Neighbourhood Determinants of Caries Experience in Preschool Children: A Multilevel Study

Abstract

Objectives: To investigate the association between neighbourhood factors and decayed, missing, and filled teeth (dmft) index among preschool children. Methods: The sample of this cross-sectional study comprised 1,110 children (0-5 years old) clustered in 16 official neighbourhoods of Canoas city, southern Brazil. Multilevel binomial models were used to estimate the association of contextual variables at neighbourhood level (Human Development Index, average income, and public primary health care units) with two oral health outcomes: decayed teeth (dt) and missing or filled teeth (mft), after adjusting for individual variables (gender, age, maternal education, equivalent household income logarithm, household, and point of care). Results: Overall, 24.9% of the sample had dental caries experience (dmft >0), and 92.3% of the dmft was untreated caries. There was no statistical significant association (p > 0.05) of contextual characteristics with the decay component. The teeth of children living in richer areas had 2.87 (95% CI: 1.05-7.86) times more chances of being treated (mft component). Variance attributed to neighbourhood level was estimated as 5.9% (p < 0.01) and 4.1% (p = 0.17) for dt and mft, respectively, in adjusted models. Conclusions: Intra-urban areas seem homogeneous, with small variability between neighbourhoods, having no contextual effect on untreated dental caries (dt). Contextual variables may influence treatment access (mft) through the use of dental services in preschool children.

Contextual and Individual Determinants of Root Caries in Older People

“…Therefore, the social and cultural factors in which the individual is included would affect outcomes in oral health [Slade et al, 1996] and may differ between municipalities. In addition, individuals residing in more economically developed areas may have more opportunity of being treated [Priesnitz et al, 2016]. Thus, the decentralization of dental services should be prioritized in order to reduce the inequality in oral health among municipalities.…”

Multilevel Analysis of Dental Caries in Swedish Children and Adolescents in Relation to Socioeconomic Status

“…Recently, the importance of the neighborhood for general health and mortality outcomes has attracted increasing interest [Meijer et al, 2013;Diez Roux et al, 2016;Priesnitz et al, 2016]. Corresponding circumstances regarding dental health might be expected, as the distribution and severity of dental caries vary considerably between different countries and within the same country or region [Pitts et al, 2011;Coles et al, 2017].…”

Importance of contextual variables related to cavitated lesions in 5‐year‐old children

“…Individual socioeconomic issues are associated with the occurrence of dental caries. Some studies have also found a relationship between dental caries and contextual factors. A child's surrounding environment can exert an influence on oral health, since individuals who live in the same context tend to exhibit similar behaviors.…”

“…The school at which a child studies can be used as an indicator of socioeconomic status and is considered a viable predictor of caries experience in epidemiological studies conducted in Brazil. Studies have been conducted to analyse the influence of individual and contextual determinants on oral health. However, studies involving multilevel analyses on dental caries among 5‐year‐old children have limitations related to the sample.…”

“…However, studies involving multilevel analyses on dental caries among 5‐year‐old children have limitations related to the sample. These studies target on different age groups, or have been conducted only in public schools or were based on data from a national oral health survey in Brazil. Moreover, the studies cited focused on different contextual variables from those analysed in the present investigation.…”