AUTHOR=Imes Emily P. , Ginnis Jeannie , Shrestha Poojan , Simancas-Pallares Miguel A. , Divaris Kimon 

TITLE=Guardian Reports of Children's Sub-optimal Oral Health Are Associated With Clinically Determined Early Childhood Caries, Unrestored Caries Lesions, and History of Toothaches

JOURNAL=Frontiers in Public Health

VOLUME=Volume 9 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2021.751733

DOI=10.3389/fpubh.2021.751733

ISSN=2296-2565

ABSTRACT=Background: Parents’/guardians’ perceptions of their children's oral health are useful proxies of their clinically determined caries status and are known to influence dental care-seeking behavior. In this study, we sought to examine 1) the social and behavioral correlates of fair/poor child oral health reported by guardians and 2) quantify the association of these reports with the prevalence of early childhood caries (ECC), unrestored caries lesions and toothaches.

Methods: We used guardian-reported child oral health information (dichotomized as fair/poor versus excellent/very good/good) obtained via a parent questionnaire that was completed for 7,965 participants (mean age=52 months; range=36-71 months) of a community-based, cross-sectional epidemiologic study of early childhood oral health in North Carolina between 2016-2019. Social, demographic, oral health-related behavioral data, and reports on children’s history of toothaches (excluding teething) were collected in the same questionnaire. Unrestored ECC (i.e., caries lesions) was measured via clinical examinations in a subset of 6,328 children and was defined as the presence of one or more tooth surfaces with an ICDAS≥3 caries lesion. Analyses relied on descriptive and bivariate methods, and multivariate modeling with average marginal effect (A.M.E.) estimation . Estimates of association [prevalence ratios (PR) and adjusted marginal effects (AME) with 95% confidence intervals (CI)] were obtained via multilevel generalized linear models.

Results: The prevalence of fair/poor oral health in this sample was 15%; it increased monotonically with children’s age, was inversely associated with parents’ education, and was higher among Hispanics (21%) and African-Americans (15%) compared to non-Hispanic whites (11%). Brushing less than twice a day, not having a dental home, and frequently consuming sugar-containing snacks and beverages were significantly associated with worse reports (P<0.0005). Children with fair/poor reported oral health were twice as likely to have unrestored caries lesions [prevalence ratio (PR)=2.0; 95% confidence interval (CI)=1.8-2.1] and 3.5 times as likely to have experienced toothaches [PR=3.5; 95% CI=3.1-3.9] compared to those with better reported oral health.

Conclusions: Guardian reports of their children’s oral health are valuable indicators of child oral health status. Those with fair/poor guardian-reported child oral health have distinguishing characteristics spanning socio-demographics, oral-health related practices, diet, and presence of a dental home.