Dental caries in 12-year-old schoolchildren and its relationship with socioeconomic and behavioural variables

PURPOSE: This study attempts to describe the caries experience in 12-year-old schoolchildren in Piracicaba, Brazil, and to verify the relationship between the disease and socioeconomic factors, and behavioural variables related to oral health. MATERIALS AND METHODS: The random sample consisted of 939 individuals from public and private schools in Piracicaba, S?o Paulo State, Brazil, in 2005. A calibrated dentist performed the examination in an outdoor setting, under natural light, using CPI probes and mirrors, following WHO recommendations. A questionnaire was sent to the parents to collect information on socioeconomic level and behavioural variables related to dental health. The mean number of decayed, missing and filled permanent teeth and surfaces (DMFT/DMFS), the Care Index and the SiC (Significant Caries Index) were determined. Multiple logistic regression analyses using the stepwise procedure were performed in order to identify the risk indicators for the DMFT and for the polarisation group. RESULTS: The DMFT and the SiC Index were 1.32 (SD = 1.92) and 3.52 (SD = 1.86), respectively, and the Care Index was 75.0%. The regression models showed that females and children with either low family income or low education level of the fathers were prone to have caries or take part in the polarisation group. CONCLUSION: The 12-year-old individuals from Piracicaba presented a low prevalence of caries. Nevertheless, those high caries-level individuals showed moderate caries experience. The socioeconomic and the behavioural variables related to dental health were risk indicators of caries in permanent dentition not only for the entire sample, but also for the polarisation group.     

Inequalities in the distribution of dental caries among 12-year-old Brazilian schoolchildren

We assessed the inequality in the distribution of dental caries and the association between indicators of socioeconomic status and caries experience in a representative sample of schoolchildren. This study followed a cross-sectional design, with a sample of 792 schoolchildren aged 12 years, representative of this age group in Santa Maria, RS, Brazil. Guardians answered questions on socioeconomic status and a dental examination provided information on the dental caries experience (DMF-T). Inequality in dental caries distribution was measured by the Gini coefficient and the Significant Caries Index (SiC). The assessment of association used Poisson regression models. Socioeconomic factors were associated with prevalence of dental caries for the whole sample and also for individuals with a high-caries level. Children from low-income households had the highest prevalence of dental caries. The Gini coefficient was 0.7 and the SiC Index 2.5. The percentage of caries prevalence was 39.3% (95% CI: 35.8%-42.8%) and the mean for DMF-T was 0.9 (± SD 1.5). Inequalities in the distribution of dental caries were observed and socioeconomic factors were found to be strong predictors of the prevalence of oral disease in children of this age group.     

Prevalence and severity of dental caries in adolescents aged 12 and 15 living in communities with various fluoride concentrations

OBJECTIVES: To determine the experience, prevalence, and severity of dental caries in adolescents naturally exposed to various fluoride concentrations. METHODS: A cross-sectional census was conducted on 1,538 adolescents aged 12 and 15 years living at high altitude above sea level (> 2,000 m or > 6,560 ft) in above-optimal fluoridated communities (levels ranging from 1.38 to 3.07 ppm) of Hidalgo, Mexico. Sociodemographic and socioeconomic data were collected using questionnaires. Two previously trained and standardized examiners performed the dental exams. RESULTS: Caries prevalence was 48.6 percent and mean of decay, missing, and filling teeth (DMFT) for the whole population was 1.15 +/- 1.17. In terms of severity, 9.6 percent of the adolescents had DMFT > or = 4, and 1.7 percent had > or = 7. The significant caries index (SiC) was 2.41 in the group of 12-year-olds, and 3.46 in the 15-year-olds. Higher experience and prevalence were observed in girls, in children with dental visit in the past year, those in the wealthiest socioeconomic status (SES) (quartiles 2, 3, and 4), those whose locale of residence is in San Marcos and Tula Centro, and in fluorosis-free children and those with moderate/severe fluorosis. In an analysis of caries severity (DMFT > or = 4), both adolescents with very mild/mild and moderate/severe dental fluorosis have higher caries severity. CONCLUSIONS: The results indicated that caries experience, prevalence, and severity as well as SiC index among 12- and 15-year-old adolescents were relatively low. Sociodemographic and socioeconomic variables commonly associated with dental caries were also observed in Mexican adolescents. Unlike other studies, we found that caries increased with higher SES. Fluoride exposure (measured through fluorosis presence) does not appear to be reducing the caries prevalence (DMFT > 0) or caries severity (DMFT > or = 4) in these high-altitude communities.     

