International comparisons of health inequalities in childhood dental caries.
OBJECTIVE
To undertake formative studies investigating how the experience of dental caries in young children living in diverse settings relates to familial and cultural perceptions and beliefs, oral health-related behaviour and oral microflora.


METHODS
The scientific consortium came from 27 sites in 17 countries, each site followed a common protocol. Each aimed to recruit 100 families with children aged 3 or 4 years, half from deprived backgrounds, and within deprived and non-deprived groups, half to be "caries-free" and half to have at least 3 decayed teeth.


METHODS
Parents completed a questionnaire, developed using psychological models, on their beliefs, attitudes and behaviours related to their child's oral health. 10% of children had plaque sampled.


RESULTS
2,822 children and families were recruited. In multivariate analyses, reported toothbrushing behaviours that doubled the odds of being caries-free were a combination of brushing before age 1, brushing twice a day and adult involvement in brushing. Analyses combining beliefs, attitudes and behaviours found that parents' perceived ability to implement regular toothbrushing into their child's daily routine was the most important predictor of whether children had caries and this factor persisted in children from disadvantaged communities. 90% of children with lactobacillus had caries.


CONCLUSIONS
Parental beliefs and attitudes play a key role in moderating oral health related behaviour in young children and in determining whether they develop caries. Further research is indicated to determine whether supporting the development of parenting skills would reduce dental caries in children from disadvantaged communities independent of ethnic origin.
Pine
Cynthia M
CM
WHO Collaborating Centre on Oral Health in Deprived Communities, University of Liverpool Dental School, England, UK. cmpine@liverpool.ac.uk
Adair
Pauline M
PM
Nicoll
Alison D
AD
Burnside
Girvan
G
Petersen
Poul Erik
PE
Beighton
David
D
Gillett
Angela
A
Anderson
Ruth
R
Anwar
Shahid
S
Brailsford
Susan
S
Broukal
Zdenek
Z
Chestnutt
Ivor G
IG
Declerck
Dominique
D
Ping
Feng Xi
FX
Ferro
Roberto
R
Freeman
Ruth
R
Gugushe
Tshepo
T
Harris
Rebecca
R
Lin
Brent
B
Lo
Edward C M
EC
Maupomé
Gerardo
G
Moola
Mohamed Hanif
MH
Naidoo
Sudeshni
S
Ramos-Gomez
Francisco
F
Samaranayake
Lakshman P
LP
Shahid
Swarngit
S
Skeie
Marit Slåttelid
MS
Splieth
Christian
C
Sutton
Betty King
BK
Soo
Teo Choo
TC
Whelton
Helen
H
D000328:Adult; D000367:Age Factors; D001294:Attitude to Health; D002675:Child, Preschool; D003467:Cultural Deprivation; D003469:Culture; D003731:Dental Caries / Q000209:etiology* / Q000382:microbiology; D003773:Dental Plaque / Q000382:microbiology; D005190:Family; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007391:International Cooperation; D007778:Lactobacillus / Q000302:isolation & purification; D015999:Multivariate Analysis; D010287:Parent-Child Relations; D016487:Parenting; D014099:Toothbrushing