Socio-economic determinants of selected dietary indicators in British pre-school children

Objectives: To assess the proportion of pre-school children meeting reference nutrient intakes (RNIs) and recommendations for daily intakes of iron, zinc, vitamins C and A, and energy from non-milk extrinsic sugars. To assess whether meeting these five dietary requirements was related to a series of socio-economic variables.Design: Secondary analysis of data on daily consumption of foods and drinks from the National Diet and Nutrition Survey (NDNS) of children aged 1.5-4.5 years based on 4-day weighed intakes.Subjects: One thousand six hundred and seventy-five British pre-school children aged 1.5-4.5 years in 1993.Results: Only 1% of children met all five RNIs/recommendations examined; 76% met only two or fewer. Very few children met the recommendations for intakes of zinc (aged over four years) and non-milk extrinsic sugars (all ages). The number of RNIs/ recommendations met was related to measures of socio-economic class. Children from families in Scotland and the North of England, who had a manual head of household and whose mothers had fewest qualifications, met the least number of RNIs/recommendations.Conclusions: Very few pre-school children have diets that meet all the RNIs and recommendations for iron, zinc, vitamins C and A, and energy from non-milk extrinsic sugars. Dietary adequacy with respect to these five parameters is related to socio-economic factors. The findings emphasise the need for a range of public health policies that focus upon the social and economic determinants of food choice within families

Multimorbidity: a challenge and opportunity for the dental profession

Multimorbidity (the coexistence of two or more chronic conditions) is common, is likely to be on the increase and has a major impact on quality of life, increased risk of mortality, and significant financial costs to the health and social care system. Multimorbidity is strongly associated with increasing age and is also directly linked to socioeconomic status. A substantial body of scientific evidence has shown an association between specific oral diseases and a range of other health conditions. Less is known, however, about the inter-relationships between oral diseases and multiple other health conditions. As multimorbidity is increasingly becoming the norm, rather than the exception, a profound shift is now needed in the training of oral health professionals, and the practice and delivery of dental care. A more integrated and coordinated approach to training and care is needed, which will require radical system-level reform and redesign of how health and dental services are commissioned, delivered and financed. Truly multidisciplinary teamwork requires system reform to facilitate effective joint working. The pattern of disease in society is changing and the dental profession needs to respond accordingly

Socioeconomic gradients in general and oral health of primary school children in Shiraz, Iran

BACKGROUND: Health status is largely determined by socio-economic status. The general health of individuals at higher social hierarchy is better than people in lower levels. Likewise, people with higher socio-economic status have better oral health than lower socio-economic groups. There has not been much work regarding the influence of socio-economic status on the health conditions of children in developing countries, particularly in Iran. The aim of this study was to compare the oral and general health conditions of primary school children of three different socio-economic areas in the city of Shiraz, Iran. METHODS: This cross-sectional study was conducted on 335, 8- to 11-year-old primary schoolchildren in Shiraz. The children were selected by a three-stage cluster sampling method from three socio-economically different areas. Tools and methods used by the United Kingdom's Medical Research Council were used to obtain anthropometric variables as indicators of general health. The Decay, Missing, Filled Teeth (DMFT) Index for permanent teeth, dmft Index for primary teeth, the Modified Developmental Defects of Enamel (DDE) Index, the Gingival Index (GI) and the Debris Index-Simplified (DI-S) were used for oral health assessment.  RESULTS: Height (P<0.001), weight (P<0.001), and BMI (P=0.001) significantly increased as the socio-economic status of area increased. GI score (P<0.001), DI-S score (P<0.001), number of permanent teeth with DDE (P=0.008), and number of DDE lesions in permanent teeth (P=0.008) significantly decreased as the socio-economic status of area increased. DISCUSSION: Findings of this study generally confirmed that social gradients exist in both general and oral health status of the primary schoolchildren of Shiraz. The influence of socio-economic status on health condition means children have different life chances based on their socio-economic conditions. These findings emphasize the significance of interventions for tackling socio-economic inequalities in order to improve the health status of children in lower socio-economic areas

