title: Addressing children's oral health inequalities: caries experience before and after the implementation of an oral health promotion program.
abstract: OBJECTIVE
  (1) To evaluate the dental status of 5-year-old children in Clermont-Ferrand (France) in 2009; (2) To measure changes in children's dental status between 2003 and 2009; and (3) To estimate the impact of an Oral Health Promotion (OHP) program implemented in nine schools since 2005.
  
  
  METHODS
  All 5-year-olds attending public schools in deprived areas (n = 15) and six randomly selected other schools in Clermont-Ferrand were invited to participate. Dental status was recorded using d(3)mft, as in 2003. Parents responded to questions about their child's oral hygiene and provided socio-demographic information.
  
  
  RESULTS
  Of children invited, 478 (77%) were examined. Mean dmft was 1.18 (SD 2.61); 27.6% had at least one tooth affected. Caries experience varied significantly with deprivation status, oral hygiene and household SES indicators. The only difference observed between 2003 and 2009 was an increase in the 'f' component (p < 0.001). Dental status had slightly deteriorated in areas characterized in 2003 by low caries levels (p=0.07). In deprived areas, mean dmft increased in schools without the OHP program (p = 0.04). Changes between 2003 and 2009 were studied at school level using Multiple Factorial Analysis; it tended to improve in four schools, which had the OHP program. Household indicators of SES changed little. Oral hygiene levels varied differently from one school to another.
  
  
  CONCLUSIONS
  Caries experience was high, with large inequalities between children. No major differences were observed between 2003 and 2009. The OHP program has done little to reduce disparities in oral health, even if dental status improved in four schools.
authors.affiliation: CHU Clermont-Ferrand, Service d'Odontologie, Hôtel-Dieu, France. stephanie.tubert@u-clermont1.fr
authors.forename: Stephanie
authors.initials: S
authors.lastname: Tubert-Jeannin
authors.forename: Stephanie
authors.initials: S
authors.lastname: Leger
authors.forename: Rachel
authors.initials: R
authors.lastname: Manevy
mesh_terms: D002675:Child, Preschool; D019140:Dental Care for Children / Q000379:methods*; D003731:Dental Caries / Q000453:epidemiology / Q000517:prevention & control*; D003753:Dental Health Surveys; D005260:Female; D005602:France / Q000453:epidemiology; D006267:Health Education, Dental; D006293:Health Promotion / Q000379:methods*; D006297:Health Services Accessibility; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008507:Medically Underserved Area; D009909:Oral Health; D009910:Oral Hygiene / Q000379:methods; D010353:Patient Education as Topic; D011314:Preventive Health Services; D016896:Treatment Outcome