly associated with all constructs, except dmfs, at their reference time points and persistently across the three-year study period. HL predicted change over time in only one variable, parents’ belief that children’s oral health is determined by chance or luck. HL is strongly associated with oral health knowledge, beliefs, behaviors, and status prospectively but is not a key driver of change over time in these oral health constructs.

Preventive Dental Care Programs for Children: Parental perceptions and participation barriers

Purpose: Dental caries is a chronic childhood disease disproportionately affecting children from low socioeconomic backgrounds. Free preventive oral health events sponsored by dental organizations are frequently under enrolled. The purpose of this study was to explore parental perceptions and barriers to participation in preventive dental care programs for their children.Methods: The transtheoretical model and social cognitive theory were used to design this qualitative case study. Open-ended questions were used to interview 20 purposefully sampled participants regarding their perceptions of free preventive dental care programs. Interviews were audio recorded, data were transcribed verbatim, coded, and analyzed thematically until saturation.Results: Two male and 18 female parents ranging in age from 22 to 49 years, with at least one child enrolled in a Title 1 New York City public elementary school, agreed to participate. Nine themes emerged from the data addressing the primary research question on the perceived barriers preventing parents from allowing their children to attend a free preventative dental care program. The themes included too busy, afraid, lack of trust, cultural differences, lack of awareness of the program, cost of care, money, negative childhood experiences and lack of dental insurance.Conclusion: Results from this study demonstrate the need to understand barriers to full enrollment in preventive oral health programs. Particular attention should be given to cultural differences between the program providers and the local residents. Preventative oral health program organizers need to explore multiple communication options to notify parents of upcoming programs.

Innovative Collaborative Service-Learning Experience among Dental Hygiene and Nurse Practitioner Students: A pediatric oral health pilot study

Purpose: Preventive oral health behaviors are essential for children during early stages of development. The purpose of this study was to pilot an innovative, collaborative service-learning (ICSL) experience for dental hygiene (DH) and primary care nurse practitioner (NP) students to address pediatric oral health.Methods: A convenience sample of DH and NP students (n=12) participated in the development, planning and delivery of an ICSL activity focusing on pediatric oral health to 44 pre-school aged children. A learning management system was used for the communicating, planning and evaluating the ICSL activity. The interprofessional socialization of the participants was measured using the Interprofessional Socialization and Valuing Scale (ISVS-9A/9/B) survey prior to and following the ICSL experience. Descriptive statistics were used to analyze the data.Results: Twelve students agreed to participate in the ICSL experience (DH= 9 and NP=3) and completed the pre and post ISVS-9A/9B surveys. There was a positive change in interprofessional socialization scales (0.42) after the ICSL experience (p=0.066) for all participants. Marginal statistically significant differences were identified among the DH participants (p=0.058) in their pre and post interprofessional socialization scores.Conclusion: Within the limitations of this pilot study, the ICSL experience had a positive impact on NP and DH students' socialization to interprofessional collaboration. This low resource, service-learning educational project has potential for easy integration within dental hygiene and advanced practice nursing curricula.

Oral Health-Related Quality of Life of Children: An Assessment of the Relationship between Child and Caregiver Reporting

Purpose: Oral and craniofacial conditions or diseases can impact an individual's health and quality of life. The purpose of this study was to assess the perceived oral health related quality of life (OHRQoL) of children, and evaluate the reported level of agreement between caregivers and their children.Methods: Purposive sampling was used to recruit children ages 8-15, and their caregivers from a dental clinic in a pediatric hospital for this descriptive, cross-sectional study. A modified version of a validated measure, Child Oral Health Impact Profile-Short Form (COHIP-SF), was used for a 22-item questionnaire encompassing three subscales: oral health, functional well-being, and social emotional well-being. Two additional items were included to assess child/caregiver's level of agreement. A dental chart review was also conducted to assess the child's overbite, overjet, and decayed surfaces. Data were analyzed through descriptive statistics and examined for assumptions of normality and linearity.Results: Sixty child/caregiver pairs (n=120) participated in this study. Overbite, overjet and decayed surfaces were not found to be related to any OHRQoL variable, including child/caregiver ratings and overall agreement (p>.05). Average OHRQoL scores for caregivers found to be more positive those of their children (p=.02). Agreement between caregivers and the child's gender was shown to be significant (p=.01). Female child scores differed significantly from males with respect to their caregiver responses (p=.02). Caregivers rated a higher OHRQoL for female children, thus overestimating their female child's reported OHRQoL.Conclusions: The moderate level of agreement found between children and caregivers reinforces the importance of including the child, as well as the caregiver, when assessing OHRQoL.

Implementing Pediatric Fluoride Varnish Application in a Rural Primary Care Medical Office: A Feasibility Study

INTRODUCTION

The objective of this study was to determine if the application of fluoride varnish (FV) to children 5 years and under was acceptable and practical for health care providers in a rural primary care office.

METHODS

We employed a quasi-experimental study design comprised of providers who received education and training in FV application. Pre- and post-study surveys regarding barriers and facilitators were administered. Data was collected on the number of FV applications, time spent on procedure, perceived barriers, and overall cost.

RESULTS

The total direct variable cost of providing FV was $4.35 per procedure, resulting in an $11.85 profit. FV application increased 9.57%. Potential barriers were lack of proper supplies, lack of adequate support staff, and lack of additional financial compensation for providers.

