Systematic Review of Intervention Studies Aiming at Reducing Inequality in Dental Caries among Children.

Eduardo Bernabé,Wael Sabbah,Anqi Shen

doi:10.3390/ijerph18031300

Abstract

(1) Background: The objective is to systematically review the evidence on intervention programs aiming at reducing inequality in dental caries among children. (2) Methods: Two independent investigators searched MEDLINE, Cochrane library, and Ovid up to December 2020 to identify intervention studies assessing the impact on socioeconomic inequalities in dental caries among children. The interventions included any health promotion/preventive intervention aiming at reducing caries among children across different socioeconomic groups. Comparison groups included children with alternative or no intervention. Cochrane criteria were used to assess interventional studies for risk of bias. (3) Results: After removal of duplicate studies, 1235 articles were retained. Out of 43 relevant papers, 13 articles were identified and used in qualitative synthesis, and reported quantifiable outcomes. The included studies varied in measurements of interventions, sample size, age groups, and follow-up time. Five studies assessed oral health promotion or health-education, four assessed topical fluorides, and four assessed water fluoridation. Interventions targeting the whole population showed a consistent reduction of socioeconomic inequalities in dental caries among children. (4) Conclusion: The quality of included papers was moderate. High heterogeneity did not allow aggregation of the findings. The overall findings suggest that whole population interventions such as water fluoridation are more likely to reduce inequalities in children’s caries than target population and individual interventions.

Highlights

Dental caries is considered one of the most prevalent chronic diseases worldwide [1].The percentage of children among disadvantaged families who suffered from early childhood caries was reported as 70% [2]
Low family income, and low maternal educational levels are related to proximal risk factors for dental caries such as poor access to dental services, inadequate use of oral hygiene products, poorer oral health knowledge, and oral hygiene [5], which result in high prevalence and severity of dental caries [7]
PICO’s format was used as criteria for eligibility; that is, ‘P’, participants were children or adolescents aged up to 18 years; ‘I’, intervention groups included children exposed to any form of clinical intervention or oral health education/oral health promotion activity; ‘C’, comparison groups included children with no intervention or with an alternative intervention; and ‘O’, studies that assessed or reported reduced inequalities in dental caries among children

Summary

Introduction

Dental caries is considered one of the most prevalent chronic diseases worldwide [1].The percentage of children among disadvantaged families who suffered from early childhood caries was reported as 70% [2]. Despite the overall decline in dental caries over the past few decades [3], inequalities in oral health and in dental caries continue to exist and present a challenge to health promotion interventions [4]. Aside from the known proximal risk factors for dental caries [5], socioeconomic position (commonly measured by family income, occupation, parental education, and area deprivation), defined by social processes, materialistic conditions, and life changes over time, subsequently lead to oral health inequalities [6]. Low family income, and low maternal educational levels are related to proximal risk factors for dental caries such as poor access to dental services, inadequate use of oral hygiene products, poorer oral health knowledge, and oral hygiene [5], which result in high prevalence and severity of dental caries [7].

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Discussion

Conclusion