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U-M study: Insights into tooth decay in kids in low-income households

ANN ARBOR, Mich.—Oral health disparities are common among pre-school aged children, but more needs to be done to combat the prevalence of tooth decay among low-income and minority populations where the problem is severe, a University of Michigan study indicates.

In an analysis of low-income, African-American households in Detroit, U-M researchers found that children ages 4 and 5 and those who had restorative dental visits were more likely to develop tooth decay, or early childhood caries.

The study looked at maternal health beliefs, behaviors and psychosocial factors related to African-American children with tooth decay living in low-income homes. Sugar exposure and mouth bacteria can trigger severe tooth decay. Cavities can result from inappropriate bottle or sippy cup use, and sugary snack foods.

Tracy Finlayson, who analyzed the first wave of a longitudinal study as a U-M doctoral student, served as lead author. She is a scholar at the University of California, Berkeley. She wrote the study with Kristine Siefert of the U-M School of Social Work, and Amid Ismail and Woosung Sohn, both with the U-M School of Dentistry.

Subsequent to Finlayson's analysis and using data from two time periods, researchers at the Detroit Dental Health Project found that when parents and caregivers believe that tooth decay is inevitable, the children are more likely to suffer from it.

Data were collected by the Detroit Dental Health Project (DDHP), a National Institutes of Health-funded study of more than 1,000 African-American families with at least one child 5 years or younger and living in 39 low-income communities. The DDHP project seeks to investigate the association between childhood cavities and tooth decay later in life. Finlayson's analysis was limited to 719 children ages 1 to 5 whose mothers were examined in the first of the three-wave cycle of the study.

Trained staff conducted personal interviews with caregivers in Detroit. All children and caregivers received dental examinations in the DDHP's Dental Assessment Center.

Caregivers were asked how confident they were about ensuring children's teeth were brushed before bedtime under situations such as being tired. Mothers reported relatively high levels of understanding appropriate bottle use and children's oral hygiene needs. However, more than three quarters of the sample endorsed a fatalistic oral health belief, as indicated in one sample item: "Cavities in baby teeth don't matter since they fall out anyway."

"Children who suffer from early childhood cavities, a condition more common than asthma, most likely will end up being treated under sedation or even general anesthesia," Ismail said. "This negative experience early in life may have a significant impact on children's dental experience."

Researchers examined three factors potentially influencing mothers' behaviors toward oral health: symptoms of depression, parenting stress, and social support. Maternal symptoms of depression were highly prevalent, but were not directly related to early childhood cavities. Parents stressing then need for proper oral health had a positive influence on preventing cavities, they found.

"Parenting stress was inversely associated with children's (oral health) status, such that for each unit increase on the stress scale, the odds of the child having cavities reduced by about one-third," Siefert said. "It may be that parents who are more conscientious about their children's health habits are also those who worry more and are more stressed. This is an important area for future research."

Parent's income level, employment and education play a role in the outcomes, they said.

Prevention of early childhood cavities should be based on understanding of the social determinants of the condition, the researchers said. This research is now being used to design community-based interventions using a common risk factor model.

The findings appeared in the May issue of Community Dentistry and Oral Epidemiology.

FinlaysonSiefertCommunity Dentistry and Oral EpidemiologyDetroit Dental Health Project (DDHP)