[Determinants of dental caries in Haitian schoolchildren and implications for public health].

This work was carried out as part of a community development project in North-West Haiti. The aim was to determine the prevalence of dental caries among young Haitians and to identify the principal determinants and risk factors. A total of 322 schoolchildren, all aged 12 years, participated in the study in March and April 1996. Demographic characteristics, hygiene and dietary habits were recorded. In parallel, a dentist assessed the amount of debris present on the teeth and investigated the children's history of caries. Almost two thirds of the children examined were free of caries. The mean number of decayed missing and filled teeth (DMFT index) was 0.93, which is low. However, a high-risk group was identified with a mean DMFT index of 3.8. This group is a source of some concern, particularly as the region's health services are often inaccessible resulting in dental caries frequently remaining untreated until tooth extraction is required. Logistic regression analysis showed that dental hygiene and, to a lesser extent, sugar intake, were the principal risk factors for dental caries. Adolescents who consume more than three meals per day and who, presumably, have a higher intake of cariogenic food, present more caries than those who consume less. These schoolchildren meet the objectives of the WHO for dental caries for 2000, but two courses of action are nonetheless necessary: caries prevention and improved access to dental health care. To prevent caries, techniques for increasing the resistance of teeth could be recommended, as in industrialized countries. However, such strategies would be difficult to implement in the rural context of a developing country. The addition of fluoride to drinking water, for example, is not practical as most of the inhabitants of rural areas do not have access to running water. The use of sealing agents, which protect against decay affecting the occlusal surfaces of molars, is also impractical, for financial reasons. Thus, basic measures involving the improvement of dental hygiene and reducing the intake of cariogenic foods remain the principal means of preventing caries. Increasing the accessibility of dental care, like prevention, involves a number of problems. Increasing the number of health centers, or renovating existing clinics requires resources, and possibly infrastructure, that the Haitian state may not be in a position to provide. The recently developed ART (Atraumatic Restoration Treatment) overcomes this problem. This method involves manually cleaning cavities and sealing then with glass ionomer. This product is highly adhesive, which frees dentists from the constraints of having to use rotating electrical equipment. Caries can therefore now be treated in remote areas with a minimum of dental equipment. However, although encouraging results were obtained in a three-year trial in Thailand, the mechanical quality of glass ionomer and its ability to block caries development are unclear. In conclusion, a lack of financial resources limits the possibilities of intervention in developing countries, drawing attention to the important question of the financing of health programs. Funding remains the key to any program and has been shown to be an essential issue in epidemiological studies.