Heima Masahiro, Lee Wonik, Milgrom Peter, Nelson Suchita
Case Western Reserve University, Cleveland, Ohio., USA.
Caries Res. 2015;49(2):177-83. doi: 10.1159/000368560. Epub 2015 Feb 3.
The objective of this study was to investigate the influence of caregiver education level on children's dental caries mediated by both caregiver and child oral health behaviors. Participants were 423 low-income African American kindergarteners and their caregivers who were part of a school-based randomized clinical trial. Path analysis tested the hypothesis that caregiver education level affected untreated dental caries and cumulative overall caries experience (decayed or filled teeth) through the mediating influence of frequency of dental visits, use of routine care, and frequency of toothbrushing for both the caregiver and the child. The results supported the hypothesis: caregivers who completed high school were 1.76 times more likely to visit dentists compared with those who did not complete high school (e(0.56) = 1.76, 95% CI: 1.03-2.99), which in turn was associated with 5.78 times greater odds of dental visits among their children (e(1.76) = 5.78, 95% CI: 3.53-9.48). Children's dental visits, subsequently, were associated with 26% fewer untreated decayed teeth compared with children without dental visits (e(-0.31) = 0.74, 95% CI: 0.60-0.91). However, this path was not present in the model with overall caries experience. Additionally, caregiver education level was directly associated with 34% less untreated decayed teeth (e(-0.42) = 0.66, 95% CI: 0.54-0.79) and 28% less decayed or filled teeth (e(-0.32) = 0.72, 95% CI: 0.60-0.88) among the children. This study overcomes important conceptual and analytic limitations in the existing literature. The findings confirm the role of caregiver education in child dental caries and indicate that caregiver's behavioral factors are important mediators of child oral health.
本研究的目的是调查照顾者教育水平通过照顾者和儿童口腔健康行为对儿童龋齿的影响。研究参与者为423名低收入非裔美国幼儿园儿童及其照顾者，他们是一项基于学校的随机临床试验的一部分。路径分析检验了以下假设：照顾者教育水平通过影响看牙频率、日常护理使用情况以及照顾者和儿童的刷牙频率，进而影响未经治疗的龋齿和累积总体龋齿经历（龋坏或已补牙）。结果支持了这一假设：完成高中学业的照顾者看牙医的可能性是未完成高中学业者的1.76倍（e(0.56) = 1.76，95%置信区间：1.03 - 2.99），这反过来又与他们孩子看牙的可能性高出5.78倍相关（e(1.76) = 5.78，95%置信区间：3.53 - 9.48）。随后，与未看牙的儿童相比，儿童看牙与未经治疗的龋坏牙齿减少26%相关（e(-0.31) = 0.74，95%置信区间：0.60 - 0.91）。然而，在总体龋齿经历模型中不存在这条路径。此外，照顾者教育水平与儿童未经治疗的龋坏牙齿减少34%（e(-0.42) = 0.66，95%置信区间：0.54 - 0.79）以及龋坏或已补牙减少28%（e(-0.32) = 0.72，95%置信区间：0.60 - 0.88）直接相关。本研究克服了现有文献中重要的概念和分析局限性。研究结果证实了照顾者教育在儿童龋齿中的作用，并表明照顾者的行为因素是儿童口腔健康的重要中介因素。
