title: Dental caries of refugee children compared with US children.
abstract: OBJECTIVE
  Dental care is a major unmet health need of refugee children. Many refugee children have never received oral health care or been exposed to common preventive oral health measures, such as a toothbrush, fluoridated toothpaste, or fluoridated water. Oral health problems among refugee children are most likely to be detected first by pediatricians and family practitioners. Given the increased influx of refugees into the United States, particularly children, it is important for the pediatric community to be aware of potential oral health problems among refugee children and be able to make referrals for treatment and recommendations for the prevention of future oral diseases. The purpose of this study was to describe the prevalence of caries experience and untreated decay among newly arrived refugee children stratified by their region of origin and compared with US children.
  
  
  METHODS
  Oral health assessments were conducted within 1 month of arrival to the United States as part of the Refugee Health Assessment Program of the Massachusetts Department of Public Health. The outcome variables include caries experience and untreated decay. Caries experience is determined by the presence of an untreated caries lesion, a restoration, or a permanent molar tooth that is missing because it has been extracted as a result of dental caries. Untreated caries is detected when 0.5 mm of tooth structure is lost and there is brown coloration of the walls of the cavity. Comparisons of the refugee children with US children in Third National Health and Nutrition Examination Survey data were made using chi2 test of independence and multiple logistic regression.
  
  
  RESULTS
  Oral health screenings were performed on 224 newly arrived refugees who ranged in age from 6 months to 18 years and had a mean age of 10.6 years (SD: 4.82; median: 10.7 years). African refugees represented 53.6%, with the majority from Somalia, Liberia, and Sudan. Eastern European refugees composed 26.8% of the study sample. The remaining 19.6% come from a number of countries, such as Afghanistan, Pakistan, and the Middle East. Refugee children had 51.3% caries experience and 48.7% with untreated decay. Caries experience in refugees varied by region of origin, with 38% from Africa exhibiting a history of caries compared with 79.7% of Eastern Europeans. The highest proportion of children with no obvious dental problems was from Africa (40.5%) compared with 16.9% from Eastern Europe. US children had caries experience similar to that of refugees (49.3%) but significantly lower risk of untreated decay (22.8%). Comparisons between refugee children and US children found significant differences for treatment urgency, untreated caries, extent of dental caries, and presence of oral pain. White refugee children, primarily from Eastern Europe, were 2.8 times as likely to have caries experience compared with white US children, with 9.4 times the risk of untreated decay compared with white US children. In contrast, African refugee children were only half as likely to have caries experience compared with white US children (95% confidence interval: 0.3-0.7) and African American children (95% confidence interval: 0.3-0.7). However, African refugee children were similar to African American children in risk of untreated decay (odds ratio: 0.94).
  
  
  CONCLUSIONS
  African refugee children had significantly lower dental caries experience as well as fewer untreated caries as compared with similarly aged Eastern European refugee children. They were also less likely to have ever been to a dentist. Possible reasons for these findings may include differences in exposure to natural fluoride in the drinking water, dietary differences, access to professional care, and cultural beliefs and practices. The prevalence of caries experience and untreated caries differed significantly between refugee children and US children. These differences varied significantly by race. When refugee children were compared with US children, the African refugee children had only half the caries experience of either white or African American children. However, African refugee children had similar likelihood of having untreated caries as compared with African American children, despite that very few African children had previous access to professional dental care. These findings are consistent with previous studies on health disparities in the United States. White refugee children, primarily from Eastern Europe, were also 3 times as likely to have caries experience compared with either white or African American children and were 9.4 times as likely to have untreated caries as white US children. Refugee children are more likely to establish primary medical care before seeking dental treatment. With the limited access to dental care among refugees, pediatricians should be particularly alert to the risk of oral diseases among refugee children.
authors.affiliation: Department of Health Policy and Health Services Research, Northeast Center for Research to Evaluate and Eliminate Dental Disparities, Boston University Goldman School of Dental Medicine, Boston, Massachusetts, USA. scote@deltadentalma.com
authors.forename: Susan
authors.initials: S
authors.lastname: Cote
authors.forename: Paul
authors.initials: P
authors.lastname: Geltman
authors.forename: Martha
authors.initials: M
authors.lastname: Nunn
authors.forename: Kathy
authors.initials: K
authors.lastname: Lituri
authors.forename: Michelle
authors.initials: M
authors.lastname: Henshaw
authors.forename: Raul I
authors.initials: RI
authors.lastname: Garcia
mesh_terms: D000293:Adolescent; D000349:Africa / Q000208:ethnology; D002648:Child; D002675:Child, Preschool; D003731:Dental Caries / Q000453:epidemiology* / Q000208:ethnology; D005061:Europe, Eastern / Q000208:ethnology; D005260:Female; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D009749:Nutrition Surveys; D009909:Oral Health; D012036:Refugees / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology