Socioeconomic factors in adolescents' oral health: are they mediated by oral hygiene behaviors or preventive interventions?
OBJECTIVE
To determine whether there is a socioeconomic status (SES) disparity in caries experience (i.e., DMFT) in an adolescent sample from Pennsylvania and to determine whether differences in oral hygiene behaviors and preventive interventions account for this disparity.


METHODS
A cross-sectional clinical assessment was conducted on a representative sample of 9th grade and 11th grade students across Pennsylvania. These students also completed a brief questionnaire regarding their oral hygiene behaviors. From this group of students, a random subsample of 530 parents completed a questionnaire assessing SES, fluoride exposure, and recency of receipt of dental services. DMFT was examined at two thresholds of severity: simple prevalence (DMFT > 0) and severe caries (DMFT > 3).


RESULTS
Using structural equation modeling, we found that lower SES was associated with higher prevalence of DMFT and higher prevalence of severe caries. Although lower SES was associated with lower rates of brushing, less use of sealants, and less recent receipt of dental services, these oral health behaviors and preventive interventions did not account for the disparities in DMFT defined by SES.


CONCLUSIONS
There is an SES gradient in caries experience in adolescents in Pennsylvania. Disparities in caries experience, however, cannot be accounted for by SES-associated differences in brushing, flossing, sealant use, fluoride exposure, or recency of use of dental services. To facilitate the design of preventive interventions, future research should determine the pathways through which SES-associated disparities occur.
University of Pittsburgh, School of Dental Medicine, Pittsburgh, PA 15261, USA. dpolk@pitt.edu
Deborah E
DE
Polk
Robert J
RJ
Weyant
Michael C
MC
Manz
D000293:Adolescent; D000294:Adolescent Behavior; D002327:Cariostatic Agents / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D004245:DMF Index; D003729:Dental Care / Q000706:statistics & numerical data; D003731:Dental Caries / Q000453:epidemiology* / Q000517:prevention & control; D003742:Dental Devices, Home Care / Q000706:statistics & numerical data; D003793:Dental Restoration, Permanent / Q000706:statistics & numerical data; D004522:Educational Status; D005260:Female; D005459:Fluorides / Q000627:therapeutic use; D015438:Health Behavior; D054625:Healthcare Disparities / Q000706:statistics & numerical data; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D008297:Male; D009909:Oral Health; D009910:Oral Hygiene / Q000706:statistics & numerical data; D010290:Parents / Q000193:education; D010414:Pennsylvania / Q000453:epidemiology; D010895:Pit and Fissure Sealants / Q000627:therapeutic use; D015995:Prevalence; D012923:Social Class; D016388:Tooth Loss / Q000453:epidemiology; D014099:Toothbrushing / Q000706:statistics & numerical data
D002327:Cariostatic Agents; D010895:Pit and Fissure Sealants; D005459:Fluorides