Oral Health - A Neglected Aspect of Subjective Well-Being in Later Life

OBJECTIVES: This study examined whether oral health is a neglected aspect of subjective well-being (SWB) among older adults. The key research question was whether deterioration in oral health among dentate older adults living in England was associated with decreases in SWB, using measures of eudemonic, evaluative, and affective dimensions of well-being. METHODS: This secondary analysis used data from the third (2006-2007) and fifth (2010-2011) waves of respondents aged 50 and older from the English Longitudinal Study of Ageing (ELSA). We fitted multivariable regression models to examine the effects of changes in oral impacts on daily life and edentulism (complete tooth loss) on SWB (quality of life, life satisfaction, and depressive symptomatology). RESULTS: A worsening in both oral health measures was associated with an increase in depressive symptoms even after adjusting for time-varying confounders including declining health, activities of daily living, and reduced social support. Becoming edentate was also associated with decreases in quality of life and life satisfaction. DISCUSSION: A deterioration in oral health and oral health-related quality of life increases the risk of depressive symptoms among older adults and highlights the importance of oral health as a determinant of subjective well-being in later life

Traumatic dental injuries and socioeconomic position – findings from the Children's Dental Health Survey 2013

OBJECTIVES: The aim of this study was to assess whether traumatic dental injuries (TDI) were socially graded among children and adolescents in England, Wales and Northern Ireland, using nationally representative data from the Children's Dental Health Survey (CDHS) 2013. METHODS: This cross-sectional study used data from the Children's Dental Health Survey 2013 which was conducted among a nationally representative sample of schoolchildren in England, Wales and Northern Ireland. Children's family socioeconomic position (SEP) was measured through free school meal eligibility and relative area deprivation using the Indices of Multiple Deprivation. The analytical sample included 6707 schoolchildren aged 8, 12 and 15. Multiple logistic regression was used to model the associations between experience of TDI and the two markers of SEP, after adjusting for sex and age. RESULTS: The overall prevalence of traumatic dental injuries to permanent incisors was 9% (n = 590). There were no statistically significant associations between TDI and either SEP measure. Further subgroup analyses (n = 2650) showed also no significant associations between TDI and additional SEP markers (parental education and social class). The odds of having sustained a traumatic dental injury were higher for boys than for girls and were greater in older age groups. CONCLUSIONS: This study found no significant relationships between the experience of traumatic dental injuries and two markers of family socioeconomic position among children living in England, Wales and Northern Ireland. This implies that rather than specifically targeting the more deprived sectors of society, TDI prevention policies should use upstream public health strategies incorporating a whole-population approach

Down syndrome and oral health: mothers' perception on their children's oral health and its impact

BACKGROUND: Individuals with Down syndrome exhibit particular oro-facial characteristics that may increase their risk of oral health problems. However, there is little research on the oral health of children and adults with Down syndrome and the way that oral health may affect Quality of Life (QoL). This study explored mothers' perceptions of the oral health problems experienced by their children with Down syndrome and how these reported problems impacted the lives of the children and their families. METHODS: The study involved 20 in-depth, semi-structured interviews with mothers of children and adolescents aged 12-18 years with Down syndrome attending special care centres in Riyadh, Saudi Arabia. RESULTS: The predominant oral-health related problem reported by mothers was difficulty in speaking. Mothers also reported that tooth decay and toothache were problems that had undesirable effects on different aspects of their children's QoL including: performing daily activities, emotional wellbeing, and social relationships. Poor oral health and functional problems had direct and indirect impacts on the family's QoL as well. CONCLUSION: Mothers perceived an array of QoL impacts from oral conditions, which affected their child with Down syndrome and the wider family

Cross cultural adaptation and psychometric properties of the Bengali version of the Scale of Oral Health Outcomes for 5-year-old children (SOHO-5)

