Elsa K. Delgado-Angulo

Poverty, social exclusion and dental caries of 12-year-old children: a cross-sectional study in Lima, Peru

BackgroundSocioeconomic differences in oral health have been reported in many countries. Poverty and social exclusion are two commonly used indicators of socioeconomic position in Latin America. The aim of this study was to explore the associations of poverty and social exclusion with dental caries experience in 12-year-old children.MethodsNinety families, with a child aged 12 years, were selected from 11 underserved communities in Lima (Peru), using a two-stage cluster sampling. Head of households were interviewed with regard to indicators of poverty and social exclusion and their children were clinically examined for dental caries. The associations of poverty and social exclusion with dental caries prevalence were tested in binary logistic regression models.ResultsAmong children in the sample, 84.5% lived in poor households and 30.0% in socially excluded families. Out of all the children, 83.3% had dental caries. Poverty and social exclusion were significantly associated with dental caries in the unadjusted models (p = 0.013 and 0.047 respectively). In the adjusted model, poverty remained significantly related to dental caries (p = 0.008), but the association between social exclusion and dental caries was no longer significant (p = 0.077). Children living in poor households were 2.25 times more likely to have dental caries (95% confidence interval: 1.24; 4.09), compared to those living in non-poor households.ConclusionThere was support for an association between poverty and dental caries, but not for an association between social exclusion and dental caries in these children. Some potential explanations for these findings are discussed.

Childhood stunting and caries increment in permanent teeth: a three and a half year longitudinal study in Peru

BACKGROUND Malnutrition has been consistently associated with caries in primary teeth, although an effect on permanent teeth has not been established because of the few longitudinal studies. AIM To explore the association between stunting and caries increment in permanent teeth over 3.5 years. DESIGN In 2003, 121 children aged 7-9 years were randomly selected from nine underserved communities in Lima (Peru). Parents provided demographic information and a food diary for their children. Clinical examinations included assessments of height, weight, oral hygiene, and dental caries. Stunting was defined using the 2000 CDC and 2007 WHO standards. In 2006, 83 children were re-examined, and the 3.5-year net DMFS increment was calculated. The association between stunting and net DMFS increment was assessed using negative binomial regression. RESULTS Stunting was related to net DMFS increment after adjustment for sex and age, oral hygiene, sugary snacks between meals, and caries experience in primary and permanent teeth. Consistent results were found when using either the 2000 CDC (incidence rate ratio: 1.61; 95%CI: 1.07, 2.44) or 2007 WHO standards (IRR: 1.79; 95%CI: 1.28, 2.51). CONCLUSION Stunting was a significant risk factor for caries increment in permanent teeth over a 3.5-year period, independent of other well-known risk factors for caries development.

Family Income and Tooth Decay in US Children: Does the Association Change with Age?

This study explored whether the association of family income with tooth decay changes with age among children in the United States. A second objective was to explore the role of access to dental health care services in explaining the interrelationships between family income, child age and tooth decay. Data from 7,491 2- to 15-year-old children who participated in the 1999–2004 National and Health and Nutrition Examination Survey were analyzed. The association of family income with the prevalence of tooth decay in primary, permanent and primary or permanent teeth was first estimated in logistic regression models with all children, and then, separately in four age groups that reflect the development of the dentition (2–5, 6–8, 9–11 and 12–15 years, respectively). Findings showed that the income gradient in tooth decay attenuated significantly in 9- to 11-year-olds only to re-emerge in 12- to 15-year-olds. The age profile of the income gradient in tooth decay was not accounted for by a diverse set of family and child characteristics. This is the first study providing some evidence for age variations in the income gradient in tooth decay among children in the United States.

Ethnic inequalities in dental caries among adults in East London

BACKGROUND This study explored ethnic inequalities in dental caries among adults and assessed the role of socioeconomic position (SEP) in explaining those inequalities. METHODS We analysed data on 2013 adults aged 16-65 years, from the East London Oral Health Inequality (ELOHI) Study, which included a random sample of adults and children living in East London in 2009-10. Participants completed a questionnaire and were clinically examined for dental caries at home. Dental caries was measured using the number of decayed, missing and filled teeth or DMFT index. Ethnic inequalities in dental caries were assessed in negative binomial regression models before and after adjustment for demographic (sex and age groups) and SEP measures (education and socioeconomic classification). RESULTS White Eastern European and White Other had higher DMFT, whereas all Asian (Pakistani, Indian, Bangladeshi and Other) and all Black (African, Caribbean and Other) ethnic groups had lower DMFT than White British. Similar inequalities were found for the number of filled and missing teeth, but there were no differences in the number of decayed teeth between ethnic groups. CONCLUSIONS This study showed considerable disparities in dental caries between and within the major ethnic categories, which were independent of demographics and SEP.

