Dental caries in preschool children at the Cluster of Health Centres of Gondomar, Portugal
Creators: name: Nogueira, Catarina Pinto
name: Silva, Daniela Duarte
name: Pinho-Costa, Luís
Publisher: name: figshare
Year: 2020
Subjects: subject: 111716 Preventive Medicine
subject: FOS: Health sciences
subject: FOS: Health sciences
subject: 111717 Primary Health Care
subject: 111799 Public Health and Health Services not elsewhere classified
subject: 111403 Paediatrics
subject: FOS: Clinical medicine
subject: FOS: Clinical medicine
subject: 110505 Oral Medicine and Pathology
subject: 111707 Family Care

description: LicenseThis work is made available according to the conditions of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) licence. Full details of this licence are available at: https://creativecommons.org/licenses/by-nc-nd/4.0/.<br>CitationPinto-Nogueira C, Duarte-Silva D, Pinho-Costa L. (2019, November 4–5). Dental caries in preschool children at the Cluster of Health Centres of Gondomar, Portugal [Conference presentation]. European Forum on Prevention and Primary Care 2019, Porto, Portugal.<br><br><br>BackgroundDespite being largely preventable, dental caries is the most common chronic disease in childhood, affecting 60% to 90% of school-aged children worldwide. In Portugal, 45% of 6-year-old children have at least one decayed tooth. Until this age, children are eligible for free basic dental services for the treatment of serious disease identified by their family doctor; preventive dental care is not covered. Thus, the role of family doctor in the prevention and early diagnosis of these diseases is of particular importance.There is, however, little information about dental caries in that particular age group to help guide family doctors in their interventions. <br>AimTo determine the prevalence of dental caries and its associated factors in preschoolers at the Cluster of Health Centres of Gondomar.<br>MethodsThis study was conducted in a subsample of the birth cohort Generation XXI, a cohort of 8647 people born between 2005 and 2006 in the public maternities of Porto. Our subsample comprised those children that at the age of 4 were registered as a patient with a Primary Care practice in the municipality of Gondomar were eligible (n=878). The dental assessment was performed by dentists. The data on the interest variables were collected by interviewing the parents or grandparents. For the purpose of our study, the number of teeth with untreated/unfilled cavities, any other signs of dental decay or missing tooth due to cavities were abstracted and used to compute our outcome variable: child with/without decayed teeth. The association between the outcome variable and relevant variables were explored using unconditional logistic regression. Then, to take into account the potential confounding effect of relevant variable, adjusted ORs were estimated through multiple logistic regression. Also, in order to manage the problem of multicollinearity, different models were built by suppressing the highly correlated variables. Descriptive and analytical analysis was performed using SPSS.<br>ResultsPreschoolers registered at the Cluster of Health Centres of Gondomar showed a prevalence of dental caries of 20.6%. A positive association was found with: history of maternal unemployment (OR 1.92 [1.01-3.37]), routine consultations with a pediatrician (OR 2.55 [1.01-6.45]), past appointment with a dentist between ages 3 and 4 (OR 2.28 [1.19-4.49]) and toothaches between ages 3 and 4 (OR 10.58 [4,65-24,07]). A favorable outcome of being caries-free was associated with: higher maternal education (OR 0.88 [0.80-0.96]) and routine consultations in a private practice (OR 0.42 [0.18-0.97]). Routine consultations with a family doctor was not found to be a protective factor (OR 1.51 [0.72-3.18]).<br> DiscussionAlthough the prevalence of dental caries was not as high as previously reported, our results report to a younger age. More importantly, our results show that delivering effective preventive dental care could reduce dental caries by more than half. This results also highlights the need for preventive strategies even earlier on, to prevent the 20% caries already present at 4 years old.Our results also point out that mothers play a pivotal role in their child’s (oral) health. This is probably rooted in the fact that, at least in Portugal, it is culturally accepted that she is the main caregiver during early childhood; as such, adverse socioeconomic factors like lesser education and unemployment may compromise the adequate implementation of and access to preventive dental care.Reverse causality likely explains some of the other associations found. That is certainly the case for toothaches: they are the most common result of dental caries and therefore, preschoolers who suffered from dental pain have had dental caries.Similarly, as preventive dental care at this age must be paid out-of-pocket, preschoolers most commonly go to the dentist only after having caries.Likewise, when a child has health problems, namely oral health problems, parents may also be more likely to seek routine care with a pediatrician (in addition to that of the family doctor).The protective effect of having routine consultations in the setting of a private practice is more of a puzzle to us but we think there’s a possibility that doctors in private practices may have better conditions to deliver effective preventive counseling namely more time and means to do it.More of a concern to us is the fact that routine care at the family doctor hasn’t proved to be protective against dental caries, despite, at least theoretically, one would expect them to have greater contact with the population at greater risk (namely the children of unemployed mothers / mothers with less schooling). Why is prevention not working? Aren’t family doctors incorporating oral health into general health promotion during routine appointments with preschoolers? Do they lack the time to do it? Are the strategies ineffective? Don’t parents have adequate health literacy to understand their doctor’s advice?<br>ConclusionIn order to tackle this public health problem there is a need both to raise awareness of family doctors to dental caries but also to allocate adequate sociodental resources to families with higher risk of childhood caries.