title: International comparisons of health inequalities in childhood dental caries.
abstract: 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.
authors.affiliation: WHO Collaborating Centre on Oral Health in Deprived Communities, University of Liverpool Dental School, England, UK. cmpine@liverpool.ac.uk
authors.forename: Cynthia M
authors.initials: CM
authors.lastname: Pine
authors.forename: Pauline M
authors.initials: PM
authors.lastname: Adair
authors.forename: Alison D
authors.initials: AD
authors.lastname: Nicoll
authors.forename: Girvan
authors.initials: G
authors.lastname: Burnside
authors.forename: Poul Erik
authors.initials: PE
authors.lastname: Petersen
authors.forename: David
authors.initials: D
authors.lastname: Beighton
authors.forename: Angela
authors.initials: A
authors.lastname: Gillett
authors.forename: Ruth
authors.initials: R
authors.lastname: Anderson
authors.forename: Shahid
authors.initials: S
authors.lastname: Anwar
authors.forename: Susan
authors.initials: S
authors.lastname: Brailsford
authors.forename: Zdenek
authors.initials: Z
authors.lastname: Broukal
authors.forename: Ivor G
authors.initials: IG
authors.lastname: Chestnutt
authors.forename: Dominique
authors.initials: D
authors.lastname: Declerck
authors.forename: Feng Xi
authors.initials: FX
authors.lastname: Ping
authors.forename: Roberto
authors.initials: R
authors.lastname: Ferro
authors.forename: Ruth
authors.initials: R
authors.lastname: Freeman
authors.forename: Tshepo
authors.initials: T
authors.lastname: Gugushe
authors.forename: Rebecca
authors.initials: R
authors.lastname: Harris
authors.forename: Brent
authors.initials: B
authors.lastname: Lin
authors.forename: Edward C M
authors.initials: EC
authors.lastname: Lo
authors.forename: Gerardo
authors.initials: G
authors.lastname: Maupomé
authors.forename: Mohamed Hanif
authors.initials: MH
authors.lastname: Moola
authors.forename: Sudeshni
authors.initials: S
authors.lastname: Naidoo
authors.forename: Francisco
authors.initials: F
authors.lastname: Ramos-Gomez
authors.forename: Lakshman P
authors.initials: LP
authors.lastname: Samaranayake
authors.forename: Swarngit
authors.initials: S
authors.lastname: Shahid
authors.forename: Marit Slåttelid
authors.initials: MS
authors.lastname: Skeie
authors.forename: Christian
authors.initials: C
authors.lastname: Splieth
authors.forename: Betty King
authors.initials: BK
authors.lastname: Sutton
authors.forename: Teo Choo
authors.initials: TC
authors.lastname: Soo
authors.forename: Helen
authors.initials: H
authors.lastname: Whelton
mesh_terms: 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