title: Factors associated with dental caries in Brazilian children: a multilevel approach.
abstract: OBJECTIVE
  The aims of the present study were to assess caries experience among Brazilian children aged eight to 10 years and determine social factors of this disease, through a multilevel approach.
  
  
  METHODS
  This is a cross-sectional study in which a representative sample of 1204 eight-to-ten-year-old children were randomly selected from 19 public and private schools in the city of Belo Horizonte, Brazil. After formal authorization from the parents, the children were clinically examined at school by two calibrated examiners (Kappa=0.78). Individual socioeconomic status was determined using household income, number of residents in the home and parents'/caregivers' schooling. The social vulnerability index and type of school were used as contextual variables. The outcome variables were severity score of dental caries in permanent teeth (DMFT index), dental caries experience in permanent teeth (DMFT = 0 or ≠ 0), severity score of dental caries in primary teeth (dmft index) and dental caries experience in primary teeth (dmft = 0 or ≠ 0).
  
  
  RESULTS
  The minority of children (37.2%) had dental caries experience. Chi-squared and Mann-Whitney tests showed that age, parents'/caregivers' schooling, household income and type of school were associated with dental caries experience in permanent and primary teeth (P < 0.05). Mann-Whitney, Kruskal-Wallis tests and Spearman correlation coefficient showed that age, parents'/caregivers' schooling, household income, and type of school were associated with severity score of dental caries in permanent and primary teeth (P < 0.05). In multilevel approach, the individual variables, age and household income demonstrated association with dental caries experience and with severity score of dental caries in primary teeth (P < 0.05). Type of school was also associated with dental caries experience and with severity score of dental caries in these teeth (P < 0.05). In the Poisson multilevel approach, the analysis of the final estimation of variance components of the null model revealed a significant difference among the 19 schools with regard to severity score of dental caries in permanent teeth too (P < 0.001). Younger children and attending private schools showed lower severity score of dental caries in permanent teeth.
  
  
  CONCLUSIONS
  Dental caries experience and severity score of dental caries in primary teeth was influenced by age, household income, and the type of school The dental caries experience in permanent teeth was influenced by age, parents'/caregivers' schooling, household income, and type of school, whereas the severity score of dental caries in permanent teeth was influenced by age and type of school.
authors.affiliation: Department of Pediatric Dentistry and Orthodontics, Faculty of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil.
authors.forename: M T
authors.initials: MT
authors.lastname: Martins
authors.forename: F
authors.initials: F
authors.lastname: Sardenberg
authors.forename: M H
authors.initials: MH
authors.lastname: Abreu
authors.forename: M P
authors.initials: MP
authors.lastname: Vale
authors.forename: S M
authors.initials: SM
authors.lastname: Paiva
authors.forename: I A
authors.initials: IA
authors.lastname: Pordeus
mesh_terms: D001938:Brazil / Q000453:epidemiology; D002648:Child; D003430:Cross-Sectional Studies; D004245:DMF Index; D003731:Dental Caries / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D012307:Risk Factors; D012959:Socioeconomic Factors; D014094:Tooth, Deciduous; D014505:Urban Population
keywords: dental caries; multilevel approach; social determinants