title: Is there an Appalachian disparity in dental caries in Pennsylvania schoolchildren?
abstract: OBJECTIVE
  To determine whether there is an Appalachian disparity in caries prevalence or extent in children living in Pennsylvania.
  
  
  METHODS
  We conducted a cross-sectional clinical assessment of caries in a sample representing 1st, 3rd, 9th, and 11th grade students across Pennsylvania. We used logistic regression and zero-inflated negative binomial regression controlling for age to examine the association of residence in an Appalachian county with caries prevalence and extent in the primary and permanent dentitions.
  
  
  RESULTS
  Compared with children living outside Appalachia, more children living in Appalachia had a dft >0 (OR = 1.37, 95% CI = 1.07-1.76) and more had a DMFT >0 (OR = 1.32, 95% CI = 1.06-1.64). In addition, compared with children living outside Appalachia, children living in Appalachia had a greater primary but not permanent caries extent (IRR = 1.10, 95% CI = 1.01-1.19).
  
  
  CONCLUSIONS
  We found Appalachian disparities in caries prevalence in both the primary and permanent dentitions and an Appalachian disparity in caries extent in the primary dentition. None of the disparities was moderated by age. This suggests that the search for the mechanism or mechanisms for the Appalachian disparities should focus on differential exposures to risk factors occurring prior to and at the start of elementary school.
authors.affiliation: School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Deborah E
authors.initials: DE
authors.lastname: Polk
authors.forename: Sunghee
authors.initials: S
authors.lastname: Kim
authors.forename: Michael
authors.initials: M
authors.lastname: Manz
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Weyant
mesh_terms: D000293:Adolescent; D001061:Appalachian Region / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004245:DMF Index; D003731:Dental Caries / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D010414:Pennsylvania / Q000453:epidemiology; D015995:Prevalence; D055815:Young Adult
keywords: Appalachia region; adolescent; child; dental caries