Measuring inequalities in the distribution of dental caries

Abstract – Objectives: To evaluate different measurements of prevalence and inequality in the distribution of dental caries as to their partial collinearity, and ability in expressing associations with the supply of fluoridated tap water, indices of socioeconomic status and provision of dental services. Methods: The DMFT, the Significant Caries (SiC) Index, the proportions of children with high- (DMFT ≥ 4) and rampant- (DMFT ≥ 7) caries experience, caries-free children (DMFT = 0), the Gini coefficient and the Dental Health Inequality Index (DHII) were the dental outcomes appraised in a sample comprising 18 718 oral examination records for 11- and 12-year-old schoolchildren in 131 towns of the state of São Paulo, Brazil. Spatial data analysis assessed the association between aggregate figures of dental indices and several covariates. Results: The DMFT, the SiC Index and the proportions of children with high- and rampant-caries experience presented strong linear associations (Pearson r near or higher than 0.95), and an analogous profile of correlation with indicators of socioeconomic status, dental services and access to fluoride tap water. The same was observed for the DHII, the Gini coefficient and the proportion of caries-free children. These observations involve the perception of variables in each set as interchangeable tools for ecological studies assessing factors influencing, respectively, prevalence levels and inequality in the distribution of dental disease. Conclusion: An improved characterization of the skewed distribution of caries experience demands the concurrent estimation of figures of prevalence and inequality in dental outcomes. This strategy may contribute to the design of socially appropriate programmes of oral health promotion.     

Prevalence and severity of dental caries in schoolchildren of Porto, Portugal

OBJECTIVES: To measure the prevalence and severity of dental caries in adolescents of the city of Porto, Portugal, and to assess socioeconomic and behavioural covariates of dental caries experience. METHODS: A sample of 700 thirteen-year-old schoolchildren was examined. Results from the dental examination were linked to anthropometric information and to data supplied by two structured questionnaires assessing nutritional factors, socio-demographic characteristics and behaviour related to health promotion. Dental caries was measured using the DMFT index, and two dichotomous outcomes, one assessing the prevalence of dental caries (DMFT > 0); the other assessing the prevalence of a high level of dental caries (DMFT > or = 4). RESULTS: Consuming soft drinks derived from cola (irrespective of sugared or diet) two or more times per week, attending a public school, being female and having parents with low educational attainment were identified as risk factors both for having dental caries and for having a high level of dental caries. CONCLUSION: Caries levels were positively associated with frequency of intake of sweetened foods and drinks.     

RISK INDICATORS AND RISK PREDICTORS OF DENTAL CARIES IN SCHOOLCHILDREN

The purpose of this study was to identify risk indicators of high caries level at baseline (HCLB) based on cross-sectional data and predictors of high caries increment (HCI) based on a 7-year-follow-up examination in 6-8-year-old schoolchildren. Two hundred and six schoolchildren were examined in 1997 and in 2004 by the same two calibrated dentists, in Piracicaba, Brazil. At baseline, dental caries, presence of sealants, fluorosis, and oral hygiene status were recorded. The children''s parents completed a questionnaire concerning socioeconomic level, fluoride use, dental service utilization, dietary and oral hygiene habits. HCLB and HCI were defined considering the upper quartile of the total caries experience distribution (dmfs+DMFS) and caries increment distribution, respectively. Logistic regression models were adjusted estimating the Odds Ratio (OR), 95% confidence intervals and p-values. Having white spot lesions (OR=5.25) was found to be a risk indicator of HCLB. Schoolchildren with dental fluorosis (OR=0.17) or those who brushed the teeth more than two times a day (OR=0.37) presented less probability of HCLB. The predictors of HCI were: dmfs>0 (OR=2.68) and mothers'' educational level up to 8 years of schooling (OR=2.87). Clinical and socioeconomic variables were found to be risk indicators and/or predictors of dental caries in schoolchildren.     

