title: Obesity and dental caries in children in Scotland: trends, inequalities, and the reach and impact of the Childsmile Programme
Creators: name: Stewart, Ryan
Publisher: name: University of Glasgow
Year: 2023

description: Background: Childhood dental caries and obesity are global public health non-communicable disease challenges. Despite recent improvements, caries experience remains highly prevalent among Scotland’s children with wide inequalities, with one half of children from the poorest areas suffer caries by 5-years-old, with extraction of teeth under general anaesthetic being the most common reason children are electively admitted to hospital. Ten percent of Primary 1 children (typically aged 5-years-old) in Scotland have obesity, with higher rates seen in more deprived areas. Caries and obesity share socioeconomic determinants that underpin these large inequalities, with sugar consumption being one of the key causative factors for both conditions. Both conditions are among the first observable outcomes of poor health in the early years and markers of poor health in adulthood. There may be opportunities within the Childsmile programme (Scotland’s national oral health improvement programme) to intervene to tackle common risk factors of caries and obesity, however, as of yet it is unclear what relationship exists between the two conditions in childhood. Furthermore, it is unknown to what extent the problem is for children with co-existing caries and obesity and if inequalities exist in this group. Aims: To examine the interrelationship between obesity and dental caries in Primary 1 schoolchildren in Scotland over time (2011 to 2018). To measure socioeconomic inequalities in childhood obesity and dental caries, separately and together. To explore the reach and impact of the national child oral health improvement programme for Scotland, Childsmile, in preventing childhood obesity and caries. Methods: Population-level repeated cross-sectional data linkage and secondary analysis of pseudonymised, individual-level National Health Service data on caries experience and obesity, from multiple cohorts of Primary 1 children in Scotland, between 2011/12 and 2017/18 and a measure of area-based deprivation (Scottish Index of Multiple Deprivation) from the child’s home postcode have been used. The thesis compares access to school-based dental inspections; primary care prevention; and Childsmile interventions between children with the co-existing conditions and their peers with neither condition adjusted by area-based socioeconomic deprivation, schoolyear, sex, and age. Results: The prevalence of caries experience in Primary 1 children has been reducing over all in Scotland from 32.9% in 2011/12 to 29.5% in 2017/18, although absolute inequalities remain large and consistent, with the difference in prevalence between the most and least deprived being 37.5% in 2011/12 and 34.1% in2017/18. The prevalence of obesity has plateaued overall (9.8% in 2011/12; 10.1% in 2017/18), however, this has masked a small but steady rise is prevalence in the 10% most deprived areas (11.8% in 2011/12; 12.9% in 2017/18). Prevalence of co-existing obesity and caries was 3.4% over the study period with large, persistent inequalities. In children from the 20% most deprived areas, 5.6% hadco-existing conditions in contrast with 1.4% from the 20% least deprived areas (adjusted odds ratio=6.63; 95% confidence interval = [6.16to7.14]). Children with coexisting conditions were less likely to attend primary dental-care than their peers, and in those who attended dental practice, were less likely to receive prevention (fluoride varnish, toothbrushing instruction, or dietary advice). Childsmile nursery-supervised toothbrushing access among children with co-existing conditions was similar to children with neither condition and children with co-existing conditions were more likely to be referred to a Childsmile Dental Health Support Worker, but less likely to be contacted by a DHSW and have the intervention delivered. Conclusion: Inequalities have been identified in young children with caries experience, obesity, and co-existing caries and obesity in Scotland, compounded by reduced and variable access to preventive dental services in children with co-existing conditions. Further efforts are needed to develop and improve preventive care, adopting a commonr risk factor approach, and the pathways for children with co-existing caries and obesity and integrate oral health to wider healthcare systems for these children to mitigate against health inequalities. Upstream, midstream, and downstream interventions must be considered to maximise the impact and reduce prevalence and inequalities.