The Generation R Study Group, ErasmusMC University Medical Center Rotterdam, The Netherlands; Department of Oral & Maxillofacial Surgery, Special Dental Care and Orthodontics, ErasmusMC University Medical Center Rotterdam, The Netherlands.
Department of Oral & Maxillofacial Surgery, Special Dental Care and Orthodontics, ErasmusMC University Medical Center Rotterdam, The Netherlands.
J Dent. 2017 Jul;62:18-24. doi: 10.1016/j.jdent.2017.04.008. Epub 2017 Apr 24.
The purpose of our study was to investigate the association of different socioeconomic and sociodemographic factors with dental caries in six-year-old children. Furthermore, we applied a district based approach to explore the distribution of dental caries among districts of low and high socioeconomic position (SEP).
In our cross-sectional study 5189 six-year-olds were included. This study was embedded in a prospective population-based birth cohort study in Rotterdam, the Netherlands, the Generation R Study. Parental education level, parental employment status, net household income, single parenting, and teenage pregnancy were considered as indicators for SEP. Dental caries was scored on intraoral photographs by using the decayed, missing, and filled teeth (dmft) index. We compared children without caries (dmft=0) to children with mild caries (dmft=1-3) or severe caries (dmft >3). Multinomial logistic regression analyses and binary logistic regression analyses were performed to study the association between SEP and caries, and between district and caries, respectively.
Only maternal education level remained significantly associated with mild caries after adjusting for all other SEP-indicators. Paternal educational level, parental employment status, and household income additionally served as independent indicators of SEP in children with severe caries. Furthermore, living in more disadvantaged districts was significantly associated with higher odds of dental caries.
Dental caries is more prevalent among six-year-old children with a low SEP, which is also visible at the district level. Maternal educational level is the most important indicator of SEP in the association with caries.
Our results should raise concerns about the existing social inequalities in dental caries and should encourage development of dental caries prevention strategies. New knowledge about the distribution of oral health inequalities between districts should be used to target the right audience for these strategies.
本研究旨在探讨不同社会经济和社会人口因素与 6 岁儿童龋齿的关系。此外，我们应用基于区的方法来探索低和高社会经济地位（SEP）区之间龋齿的分布情况。
在我们的横断面研究中，纳入了 5189 名 6 岁儿童。本研究是荷兰鹿特丹前瞻性人群出生队列研究——“世代研究”的一部分。父母的教育水平、父母的就业状况、净家庭收入、单亲家庭和青少年怀孕被视为 SEP 的指标。龋齿通过使用龋失补牙（dmft）指数在口腔内照片上进行评分。我们将无龋齿（dmft=0）的儿童与轻度龋齿（dmft=1-3）或重度龋齿（dmft>3）的儿童进行比较。采用多变量逻辑回归分析和二项逻辑回归分析分别研究 SEP 与龋齿之间的关系，以及区与龋齿之间的关系。
在调整了所有其他 SEP 指标后，只有母亲的教育水平与轻度龋齿仍显著相关。父亲的教育水平、父母的就业状况和家庭收入也是重度龋齿儿童 SEP 的独立指标。此外，生活在条件较差的区与更高的龋齿发病几率显著相关。
社会经济地位较低的 6 岁儿童龋齿更为普遍，在区一级也可见到这种情况。母亲的教育水平是 SEP 与龋齿关系中最重要的指标。
我们的研究结果应该引起对现有龋齿社会不平等现象的关注，并鼓励制定龋齿预防策略。应利用有关区之间口腔健康不平等分布的新知识，为这些策略确定目标受众。