Dental caries and associated factors in Mexican schoolchildren aged 6-13 years

The objectives of the present study were to establish dental caries prevalence (percentage with caries) and experience in the primary and permanent dentition (dmft and DMFT) of 6 to 13-year-old schoolchildren in Campeche, Mexico, and to estimate the contributing roles of the likely risk indicators. A cross-sectional study was carried out in 1,644 children aged 6-13 years. Self-administered questionnaires obtained information on social, economic, behavioral, and demographic variables. The primary dentition of 1,309 children and the permanent dentition of 1,640 children were evaluated in the oral examinations. The main outcome measures were DMFT, dmft, and SiC indices. Data were modeled using logistic regression analysis. The overall caries prevalence was 77.4%, 73.6% in the primary dentition (61.6% in 6-year-olds), and 49.4% in the permanent dentition. The dmft and DMFT indices were 2.85+/-2.73 and 1.44+/-2.05, respectively (DMFT = 3.11+/-2.62 in 12-year-olds). The SiC index was 6.05 at 12 years of age. Associated variables to dental caries in both dentitions were presence of enamel defects, presence of dental plaque, low socio-economic status, female sex, and older age. Mother's schooling was negatively associated (OR = 0.95) with caries in primary dentition. Caries experience in the primary dentition (OR = 6.02) was positively associated with caries in the permanent dentition. Dental caries status in these Mexican children was closer to the goals proposed by the WHO/FDI for 2000 than previous studies. This study has identified clinical, socio-economic, and behavioral determinants for dental caries in primary and permanent dentition on Mexican schoolchildren.     

Assessment of dental caries predictors in a seven-year longitudinal study

OBJECTIVE: To identify, in a group of 6-8-year-old schoolchildren, risk factors for dental caries increment in permanent dentition. METHODS: Two hundred and six children from three different schools in Piracicaba, Brazil, were examined at baseline and after 7 years by the same two calibrated dentists. Data on dental caries (dmfs, DMFS, presence of initial lesions), fluorosis, oral hygiene and presence of sealant were collected at the clinical examination that was performed in an outdoor setting, under natural light, using a dental mirror and probe following the WHO recommendations. Information on socioeconomic level, fluoride usage, dental service utilization, dietary and oral hygiene habits was also obtained at baseline in a semi-structured questionnaire sent to the parents. The dependent variable was the 7-year DMFS increment. A univariate analysis was performed to test the association of independent variables in caries increment. Then a logistic regression model was used to estimate the adjusted Odds Ratio for caries increment. RESULTS: Clinical (dmfs, DMFS) and non-clinical variables (daily toothbrushing, use of preventive topical methods, parents' educational level) were entered in the multiple logistic regression analysis. The prediction model included the clinical and socioeconomic variables, DMFS, dmfs and mother's educational level. The best caries predictor was the dmfs variable. CONCLUSION: Caries experience and mother's educational level were predictors of caries increment in permanent dentition.     

Factors associated with prevalence of dental caries in Brazilian schoolchildren residing in Japan

Brazilian immigrants comprise the third largest ethnic group within the Japanese population. The aim of this cross-sectional study was to determine the factors associated with the prevalence of dental caries in Brazilian schoolchildren living in Japan. A total of 378 schoolchildren, aged between 6 and 14 years, attending Brazilian schools in Japan were included. Clinical data were collected according to World Health Organization criteria. Socioeconomic data, oral health behavior and diet information were collected through questionnaires. The correlation between associated factors and dental caries prevalence was analyzed using chi-square test and multiple logistic regression analysis. The percentage of caries-free schoolchildren was 61.90% and the mean DMFT was 1.28 ± 2.22 (mean ± SD). The mother's educational level and previous access to dental care services in Brazil were strongly associated with caries experience (P < 0.05). This study indicated that these variables are risk factors associated with caries experience in a community of Brazilian schoolchildren residing in Japan.     

