Association between untreated dental caries and household food insecurity in schoolchildren

Abstract

The aim of the present study was to assess the association between untreated dental caries (UDC) and household food insecurity (HFI) among schoolchildren in different income strata. A population-based study was carried out with a sample of 584 12-y-old schoolchildren. Oral examinations were performed and HFI was determined using a validated scale. Other independent variables were analyzed for being of interest to the stratification of the results (per capita household income) or for acting as potential confounding variables. The prevalence of UDC and HFI was 45% and 39%, respectively. The multivariate models demonstrated that the UDC was significantly more prevalent among children in food-insecure households with per capita income of up to US$ 70.71 than among those in the same income stratum that were free of HFI [PR = 1.52 (95%CI = 1.01-2.29)]. HFI was associated with a greater frequency of UDC among low-income schoolchildren, but had no significant impact on this variable among children from other income strata. Thus, ensuring access to quality food may be a good strategy for minimizing inequities in oral health and reducing dental caries experience among schoolchildren from low-income families.

How much does household food insecurity explain income inequalities in untreated dental caries?

“…Many studies have indicated an association between HFI and health outcomes in childhood, such as an increase in rates of iron deficiency, acute infection, chronic diseases, delayed cognitive development, anaemia, and short stature for age . With regard to oral health, the few studies that have investigated the influence of HFI on oral health problems in children report a greater prevalence rate of dental caries among those who live in a situation of food insecurity . The mechanism that links HFI to dental caries may be dietary behaviour, including the quantity and frequency of carbohydrate intake .…”

“…The calculation of the sample size was detailed in a previous study . The minimal sample was determined to be 304 individuals, to which 60% were added to compensate for the cluster effect, resulting in a total of 466 12‐year‐olds.…”

“…Social determinants act in synergy with biological determinants regarding the risk of dental caries . The literature reports a significant association between dental caries and variables related to socioeconomic aspects, such as the number of children in the family, income, number of residents in the home, type of school, mother's schooling, sugar intake, and tooth brushing frequency . The evaluation of socioeconomic inequalities in health can contribute to the identification of opportunities for preventive interventions .…”

“…Low income and poverty may be determinants of a worse oral health status due to the associations with educational background and access to prevention measures, such as toothpaste, dental floss, a low caloric sugar‐reduced diet, and the professional application of dental sealants . Thus, low income could be related to greater exposure to common risk factors as well as food insecurity …”

Oral health status of elementary-school children varied according to school they attended

“…33 This study also found that girls and students at older ages were at higher risk for developing caries, which might indicate dietary habits and direct biological effects as factors contributing to caries experiences. Differences in caries levels are attributed to social factors affecting schoolchildren, such as household food insecurity, 34 nonworking parents, 35 and parental education status. 36 It can be concluded that sex and age were associated with DMF-T, suggesting the importance of biological factors as proximate determinants of caries.…”