Assessing a multilevel model of young children’s oral health with national survey data

Abstract

Objectives-To empirically test a multilevel conceptual model of children's oral health incorporating 22 domains of children's oral health across four levels: child, family, neighborhood and state. Study design-We examined child-, family-, neighborhood-, and state-level factors influencing parent's report of children's oral health using a multilevel logistic regression model, estimated for 26 736 children ages 1-5 years.Principal findings-Factors operating at all four levels were associated with the likelihood that parents rated their children's oral health as fair or poor, although most significant correlates are represented at the child or family level. Of 22 domains identified in our conceptual model, 15 domains contained factors significantly associated with young children's oral health. At the state level, access to fluoridated water was significantly associated with favorable oral health for children.Conclusions-Our results suggest that efforts to understand or improve children's oral health should consider a multilevel approach that goes beyond solely child-level factors. NIH Public Access Author ManuscriptCommunity Dent Oral Epidemiol. Author manuscript; available in PMC 2011 August 1. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptDespite reductions in dental caries rates over the past 25 years resulting from water fluoridation, fluoride toothpaste use, and improvements in oral hygiene and nutrition, dental caries remains the most common chronic childhood disease, overall (1), and the cause of the vast predominance of oral health problems in children. Nationally, 42% of children 2-11 years old have caries experience in their primary teeth, with 23% having untreated caries; among 12-19-year-olds, 59% have caries experience in their permanent teeth with 20% having untreated caries (2). Dental caries accounted for 117 lost school-hours per 100 school-age children in 1989 (3). As overall caries rates decrease, diminishing returns can be expected from applying current individual-based approaches to fight disease.Population health research has looked beyond the biomedical model to explain disease states, but with the exceptions of water fluoridation and school-based dental sealant programs, population-based approaches have not been implemented extensively in oral health. Health conditions (e.g., diabetes and HIV), health behaviors (e.g., use of alcohol, tobacco, sugary diet, certain drugs, and lack of preventive care), socioeconomic factors (e.g., lower education and income), and minority race/ethnicity are related to poor oral health (4-6). However, few models explain the relationships between the larger contextual, environmental and societal factors and oral health. An individual is exposed to multiple factors at a time and over a lifetime, so focusing primarily on traditional biomedical factors limits our understanding of how these different complex factors operate.Population health models generally classify health determinants into five broad categories: genetic endowmen...

Dentist Supply and Children’s Oral Health in the United States

“…In addition to their conceptual relevance for both dentist location decisions and parents access and use of dental care, several of these factors have been shown to be relevant for oral health, including in this sample. 18,20,25 In an alternative model, we included an aggregate index of neighborhood quality derived from these variables (generated using principal component analysis), but this had no effect on the results for dentist supply (details available upon request).…”

Caregivers’ Health Literacy and Their Young Children’s Oral-health–related Expenditures

“…Both conceptual frameworks (FisherOwens et al, 2007;Bramlett et al, 2010) and scientific evidence support the hypothesis that caregivers' low health literacy may be associated with the use of tertiary dental services for their children, which can translate to increased expenditures for oral-health-related services and/or specifically restorative and emergency dental services. In our previous investigations, we have found low caregiver literacy to be linked to poorer child oral health outcomes and more detrimental oral-health-related behaviors, including worse oral health status Vann et al, 2010), knowledge (Hom et al, 2012), child oralhealth-related quality of life (Divaris et al, 2012a), and deleterious feeding practices .…”

Neighbourhood Determinants of Caries Experience in Preschool Children: A Multilevel Study

“…Indeed, there are few studies and conflicting evidence about the association of contextual effect on oral health in preschool children Aida et al, 2008;Pereira et al, 2010;Borrell and Baquero, 2011;Borenstein et al, 2013;Martins et al, 2014]. While a study demonstrated a strong influence of contextual factors on dental caries among preschool children [Aida et al, 2008], others showed a weak or no effect, mainly when individual variables were included as controls [Bramlett et al, 2010;Piovesan et al, 2011].…”