BACKGROUND: The oral health related quality of life (OHRQoL) of children in Bangladesh has not yet been measured, as there is no validated OHRQoL measure for that population. The aim of this study was to cross-culturally adapt the child self-report and parental proxy report versions of the Scale of Oral Health Outcomes for 5-year-old children (SOHO-5) into Bengali and test their psychometric properties: face validity, construct validity (convergent and discriminant validity) and reliability (internal consistency and test-retest reliability), among 5-9-year-old children and their parents in Bangladesh and assess associations between dental caries/sepsis and OHRQoL in this population. METHODS: The forward-backward translated Bengali SOHO-5 was piloted among 272 children and their parents to test its face validity. The questionnaire was administered to 788 children and their parents to evaluate its psychometric properties. Internal consistency of Bengali SOHO-5 was assessed using Cronbach's alpha, and test-retest reliability was assessed using Kappa. Convergent and discriminant validity were assessed through nonparametric tests. The calculation of effect sizes and standard error of measurement facilitated the assessment of minimally important difference (MID) for SOHO-5. The associations of reporting an oral impact with caries and sepsis were assessed via logistic regression models. RESULTS: Both child self-report and parental proxy report questionnaires showed good face validity. Cronbach's alpha scores were 0.79 and 0.87 for child and parental questionnaire, respectively. A weighted Kappa score of 0.85 demonstrated test-retest reliability of child questionnaire. SOHO-5 scores were significantly associated with subjective oral health outcomes and discriminated clearly between different caries severity and sepsis groups. These differences were considerably higher than the MID. After adjusting for child's age, sex, setting, maternal education and family income, the odds of reporting an oral impact were 2.25 (95% CI 1.98-2.56) and 4.44 (95% CI 3.14-6.28) times higher for each additional tooth with caries and sepsis, respectively. CONCLUSION: This study provided strong evidence supporting the validity and reliability of both versions of Bengali SOHO-5 as OHRQoL measures. Dental caries and sepsis were associated with poor OHRQoL in this population. The Bengali SOHO-5 is expected to be a useful outcome measure for research and clinical purposes in Bengali speaking child populations

The role of oral health-related quality of life in the association between dental caries and height, weight and BMI among children in Bangladesh

Objectives: To examine whether oral health-related quality of life (OHRQoL) explained the negative associations between dental caries and anthropometric measures of child growth among a sample of 5- to 9-year-old children in Dhaka, Bangladesh, while taking potential confounding factors (maternal education, family income, study setting, child's birth weight and childhood diseases) into account. In addition, to test whether specific oral impacts had a role in explaining these associations. Methods: Data collection was conducted via a cross-sectional survey among children and their parents from both hospital and school settings in Dhaka. Dental caries and severe consequences of dental caries (defined here as dental sepsis) were the exposure variables, and age- and sex-adjusted height-z-scores (HAZ), weight-z-scores (WAZ) and BMI-z-scores (BAZ) were the outcome variables. OHRQoL was measured using the Bengali version of the Scale of Oral Health Outcomes for 5-year-old children (SOHO-5). First, associations between oral impacts (prevalence of overall impacts and specific items of the SOHO-5) and outcome measures were assessed. Multiple linear regression was used to assess associations between caries and anthropometric measures, adjusted for potential confounders. Oral impacts were then added to test whether their inclusion attenuated the associations between exposures and outcomes. To further investigate potential mediating role of oral impacts, structural equation modelling (SEM) was used to test the hypothesis that dental caries and sepsis were associated with the outcomes directly and also indirectly via oral impacts in general. A similar approach was used to investigate mediation by specific SOHO-5 items. Results: The sample consisted of 715 children, 73.1% of whom had dental caries, 37.5% presented with sepsis, and 57.3% reported at least one oral impact (SOHO-5 score ≥1). Prevalence of overall oral impacts and also the impact on ‘eating difficulty’ (a specific item of SOHO-5) were negatively associated with all three outcomes. Dental caries and sepsis was associated with lower HAZ, WAZ and BAZ, and adjustment for overall oral impacts considerably attenuated the associations between ‘severe dental caries’ and outcomes, and dental sepsis and outcomes. Using SEM, we found significant indirect associations between caries and sepsis and anthropometric measures via oral impacts (except for dental caries and HAZ). Considering specific oral impacts, eating difficulties explained about 44% and 65% of the associations between caries and anthropometric outcomes, and dental sepsis and anthropometric outcomes, respectively. Conclusions: Oral impacts, in particular eating difficulties, appear to mediate associations between caries and markers of child growth among this population