Abstract
BackgroundSocio-economic factors are considered as main determinants causing disparities in oral health across different countries. The aim of the present study was to investigate the associations of social and economic factors with dental caries experience among 6- and 12-year-old Iranian children.MethodsIn this cross-sectional study, a total of 31,146 students, aged 6 and 12 years old, were enrolled from all (31) provinces in Iran. Based on the standardized World Health Organization (WHO) criteria for oral health surveys, dental caries indices in primary and permanent teeth were assessed by clinical examination in schools. Data on socio-economic status was obtained from the modified WHO questionnaire and national data bank. The decayed, missing and filled teeth (dmft/DMFT) indices for primary and permanent dentition were compared at the individual and provincial levels using multilevel regression analysis. Poisson regression analysis was used to evaluate the association of social (demographic and behavioral) determinants with dental caries indices among individuals. To assess the causes of difference in dental caries indices across provinces, justifiable economic factors were also analyzed using poisson regression analysis.ResultsThe mean (SE) of dmft and DMFT were 5.84 (0.05) and 1.84 (0.03), for 6-and 12-year-old children, respectively. The differences of dental caries indices were statistically significant among provinces. Higher level of parental education was negatively related to dental caries indices of both age groups. Rural residency was positively and dental flossing was reversely associated with dmft index of 6-year-old children. Negative associations were found between frequency of tooth brushing and preventive dental utilization with dmft and DMFT indices. Gross Domestic Product (GDP) index had negative and Consumer Price Index (CPI) had positive associations with dmft and DMFT indices in both age groups. However, positive relationships were observed between Gini index with DMFT index among 12-year-old children; as well as between the number of dentists per capita with dmft index among 6-year-old children.ConclusionSocio-demographic and behavioral factors were found to be associated with dental caries experience. However, economic indicators had the greatest importance.
Highlights
Socio-economic factors are considered as main determinants causing disparities in oral health across different countries
A total of 31,146 Iranian students from all (31) provinces were participated in this study, of which 15,630 school children were 6 years old and 15,508 were 12 years old
We found reverse associations of higher level of fathers’ and mothers’ education with dental caries experience of 6-and 12year-old children, respectively, which is consistent with the results of a systematic review of 25 studies conducted in Iran from 1994 to 2017 [13]
Summary
Socio-economic factors are considered as main determinants causing disparities in oral health across different countries. From the public health perspective, oral diseases are one of the most prevalent diseases worldwide, with extensive social and economic effects. Policies related to oral disease prevention have been mostly overlooked by public health policy makers [1]. Dental caries prevalence, resulted from oral health surveys, is essential to evaluate oral health status of populations. Assessment of such prevalence is required to evaluate its determinants, design/formulate effective preventive programmes and predict possible future needs for oral health care [3]. Based on a report by World Health Organization (WHO), dental treatments have always been the most expensive treatments among all chronic diseases [4], and impose great economic burden on both individuals and health care systems [5]
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