A multi-variable analysis of four factors affecting caries levels among five-year-old children;deprivation,ethnicity,exposure to fluoridated water and geographic region

Abstract

Objective: To assess the role of factors posited to affect population caries levels across England. Basic research design: Multivariable regression analysis assessing four potential determinants of caries severity and prevalence: deprivation, exposure to fluoridated water, ethnicity and geographic region Participants: Random sample of 121,875 five-year-old children in England in the 2014/15 academic year. Main outcome measures: Decayed, missing and filled teeth, with decay measured at the dentinal level, (d₃mft), presented as prevalence (dmft⟩0) and extent of decay among children who have any (d₃mft if d₃mft>0). Independent variables: Parental reported ethnicity from school records, index of multiple deprivation (IMD) scores, region and exposure to water fluoridation calculated utilising home postcodes. Results: The data support wider literature displaying associations between caries and deprivation across a social gradient. The important, new findings are deprivation, some ethnic groups and lack of exposure to water fluoridation are all associated with increased prevalence and severity of caries when considered together and independently. New evidence supports the impact of water fluoridation on health inequalities in that the greatest impact of exposure to fluoridated water was seen in the most deprived children and those from an Asian / Asian British ethnic group. Conclusions: Five-year-old children who were from the most deprived areas, not exposed to fluoridated water, of an Eastern European ethnic group and living in the North West demonstrated the highest prevalence and severity of caries in the survey under scrutiny. This is of public health importance, providing evidence for population groups to target with health improvement activities

Keywords

caries children deprivation ethnicity water fluoridation

Get full access to this article

View all access options for this article.

References

Arora

Mackay

F., Conway, D. I., and Pell, J. P. (2016): Ethnic differences in oral health and use of dental services: cross-sectional study using the 2009 Adult Dental Health Survey. BioMed Central Oral Health 17, 1.

Conway

D. I.

Quarrell

McCall

D. R.

Gilmour

Bedi

Macpherson

L. M.

(2007): Dental caries in 5-year-old children attending multi-ethnic schools in Greater Glasgow-the impact of ethnic background and levels of deprivation. Community Dental Health 24, 161-165.

Fournier

Skaug

H.J.

Ancheta

Ianelli

Magnusson

Maunder

Nielsen

and Sibert

(2012): AD Model Builder: using automatic differentiation for statistical inference of highly parameterized complex nonlinear models. Optimization Methods and Software, 233-249.

Gray

Morris

J., and Davies, J. (2000): The oral health of South Asian five-year-old children in deprived areas of Dudley compared with White children of equal deprivation and fluorida-tion status. Community Dental Health 17, 243-245.

Iheozor-Ejiofor

Worthington

V., Walsh, T., O’Malley, L., Clarkson, J. E., Macey, R., Alam, R., Tugwell, P., Welch, V., and Glenny, A. M. (2015): Water fluoridation for the prevention of dental caries. Cochrane Database of Systematic Reviews, Cd010856.

Marcenes

Muirhead

E., Murray, S., Redshaw, P., Bennett, U., and Wright, D. (2013): Ethnic disparities in the oral health of three- to four-year-old children in East London. British Dental Journal 215, E4.

McDonagh

M. S.

Whiting

F., Wilson, P. M., Sutton, A. J., Chestnutt, I., Cooper, J., Misso, K., Bradley, M., Treasure, E., and Kleijnen, J. (2000): Systematic review of water fluoridation British Medical Journal 321, 855-859.

Ministry of Housing Communities and Local Government (2015): English indices of deprivation 2015. From www.gov.uk/govern-ment/statistics/english-indices-of-deprivation-2015,

Petersen

P. E.

Kwan

(2011): Equity, social determinants and public health programmes--the case of oral health. Community Dentistry Oral Epidemiology 39, 481-487.

10.

PHE (2014): Dental Public Health epidemiology programme: Oral health survey of five-year-old children 2014-15 National protocol Version 2 Gateway number: 201416 . From http://www. nwph.net/dentalhealth/14_15_5yearold/Protocol_2014_15_5%20 yr%20olds%20v2.pdf

11.

PHE (2016a): Hospital episodes for extraction of teeth for children 0-19years 2011-12 to 2015-16. From www.nwph.net/dentalhealth/Extractions.aspx

12.

PHE . (2016b): Dental Public Health epidemiology programme: National Dental Epidemiology Programme for England: oral health survey of five-year-old children 2015. From www.nwph. net/dentalhealth/survey-results%205(14_15).aspx.

13.

PHE (2018): Water Fluoridation Health monitoring report for England 2018. From https://assets.publishing.service.gov.uk/gov-ernment/uploads/system/uploads/attachment_data/file/692754/Water_Fluoridation_Health_monitoring_report_for_Eng

14.

land_2018_final.pdf Pitts, N. B., Palmer, J. D. (1994): The dental caries experience of 5-, 12- and 14-year-old children in Great Britain. Surveys coordinated by the British Association for the Study of Com-munity Dentistry in 1991/92, 1992/3 and 1990-91. Community Dental Health 11, 42-52.

15.

Prendergast

M. J.

Beal

F., and Williams, S. A. (1997): The relationship between deprivation, ethnicity and dental health in 5-year-old children in Leeds, UK. Community Dental Health 14, 18-21.

16.

RCoreTeam (2017): “R:A language and environment for statistical computing, R Foundation for Statistical Computing, Vienna, Austria. From www.R-project.org/

17.

RCS . (2015): The state of children’s oral health in England, RCS. From www.rcseng.ac.uk/fds/policy/documents/fds-report-on-the-state-of-childrens-oral-health.

18.

Sabbah

Tsakos

Chandola

Sheiham

and

Watt

, R. G. (2007): Social gradients in oral and general health. Journal of Dental Research 86, 992-996.

19.

Skaug

Fournier

Bolker

Magnusson

and Nielsen

(2016): Generalized Linear Mixed Models using ‘AD Model Builder’. R package version 0.8.3.3.

20.

Watt

and

Sheiham

, A. (1999): Inequalities in oral health: a review of the evidence and recommendations for action. British Dental Journal 187, 6-12.

21.

Watt

R. G.

(2007): From victim blaming to upstream action: tackling the social determinants of oral health inequalities. Community Dental Oral Epidemiology 35, 1-11.