Persistent oral health disparity in 12-year-old Hispanics: a cross-sectional study

Abstract

BackgroundDental caries is the most prevalent chronic illness worldwide. In the US dental caries has been described as a “silent epidemic”, affecting 58.2 % of 12–15 year-olds, particularly in minority and immigrant groups. Caries is associated with complex yet preventable biological and behavioral factors such as dental plaque and diet, as well as social determinants of health. In developed nations, a higher risk caries has been associated with populations of low socio-economic status (SES), especially in areas with greater income disparity. An island-wide study conducted in Puerto Rico in 1997 revealed a high prevalence of dental caries in 12-year-olds and a significant health disparity between children attending private and public schools. The purpose of the present study was twofold: 1) to estimate caries levels of 12-year-old school Puerto Ricans in 2011; and 2) compare results to data obtained in 1997 to explore any possible change in caries outcomes after a government health insurance (GHI) reform was implemented.MethodsIn this cross-sectional study, a probability sample of 133 out of 1,843 schools was selected proportional to enrollment size, and stratified by 1997 GHI regions, school type, and gender. Calibrated examiners conducted oral soft tissue and caries examinations. Dental caries prevalence was estimated. Mean Decayed Missing Filled Tooth/Surface (DMFT/S) indices and mean Significant Caries Index (SiC) were calculated and compared retrospectively to data obtained in 1997.ResultsThe final sample included 1,587 school-enrolled children. About 53 % of participants were female and 77 % attended public schools. Between 1997 and 2011, reductions were observed in caries prevalence (81 to 69 %), mean DMFT scores (3.8 to 2.5), mean DMFS scores (6.5 to 3.9), and mean SiC index (7.3 to 5.6) in both private and public schools, with a more prominent decrease in private schools. Between 1997 and 2011, overall the filled component increased (50 to 67 %), while decayed and missing component decreased (42 to 30 %) and (8 to 3 %), respectively.ConclusionsAmong 12-year-old schoolchildren in Puerto Rico between 1997 and 2011, caries prevalence, extent, and severity decreased as well as the DMFT missing component, while the filled component increased. Dental caries prevalence was high and the health disparity persists between children enrolled in public and private schools after more than a decade of the GHI implementation. The relationship between GHI implementation and other potentially relevant co-factors for caries warrants further research, as does the seemingly entrenched disparity across groups.

Perfil de saúde bucal em escolares residentes em uma região endêmica de fluorose dental

“…Em outra investigação 15 1500 crianças selecionadas aleatoriamente em diferentes regiões com flúor in natura. Verificou-se uma prevalência de fluorose em 74,9% das crianças e 56,5% de cárie dentária.…”

Association between Type, Amount, and Pattern of Carbohydrate Consumption with Dental Caries in 12-Year-Olds in Puerto Rico

“…A probabilistic stratified sample of children from 133 schools, stratified by gender, was used from the different regions of Puerto Rico as published previously [Elias-Boneta et al, 2016]. From this sample, a representative and subset sample completed a 24-h dietary recall.…”

“…Epidemiology and oral disease prevention program, 1991] by two trained and calibrated dentists and conducted in two mobile examination units, as previously described [Elias-Boneta et al, 2016]. For the present analysis, we used the decayed component (DT) of the Decayed, Missing, Filled Tooth index, which detects the teeth with present and past caries experience at the time of the examination.…”

“…All analyses accounted for sampling methods (sample was stratified by GHI regions and clustered within schools), using weights inversely proportional to the probability of selection, adjusted for non-response, and later normalized, as previously described [Elias-Boneta et al, 2016]. Descriptive statistics were used to describe the distribution of the study variables.…”

“…In the United States (US), 58% of adolescents 12–15 years have caries in their permanent teeth [Dye et al, 2015]. In Puerto Rico (PR), this prevalence is higher, 61% among 12-year olds [Elias-Boneta et al, 2016], which may be attributed to several factors, such as the lack of a fluoridation program [Elias-Boneta et al, 2016], dietary patterns, among others. Dental caries can have important clinical complications depending on its severity and whether or not they are treated early [Konig and Navia, 1995].…”