Ethnic Disparities in Oral Health Related Quality of Life among Adults in London, England

OBJECTIVE To explore ethnic disparities in oral health related quality of life (OHQoL) among adults, and the role that socioeconomic factors play in that association. RESEARCH DESIGN Data from 705 adults from a socially deprived, ethnically diverse metropolitan area of London (England) were analysed for this study. Ethnicity was self-assigned based on the 2001 UK Census categories. OHQoL was measured using the Oral Health Impact Profile (OHIP-14), which provides information on the prevalence, extent and intensity of oral impacts on quality of life in the previous 12 months. Ethnic disparities were assessed in logistic regression models for prevalence of oral impacts and negative binomial regression models for extent and intensity of oral impacts. RESULTS The prevalence of oral impacts was 12.7% (95% CI: 10.2-15.1) and the mean OHIP-14 extent and severity scores were 0.27 (95% CI: 0.20-0.34) and 4.19 (95% CI: 3.74-4.64), respectively. Black adults showed greater and Asian adults lower prevalence, extent and severity of oral impacts than White adults. However, significant differences were only found for the extent of oral impacts; Black adults reporting more and Asian adults fewer OHIP-14 items affected than their White counterparts. After adjustments for socioeconomic factors, Asian adults had significantly fewer OHIP-14 items affected than White adults (rate ratio: 0.28; 95%CI: 0.08-0.94). CONCLUSION This study found disparities in OHQoL between the three main ethnic groups in South East London. Asian adults had better and Black adults had similar OHQoL than White adults after accounting for demographic and social factors.

First molar eruption related to plaque acidogenicity in children of different socio-economic status.

Objective. The aim of this study was to evaluate the association between the eruption stage of the lower first permanent molar and dental plaque acidogenicity. Socio-economic status (SES), gender, and oral hygiene condition were also variables considered. Material and methods. 230 children between 6 and 8 years of age were recruited from one public and one private primary school with different SES in Lima, Peru. Clinical examinations were performed to assess lower first permanent molar eruption stage, plaque acidogenicity, and oral hygiene condition. Bivariate associations were analyzed through chi-square tests and the variable interactions were analyzed through a hierarchical log-linear analysis with backward elimination. Results. 21.8% of the population had highly acidogenic plaque, 34.3% acidogenic plaque, and 43.9% non-acidogenic plaque. Of the lower first permanent molars, 46.1% were fully erupted, whereas 53.9% were partially erupted. According to the final log-linear model, children with fully erupted molars and non-acidogenic plaque are less frequent in low than in high SES. Also, the frequency of children with partially erupted molars and acidogenic to highly acidogenic plaque is higher in males than in females. Finally, fully erupted molars and non-acidogenic plaque are more frequent in children with good hygiene than in children with moderate to poor hygiene. Conclusions. Association between eruption stage of the lower first permanent molar and plaque acidogenicity was not significant in a bivariate context. However, in a multivariate context, socio-economic status, oral hygiene condition, and gender had an impact on the association between the two main variables.

Graduates’ satisfaction with and attitudes towards a master programme in dental public health

BackgroundMonitoring graduates’ views of their learning experiences is important to ensure programme standards and further improvement. This study evaluated graduates’ satisfaction with and attitudes towards a Master programme in Dental Public Health.MethodsAn online questionnaire was sent to individuals who completed successfully the Master of Science programme in Dental Public Health at King’s College London Dental Institute and had a valid email address. Participants provided information on demographic characteristics, satisfaction with and attitudes towards the programme. Satisfaction and attitudes scores were compared by demographic characteristics using multiple linear regression models.ResultsSatisfaction scores with the programme were high, with 92% of respondents reporting the programme had met or exceeded their expectations. Learning resources and quality of teaching and learning were the aspects of the programme graduates were most satisfied with. The main motivations for taking the programme were to progress in career path and improve employment prospects. As for attitudes, 70.7% of respondents would recommend this course to a colleague or a friend. There were no significant differences in satisfaction and attitude scores by graduates’ demographic background.ConclusionGraduates were satisfied with most aspects of the programme and reported positive attitudes towards it. This study highlights the value of using graduates’ views for programme’s improvement and the need for a regular monitoring of the programme.

Childhood stunting and caries increment in permanent teeth: a three and a half year longitudinal study in Peru: Stunting and caries increment

BACKGROUND Malnutrition has been consistently associated with caries in primary teeth, although an effect on permanent teeth has not been established because of the few longitudinal studies. AIM To explore the association between stunting and caries increment in permanent teeth over 3.5 years. DESIGN In 2003, 121 children aged 7-9 years were randomly selected from nine underserved communities in Lima (Peru). Parents provided demographic information and a food diary for their children. Clinical examinations included assessments of height, weight, oral hygiene, and dental caries. Stunting was defined using the 2000 CDC and 2007 WHO standards. In 2006, 83 children were re-examined, and the 3.5-year net DMFS increment was calculated. The association between stunting and net DMFS increment was assessed using negative binomial regression. RESULTS Stunting was related to net DMFS increment after adjustment for sex and age, oral hygiene, sugary snacks between meals, and caries experience in primary and permanent teeth. Consistent results were found when using either the 2000 CDC (incidence rate ratio: 1.61; 95%CI: 1.07, 2.44) or 2007 WHO standards (IRR: 1.79; 95%CI: 1.28, 2.51). CONCLUSION Stunting was a significant risk factor for caries increment in permanent teeth over a 3.5-year period, independent of other well-known risk factors for caries development.