Neighbourhood characteristics and children’s oral health: a multilevel population-based cohort study

Abstract

Background To understand determinants of oral health inequalities, multilevel modelling is a useful manner to study contextual factors in relation to individual oral health. Several studies outside Europe have been performed so far, however, contextual variables used are diverse and results conflicting. Therefore, this study investigated whether neighbourhood level differences in oral health exist, and whether any of the neighbourhood characteristics used were associated with oral health. Methods This study is embedded in The Generation R Study, a prospective cohort study conducted in The Netherlands. In total, 5 960 6-year-old children, representing 158 neighbourhoods in the area of Rotterdam, were included. Data on individual and neighbourhood characteristics were derived from questionnaires, and via open data resources. Caries was assessed via intraoral photographs, and defined as decayed, missing and filled teeth (dmft). Results Differences between neighbourhoods explained 13.3% of the risk of getting severe caries, and 2% of the chance of visiting the dentist yearly. After adjustments for neighbourhood and individual characteristics, neighbourhood deprivation was significantly associated with severe dental caries (OR: 1.48, 95% CI: 1.02–2.15), and suggestive of a low odds of visiting the dentist yearly (OR: 0.81, 95% CI: 0.56–1.18). Conclusions Childhood caries and use of dental services differs between neighbourhoods and living in a deprived neighbourhood is associated with increased dental caries and decreased yearly use of dental services. This highlights the importance of neighbourhoods for understanding differences in children’s oral health, and for targeted policies and interventions to improve the oral health of children living in deprived neighbourhoods.

Professionals’ perspectives on how to address persistent oral health inequality among young children: an exploratory multi-stakeholder analysis in a disadvantaged neighbourhood of Amsterdam, the Netherlands

“…In scientific research, it is still common to portray socially disadvantaged populations as ‘unhealthy’ and ‘problematic’ with inherently ‘deviant’ personality traits and ‘adverse’ culture [ 40 ]. Although scientific evidence clearly shows that children from vulnerable families have an increased risk for poor oral health, it is unjust to presume that these families are simply not capable to adhere to preventive caries measures [ 8 ]. It should be taken into account that the living environment contributes to an unhealthy lifestyle in vulnerable communities.…”

“…Caries disproportionally affects disadvantaged groups and represents a disease of socioeconomic and health inequalities [ 6 , 7 ]. In the Netherlands, young children living in disadvantaged neighbourhoods have an increased risk for dental caries [ 8 ]. The prevalence of caries among 5-year-old children from low socioeconomic position (SEP) families is reported as 29%, whereas the prevalence among 5-year-olds in the high SEP group is 19% [ 9 ].…”

“…To tackle the burden of poor oral health in young children, it is necessary to gain a better understanding of the determinants causing oral health inequalities [11,12]. Previous research has mainly focused on individual-level determinants resulting in behaviour change interventions, such as preventive strategies for oral hygiene and sugar control [8,13]. However, these preventive approaches have failed to effectively improve oral health behaviour of disadvantaged children [9,[14][15][16][17].…”

Safe, supportive neighborhoods: Are they associated with childhood oral health?

“…The findings from this study highlight the role of social structures, such as safe and supportive neighborhoods, in enhancing and strengthening community level interventions that support PCEs to support oral health in children [31]. The implementation of interventions in the community to build assets in order to improve population oral health metrics are needed.…”

Understanding parental perspectives on young children’s oral health (≤ 4 years) growing up in a disadvantaged neighbourhood of Amsterdam, the Netherlands: an exploratory study

“…In addition to the health effects, caries may burden a young child’s quality of life, leading to high costs for families and society [ 4 ]. Moreover, caries frequently affect groups living in vulnerable circumstances, such as children growing up in disadvantaged neighbourhoods [ 5 , 6 ]. Childhood caries mirrors socioeconomic and oral health inequalities [ 1 , 7 ].…”