Abstract
BackgroundGross and important inequities have historically existed in the oral health profiles of New Zealand children. Following the New Zealand Government’s strategic oral health vision, launched in 2006, nationally collected information from 2004 to 2013 was used to analyze patterns in the prevalence of no obvious decay experience (caries-free) and mean decayed-missing-filled teeth indices over time and by community water fluoridation (CWF) and ethnic classifications in New Zealand children aged 5 years and in school year 8 (generally aged 12–13 years).MethodsNational aggregated data collected from children’s routine child oral health service dental examinations were retrieved, and combined with demographic information from Statistics New Zealand. Children’s CWF status was defined by the public water supply status of their school. Crude and standardized population estimates of caries-free prevalence and mean decayed-missing-filled teeth indices over time were derived. Unweighted linear regression models of main effects and two-factor interactions were investigated by age group.ResultsDental examination data were available from 417,318 children aged 5 years and 471,333 year 8 children; of whom 93,715 (22.5 %) and 94,001 (19.9 %), respectively, were Māori. Dental examination coverage of Māori children was significantly less than their non-Māori counterparts (approximately 11 % and 14 % for aged 5 and year 8 children, respectively). Regression analysis revealed that caries-free prevalence and mean decayed-missing-filled teeth indices significantly improved over the study period for both age groups. Significant and sustained differences were observed between Māori and non-Māori children, and between CWF and non-CWF exposed groups. However, a convergence of dental profiles between non-Māori children in CWF and non-CWF regions was observed.DiscussionSignificant and important gains in New Zealand children’s oral health profiles appear to have been made over the last decade. Māori children continued to carry a disproportionate oral health burden, even for those in CWF regions. The apparent profile convergence between non-Māori children in CWF and non-CWF regions is noteworthy; although a likely consequence of demographic shifts and unmeasured confounders.ConclusionsCWF itself did not remove disparities in caries levels between Māori and non-Māori children. Multiple, multi-pronged strategies are needed that overcome the array of factors which disadvantage Māori.
Highlights
Gross and important inequities have historically existed in the oral health profiles of New Zealand children
Over the study period, dental examination data were available from 417,318 children aged 5 years and 471,333 year 8 children; of whom 93,715 (22.5 %) and 94,001 (19.9 %), respectively, were identified as being Māori
A significant increase in the proportion of New Zealand children aged 5 years who received dental examinations was observed over this period (p = 0.009), with overall coverage increasing by 1.4 % (95 % confidence interval (CI): 0.5 %, 2.4 %) per year
Summary
Gross and important inequities have historically existed in the oral health profiles of New Zealand children. Dental caries severity is measured by counting the number of affected teeth or tooth surfaces; it is cumulative and individuals tend to have a similar rate of increase over time – meaning those with poor oral health early in life are likely to have worse oral health in later years unless effective preventive interventions are introduced [6]. While rates have improved in New Zealand since the 1980s, over 40 % of children still experience dental caries by 5 years of age, and large inequities exist [2]. In the last two decades the national rate of hospital admissions for dental care treatment under general anaesthesia has increased nearly four-fold, from 0.76 per 1000 people in 1990 to 3.01 per 1000 in 2009, with children aged under 8 years having the highest admission rates [9]. The intricate interplay between these and other individual, social, cultural, economic, and environmental factors can make the development of efficacious oral health preventive strategies challenging
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