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

• Published in: Frontiers in public health Vol. 9; p. 751733
• Main Authors: Imes, Emily P, Ginnis, Jeannie, Shrestha, Poojan, Simancas-Pallares, Miguel A, Divaris, Kimon
• Format: Journal Article
• Language: English
• Published: Switzerland Frontiers Media S.A 24-12-2021
• Subjects: Child; Child, Preschool; children; Cross-Sectional Studies; dental caries; Dental Caries - epidemiology; Dental Caries Susceptibility; Humans; Oral Health; parents; pediatric dentistry; Public Health; subjective oral health; Toothache; dental caries; subjective oral health; children; pediatric dentistry; parents
• ISSN: 2296-2565; 2296-2565
• DOI: 10.3389/fpubh.2021.751733

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.
We used guardian-reported child oral health information (dichotomized as fair/poor vs. excellent/very good/good) obtained
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 and 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
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 accounting for the clustered nature of the data. Estimates of association [prevalence ratios (PR) and adjusted marginal effects (AME) with 95% confidence intervals (CI)] were obtained
multilevel generalized linear models using Stata's
function and accounting for the clustered nature of the data.
The prevalence of fair/poor oral health in this sample was 15%-it increased monotonically with children's age, was inversely associated with parents' educational attainment, 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 (
< 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.
Guardian reports of their children's oral health are valuable indicators of clinical and public health-important 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.