title: The development of a directed population approach to tackle inequalities in dental caries prevalence among secondary school children based on a small area profile.
abstract: BACKGROUND
  It has been observed that the prevalence of dental caries among children has declined in the last decade in Germany. However, despite of these improvements there is still a proportion of children suffering from dental decay.
  
  
  OBJECTIVE
  The aims of this study were to evaluate if a social gradient in the prevalence of dental caries exists and, based on those findings, to develop a strategy to target those children with heightened risk to develop dental caries in order to assist oral health care professionals to refocus the current uniform school-based dental health programme to a caries preventive strategy based on a directed population approach.
  
  
  METHODS
  A representative, random sample of 12-year olds in Freiburg (Germany) was examined and dental caries was recorded using WHO criteria. Educational attainment of the child's parents was used as an indicator of socio-economic status and classified by use of the CASMIN Educational Classification.
  
  
  RESULTS
  A total of 322 children participated. An examination of dental caries score revealed that its distribution was positively skewed. For this reason this study provides summary analyses based on medians and a non-parametric rank-sum test. The Kruskal-Wallis H-test showed a significant difference between median scores across the different educational levels (p-value = 0.015) which was due to lower dental caries levels in children with non-deprived social background.
  
  
  CONCLUSIONS
  In order to reduce current social inequalities in child oral health the current uniform school-based dental health programme at secondary school level should be developed to a targeted school-based screening and prevention programme.
authors.affiliation: Department of Orthodontics, School of Dental Science, University of Cologne, Germany. darius.sagheri@uk-koeln.de
authors.forename: Darius
authors.initials: D
authors.lastname: Sagheri
authors.forename: Petra
authors.initials: P
authors.lastname: Hahn
authors.forename: Elmar
authors.initials: E
authors.lastname: Hellwig
mesh_terms: D002648:Child; D004245:DMF Index; D003731:Dental Caries / Q000453:epidemiology* / Q000517:prevention & control; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D015995:Prevalence; D012571:School Dentistry / Q000458:organization & administration; D017062:Small-Area Analysis; D012923:Social Class