Dental caries and associated factors in Mexican schoolchildren aged 6–13 years

The objectives of the present study were to establish dental caries prevalence (percentage with caries) and experience in the primary and permanent dentition (dmft and DMFT) of 6 to 13-year-old schoolchildren in Campeche, Mexico, and to estimate the contributing roles of the likely risk indicators. A cross-sectional study was carried out in 1,644 children aged 6–13 years. Self-administered questionnaires obtained information on social, economic, behavioral, and demographic variables. The primary dentition of 1,309 children and the permanent dentition of 1,640 children were evaluated in the oral examinations. The main outcome measures were DMFT, dmft, and SiC indices. Data were modeled using logistic regression analysis. The overall caries prevalence was 77.4%, 73.6% in the primary dentition (61.6% in 6-year-olds), and 49.4% in the permanent dentition. The dmft and DMFT indices were 2.85±2.73 and 1.44±2.05, respectively (DMFT=3.11±2.62 in 12-year-olds). The SiC index was 6.05 at 12 years of age. Associated variables to dental caries in both dentitions were presence of enamel defects, presence of dental plaque, low socio-economic status, female sex, and older age. Mother's schooling was negatively associated (OR=0.95) with caries in primary dentition. Caries experience in the primary dentition (OR=6.02) was positively associated with caries in the permanent dentition. Dental caries status in these Mexican children was closer to the goals proposed by the WHO/FDI for 2000 than previous studies. This study has identified clinical, socio-economic, and behavioral determinants for dental caries in primary and permanent dentition on Mexican schoolchildren.     

Trends in dental caries among Brazilian schoolchildren: 40 years of monitoring (1971–2011)

The study aimed to estimate the prevalence, severity, and inequality in the distribution of dental caries in schoolchildren from Florianópolis, Santa Catarina, Brazil, in 2011, and to compare the results with data from previous studies carried out since 1971. All 12‐ and 13‐year‐old schoolchildren enrolled in a public school were eligible. Dental caries were assessed according to the World Health Organisation diagnostic criteria. Decayed, missing and filled surfaces and teeth (DMFS/DMFT) indexes, the Significant Caries Index (SiC) and the Gini coefficient (to assess inequalities in the distribution of dental caries) were estimated. The response rate was 82.3% (n = 130). The prevalence of dental caries decreased from 98.0% (95% CI 96.0–100.0) in 1971 to 36.9% (95% CI 28.5–45.3) in 2011. The mean DMFT ranged from 9.2 in 1971 to 0.7 in 2011. The mean DMFS index was 1.2 (95% CI 0.8–1.6) in 2011. The Gini coefficient was 0.624 in 2002 but increased to 0.725 in 2011; the Lorenz curve showed that 70–75% of dental caries attacks was restricted to 20% of the population in 2011. A reduction of 41.2% in the mean SiC index was observed between 2002 (3.4, 95% CI 3.0–3.8) and 2011 (1.9, 95% CI 1.6–2.1). An effective decline in the prevalence and severity of dental caries in schoolchildren was observed throughout 40 years of monitoring. However, a small proportion of the population has experienced most of the caries burden in the recent years studied.     

