THE INEQUALITIES IN EARLY CHILDHOOD CARIES ACROSS EUROPE

Abstract

It is generally thought that early childhood caries (ECC) is a public health problem associated with impaired oral health-related quality of life and high costs for families and the society in general. There are numerous epidemiological studies available from various European countries and current ECC inequalities, not only across Europe but also within countries, are obvious. The burden of caries from different countries and regions can however not directly be compared with each other due to design, methodological and reporting issues. For example, there is no consensus on the definition of ECC, which age group(s) that should be examined, sample selection techniques, calibration and number of examiners, inclusion of non-cavitated early lesions, with or without bitewing radiographs, etc. On top of that, small children are not always cooperative, allowing proper cleaning and drying before the examinations. Consequently, it is not surprising to find that prevalence of ECC, assessed with the WHO-criteria, can vary from 86% in Kosovo to 15% in Italy. Likewise, the prevalence of severe ECC seems to range between 3 and 12% across Europe. The mean dmft is reported to vary 0.9 from 10.9. In spite of the abovementioned limitations, it is possible to trace an increasing tendency in the prevalence of ECC from the north-western to the south-eastern countries of Europe. Within all European countries however, there is a clear relationship between socio-economic inequalities and caries; children to low-income and low-educated parents with and without immigrant background display a higher risk of having caries lesions early in life. Poor and near poor 2-5 year-olds have on average 3 times higher dft than non-poor children and this association can be even stronger in the most developed countries. A further problem is that the majority of the disadvantaged children remain untreated. As a first step to combat existing caries inequalities in preschool children, it is important to better map and understand the disease as well as main socio-economic and behavioral determinants. The reporting of ECC (prevalence and severity) in epidemiologic studies must be standardized and the importance of including 3 and 5-year-old children in periodical examinations should be underlined. The adoption of a validated scoring system that allows proper staging of caries lesions is another key factor that should be adopted.