This study investigated the effect of geographic location on Severe Early Childhood Caries (S-ECC) in Native American Children three years of age from a Norther Plains Tribal Community. Geographic location of study participants was ascertained by postal district and categorized into geographic regions as well as dental clinic accessibility, defined as dental services present or absent in that district. The association of location category and dental caries (dmfs) was evaluated cross-sectionally at 36 months of age. Descriptive statistics demonstrated differences in dental caries distribution by geographic region and accessibility category. Bivariate analysis of disease by location showed a significant difference in dmfs between 4 geographic regions (p=0.0159) but not between accessibility categories (p=0.0687). Multivariable regression modeling for geographic region demonstrated the unique effect of geographic region on dental caries experience as well as five other key risk factors. Incident Rate Ratios (IRR) were computed for each of the risk factors, including number of erupted teeth (IRR=1.89, p=0.0147), fluoride exposure from tap water (IRR=1.70, p=0.0173), annual family income (IRR=1.58, p=0.0392), maternal DMFS (IRR=1.02, p=0.0040), and Mean Adequacy Ratio (IRR=1.05, p=0.1042). This study demonstrated statistically significant variation in cumulative dental caries experience of Native American children aged 36 months among geographic regions and identified the specific unites of association through multivariate modeling. These findings can be used for local dental caries prevention programs and contribute to a broader understanding of S-ECC among very young Native American children. v PUBLIC ABSTRACT Native American children experience higher levels of dental decay than children of other races and ethnicities in the U.S. This study investigated the role of geographic location in experience of dental decay in Native American children aged 36 months. Geographic location was designated based on participants' postal district address. Two location categories were created: 1) geographic region, and 2) accessibility (presence or absence of a dental clinic in that district). The study evaluated the relationship between the number of tooth surfaces with dental decay and each location category. Several other important demographic and risk factors were also included in these comparisons. Dental decay differed with statistical significance among four geographic regions but did not differ with statistical significance among two accessibility categories. When adjusting for other important factors, the anticipated dental decay rate resulting from geographic region was quantified. The anticipated contribution of five other key risk factors to anticipated dental decay rate was also quantified. These factors included the number of erupted teeth of the child, whether fluoride was present in the household tap water, the annual family income, the extent of mothers' dental decay, and a measure of nutritional intake. This study ...
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