Prevalence and severity of dental caries in Costa Rican schoolchildren: results of the 1999 national survey

In 1987, Costa Rica implemented a comprehensive national salt fluoridation programme using sodium fluoride (225-275mg F/kg salt). AIM: To describe dental caries prevalence and severity in Costa Rican children in 1999. METHODS: Eight calibrated examiners (inter-examiner Kappa = 0.70 or higher) recorded information on dental caries, treatment needs, enamel fluorosis, and dentofacial anomalies for schoolchildren aged 6-8,12, and 15-years (N=3758). The survey utilised a multistrata probability sample with fixed allocation to represent seven regions of the country. RESULTS: The overall mean dmft for age 6-8 years was 3.32. The DMFT for age 12 was 2.46 and for age 15 was 4.37. Regional differences were observed; for example, the DMFT at age 12 years ranged from 1.93 to 3.86. Compared with pre-fluoridation data collected in 1984, schoolchildren aged 12 years, experienced a 28 per cent decrease in caries prevalence (100 per cent to 72 per cent) and a 73 per cent decrease in severity (DMFT from 9.13 to 2.46, representing an 8.3 per cent compound annual per cent reduction). CONCLUSIONS: Between 1984 and 1999, Costa Rican schoolchildren experienced substantial reductions in caries prevalence and severity. Many factors may be involved in this decline, but the most important appears to be exposure to fluoridated salt.     

Prevalence and severity of dental caries in Libyan schoolchildren

Objectives: To assess prevalence and severity of dental caries, examine gender differences and assess the relationship of dental caries to socioeconomic status in a group of Libyan schoolchildren. Design and setting: A cross sectional observational study with cluster sampling within schools. Participants: A random sample of 791, 12‐year‐olds in 36 elementary public schools in Benghazi. Methods and main outcome measures: Dental caries was assessed using the DMFT and DMFS indices and WHO (1997) criteria. Information about socioeconomic status was collected through a dental health questionnaire. Results: The prevalence of dental caries was 57.8%. The mean DMFT and DMFS indices were 1.68 (SD ± 1.86) and 2.39 (SD ± 3.05) for all subjects and 2.90 (SD ± 1.56) and 4.14 (SD ± 2.97) for subjects with caries experience. Dental caries was more prevalent amongst girls (P = 0.002). There was a statistically significantly negative association between dental caries and the level of father’s education (P = 0.015). Conclusions: While dental caries prevalence in 12 year‐old Libyan children was high, the mean DMFT was low compared with other developing countries, but higher than the WHO goal for year 2020. The high level of untreated caries is a cause for concern, representing a high unmet treatment need.     

海南省12岁儿童龋病和氟牙症的流行病学抽样调查

目的：了解海南省城乡12岁年龄组人群恒牙龋病及氟牙症的患病状况,为海南省口腔卫生保健工作提供科学依据。方法：采用多阶段分层等容量随机抽样的方法,抽取海南省12岁城乡常住人口777人,按照《第3次全国口腔健康流行病学调查方案》中临床龋病和氟牙症的检查方法和标准,检查全口恒牙龋病和氟牙症的患病状况。结果：海南省12岁年龄组恒牙患龋率和龋均分别为49.9%和1.1。农村和城市地区的患龋率分别为49.4%和50.3%,城乡之间的差异无统计学意义;男性和女性的患龋率分别为45.3%和55%,具有统计学差异（P〈0.05）。氟牙症患病率为3.6%,氟牙症指数（FCI）为0.09。结论：海南省12岁年龄组人群患龋率和龋均较高,氟牙症患病率和氟牙症指数处于较低水平。海南省应加强口腔预防保健工作。     

Influence of self-perceived oral health and socioeconomic predictors on the utilization of dental care services by schoolchildren

The influence of socioeconomic factors and self-rated oral health on children's dental health assistance was assessed. This study followed a cross-sectional design, with a multistage random sample of 792 12-year-old schoolchildren from Santa Maria, a city in southern Brazil. A dental examination provided information on the prevalence of dental caries (DMFT index). Data about the use of dental service, socioeconomic status, and self-perceived oral health were collected by means of structured interviews. These associations were assessed using Poisson regression models (prevalence ratio; 95% confidence interval). The prevalence of regular use of dental service was 47.8%. Children from low socioeconomic backgrounds and those who rated their oral health as "poor" used the service less frequently. The distribution of the kind of oral healthcare assistance used (public/private) varied across socioeconomic groups. The better-off children were less likely to have used the public service. Clinical, socioeconomic, and psychosocial factors were strong predictors for the utilization of dental care services by schoolchildren.     

