International comparisons of health inequalities in childhood dental caries

Pine, Cynthia M and Adair, Pauline M and Nicoll, Alison D and Burnside, Girvan and Petersen, Poul Erik and Beighton, David and Gillett, Angela and Anderson, Ruth and Anwar, Shahid and Brailsford, Susan and Broukal, Zdenek and Chestnutt, Ivor G and Declerck, Dominique and Ping, Feng Xi and Ferro, Roberto and Freeman, Ruth and Gugushe, Tshepo and Harris, Rebecca and Lin, Brent and Lo, Edward C M and Maupomé, Gerardo and Moola, Mohamed Hanif and Naidoo, Sudeshni and Ramos-Gomez, Francisco and Samaranayake, Lakshman P and Shahid, Swarngit and Skeie, Marit Slåttelid and Splieth, Christian and Sutton, Betty King and Soo, Teo Choo and Whelton, Helen (2004) International comparisons of health inequalities in childhood dental caries. Community Dental Health, 21 (1 Supp). pp. 121-30. ISSN 0265-539X

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Objective: To undertake formative studies investigating how the experience of dental caries in young children living in diverse settings relates to familial and cultural perceptions and beliefs, oral health-related behaviour and oral microflora. Participants: The scientific consortium came from 27 sites in 17 countries, each site followed a common protocol. Each aimed to recruit 100 families with children aged 3 or 4 years, half from deprived backgrounds, and within deprived and non-deprived groups, half to be "caries-free" and half to have at least 3 decayed teeth. Outcome measures: Parents completed a questionnaire, developed using psychological models, on their beliefs, attitudes and behaviours related to their child's oral health. 10% of children had plaque sampled. Results: 2,822 children and families were recruited. In multivariate analyses, reported toothbrushing behaviours that doubled the odds of being caries-free were a combination of brushing before age 1, brushing twice a day and adult involvement in brushing. Analyses combining beliefs, attitudes and behaviours found that parents' perceived ability to implement regular toothbrushing into their child's daily routine was the most important predictor of whether children had caries and this factor persisted in children from disadvantaged communities. 90% of children with lactobacillus had caries. Conclusions: Parental beliefs and attitudes play a key role in moderating oral health related behaviour in young children and in determining whether they develop caries. Further research is indicated to determine whether supporting the development of parenting skills would reduce dental caries in children from disadvantaged communities independent of ethnic origin.