Abstract
Oral health-related behaviors and living conditions play an important role in general and oral health. This study aimed to evaluate caries prevalence and severity in schoolchildren residing in rural and urban areas of Romania, and to correlate these with oral health-related behaviors. An estimation of the required sample size was conducted (sampling error of ±3% at a 95% confidence level), followed by the stratification of administrative units and then the selection of 49 schools. The Hurdle approach was used to analyze the dataset, requiring two sets of analyses for each outcome variable: a multilevel binary model to predict prevalence, and a multilevel Poisson analysis using only non-zero values. The mean and standard deviation (SD) for the dentinal caries index was 4.96 (5.33). Girls were more likely to have non-zero restoration codes (β = 0.14, SE = 0.08, p < 0.05). Low education levels of each parent were associated with an increased likelihood of having non-zero carious tooth surfaces (β = 0.23, SE = 0.06, p = 0.01; β = 0.22, SE = 0.06, p < 0.01). The presence of cavities was predicted by the consumption of carbonated soft drinks (β = 0.19, SE = 0.07, p < 0.01), candies (β = 0.13, SE = 0.06, p < 0.01), sweetened milk (β = 0.12, SE = 0.06, p < 0.05), tea (β = 0.16, SE = 0.08, p < 0.05), or cocoa (β = 0.13, SE = 0.06, p < 0.05). Furthermore, the non-zero values of the dentinal caries index were more likely in rural schools (β = −0.37, SE = 0.11, p < 0.01), and a negative association between the county development index and the fillings/restorations index (β = −0.01, SE = 0.01, p < 0.05) was also established. The outcome of this research highlights that the presence of caries (dentinal caries index) in Romanian schoolchildren is influenced by their socioeconomic background, as well as their specific consumption behaviors.
Highlights
Caries is a multi-factorial disease resulting from a series of events that evolve in a chain, lasting for years [1,2]
The public schools to be included in the survey were selected based on the number of children registered by the National School Inspectorate in the 42 counties of Romania
A total of 43.71% of the children resided in rural areas and 56.29% in urban areas, mostly small cities
Summary
Caries is a multi-factorial disease resulting from a series of events that evolve in a chain, lasting for years [1,2]. It is still the single most common non-communicable disease worldwide, and it is not self-limiting or treatable with antibiotics. Public health efforts, aimed at addressing the pediatric caries epidemic, have mostly focused on tooth level interventions [4], and have led to a decreasing trend in most industrialized countries [5]. In order to benefit from a more comprehensive understanding of how social factors might influence the prevalence of caries, the differences observed between rural and urban areas constitute a strong factor to be considered. Rural living deprivation has been linked with poorer dental health in several surveys [8,9,10]
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