DISCUSSION

FV application is a service that can be delivered in a rural practice with existing resources, but the initiative needs support from practice management.

Literature review and micro-computed tomography analysis of natal teeth: A pilot study

AIM

To outline the current literature surrounding natal teeth, and then, in a pilot study, to evaluate natal teeth using micro-computed tomography (micro-CT) to determine their anatomical profile, and compare and contrast different analytical methods to assess natal teeth.

METHODS

2 extracted natal teeth (mandibular central incisors) and 1 exfoliated mandibular primary central incisor were subjected to micro-CT analysis.

RESULTS

Within natal teeth, there were no statistical differences in tooth mineral density (TMD) of both enamel and dentine (P > .05), whereas mandibular primary central incisors had a significantly higher TMD of both enamel and dentine in comparison with both natal tooth 1 and natal tooth 2 (P < .05). Mandibular primary central incisors had a greater thickness and volume of both enamel and dentine, but exhibited lower pulpal space volume.

CONCLUSION

Micro-CT is an alternative and non-invasive method to anatomically assess natal teeth. According to the pilot study, natal teeth exhibited lower TMD, decreased enamel and dentine thickness, and smaller pulpal space volume in comparison with mandibular primary incisor teeth. This pilot study creates a foundation to establish the collection and analysis of natal teeth on a larger scale over time using micro-CT.

Factors facilitating dental practitioners' provision of infant-toddler dental homes in Alberta

BACKGROUND

The Canadian Dental Association and Canadian Dental Hygienists Association recommend that a child's first dental visit should occur no later than 1 year of age. However, this recommendation has not been strongly supported by the dental community. The purpose of this study was to explore factors influencing the provision of infant-toddler dental homes from providers' perspectives. Understanding facilitating factors is integral to developing strategies to improve infant-toddler oral health care.

METHODS

This study employed a qualitative interpretive descriptive methodology, using semi-structured interviews with a purposive sample of 13 dentists and dental hygienists who routinely provide dental homes for the infant-toddler cohort. The constant comparative method was used to support thematic analysis.

RESULTS

Thematic analysis revealed factors that were both endogenous and exogenous to the practitioner. They were categorized into 4 interrelated themes: 1) practitioner; 2) practice; 3) profession; and 4) population. Together these 4 themes form a model of the 4 Ps that influence provision of infant-toddler dental homes. Common endogenous factors include the practitioner's comfort with young children and having clinical exposure to pediatric clients during dental education. Common exogenous factors include parental awareness and adequate insurance coverage for preventive procedures. Strategies to improve acceptance of infant-toddler dental homes include enhanced practitioner education and public awareness, consistent messaging from the dental community, as well as increased remuneration for preventive pediatric oral health care.

CONCLUSION

Provision of infant-toddler dental homes is affected by multifaceted variables. Consequently, strategies to improve uptake must employ a multipronged approach.

Early Childhood Caries: Prevalence, Risk Factors, and Prevention

Early childhood caries (ECC) is major oral health problem, mainly in socially disadvantaged populations. ECC affects infants and preschool children worldwide. The prevalence of ECC differs according to the group examined, and a prevalence of up to 85% has been reported for disadvantaged groups. ECC is the presence of one or more decayed, missing, or filled primary teeth in children aged 71 months (5 years) or younger. It begins with white-spot lesions in the upper primary incisors along the margin of the gingiva. If the disease continues, caries can progress, leading to complete destruction of the crown. The main risk factors in the development of ECC can be categorized as microbiological, dietary, and environmental risk factors. Even though it is largely a preventable condition, ECC remains one of the most common childhood diseases. The major contributing factors for the for the high prevalence of ECC are improper feeding practices, familial socioeconomic background, lack of parental education, and lack of access to dental care. Oral health plays an important role in children to maintain the oral functions and is required for eating, speech development, and a positive self-image. The review will focus on the prevalence, risk factors, and preventive strategies and the management of ECC.

Factors associated with receiving treatment for dental decay among Medicaid-enrolled children younger than 12 years of age in Iowa, 2010

OBJECTIVES

The Iowa Department of Public Health I-Smile program provides dental screening and care coordination to over 23,000 low-income and Medicaid-enrolled children per year. The purposes of this study were to evaluate I-Smile program effectiveness to ensure that Medicaid-enrolled children obtained dental treatment after having been screened and to determine the factors associated with failure to receive dental care after screening through the I-Smile program.

METHODS

Based on I-Smile program priorities, we limited our sample to children younger than 12 years of age who screened positive for decay and who linked to a paid Medicaid claim for dental treatment (n = 1,816). We conducted bivariate analyses to examine associations between children's characteristics who screened positive for decay and received treatment within 6 months of their initial screening. We also performed multivariate logistic regression to assess the association of sociodemographic characteristics with receipt of treatment among children who screened positive for decay.

RESULTS

Eleven percent of children screened positive for decay. Nearly 24 percent of children with decay received treatment based on a Medicaid-paid claim. Being 5 years or older [adjusted odds ratio (aOR): 1.48, confidence interval (CI): 1.17, 1.88] and not having a dental home (aOR: 1.90, CI: 1.41, 2.58) were associated with higher odds of not receiving dental treatment.

CONCLUSIONS

Children 5 years and older and without a dental home were less likely to obtain dental treatment. Opportunities exist for the I-Smile program to increase the numbers of at-risk children with dental homes and who obtain dental care after screening.