Dental caries and fluorosis in low- and high-fluoride areas in Turkey.

OBJECTIVE: The aim of this study was to investigate the caries prevalence of children living in either low- or high-fluoride areas and to relate caries experience to the severity of dental fluorosis. METHOD AND MATERIALS: A total of 278 12- to 14-year-old schoolchildren, 149 in a low-fluoride area (LFA) and 129 in a high-fluoride area (HFA), were included in the study. The naturally occurring fluoride concentrations in the drinking water were 0.30 to 0.40 ppm in the LFA, 1.42 to 1.54 ppm in the HFA1, and 1.55 to 1.66 ppm in the HFA2. Dental caries was recorded with the World Health Organization criteria, and dental fluorosis was measured using the Tooth Surface Index of Fluorosis. RESULTS: The percentages of children who had an average TSIF > or = 1 were 0%, 29%, and 77% in the LFA, HFA1, and HFA2, respectively. The mean decayed, missing, and filled permanent teeth (DMFT) and decayed, missing, and filled permanent surfaces (DMFS) were 0.84 +/- 0.98 and 1.58 +/- 2.24 in LFA, 1.30 +/- 1.46 and 1.78 +/- 2.52 in HFA1, and 1.26 +/- 1.42 and 1.97 +/- 2.60 in HFA2, respectively. There was no significant difference in caries prevalence among children living in low- and high-fluoride areas when evaluated with an analysis of covariance model, including the frequency of toothbrushing. Toothbrushing frequency had a significant effect on the decayed teeth, decayed surfaces, DMFT, and DMFS. In high-fluoride areas, there was no relationship between caries prevalence and severity of fluorosis. CONCLUSION: Increasing water fluoride levels were associated with higher prevalence and severity of dental fluorosis and had no influence on caries experience in children with poor oral hygiene.     

Streptococcus mutans and dental caries in urban and rural schoolchildren in Thailand

Two groups of Thai schoolchildren aged 11-13 yr were examined for dental caries, dental fluorosis and Streptococcus mutans. One hundred children lived in an urban district, Bangkok, and 71 children in a rural district, Petchaboon. Saliva samples were analyzed for S. mutans by the spatula method. The fluoride content of the drinking waters was also determined. The prevalence of caries, diagnosed according to WHO, was 89% in Bangkok and 18% in the rural district. Mean DMFT was 3.46 and 0.38 respectively. S. mutans was found in 98% of the urban children and in 82% of the rural. The differences in distribution between S. mutans and DMFT classes were statistically significant for the total sample. Mild fluorosis was present in some of the rural children.     

Dental caries and fluorosis prevalence study in a nonfluoridated Brazilian community: trend analysis and toothpaste association

The main purpose of this study is to compare data from previous surveys to current prevalence rates of dental caries and dental fluorosis in eleven- and twelve-year-olds in a non-fluoridated Brazilian community (< 0.2 ppm F). This study also assesses the possible association between use of fluoride toothpaste and the prevalence of dental caries and dental fluorosis. The sample subjects are randomly selected schoolchildren who were examined with a dental probe and buccal mirror under natural light. The intra-examiner error was calculated, using Kappa statistics (K tau 0.85). The results showed that between 1991 and 1997 there was a 56.7 percent decrease in the prevalence of dental caries and an 80.1 percent increase in dental fluorosis. Children with dental fluorosis were 1.75 times more likely to be free of caries (OR = 1.75-CI:0.43, 6.68). Children who started using fluoride toothpaste before the age of three were 4.43 times more likely to have dental fluorosis than those who started using it after the age of three (OR = 4.43-CI:0.51, 99.61). The results of the cross-sectional surveys conducted with schoolchildren in 1991, 1995, and 1997 suggest a continuing decrease in the prevalence of dental caries and an increase in the prevalence of dental fluorosis in this nonfluoridated Brazilian town.