title: The Role of School Social Environment on Dental Caries Experience in 8- to 12-Year-Old Brazilian Children: A Multilevel Analysis.
abstract: OBJECTIVE
  Although children spend most of their time involved in activities related to school, few studies have focused on the association between school social environment and oral health. This cross-sectional study assessed individual and school-related social environment correlates of dental caries in Brazilian schoolchildren aged 8-12 years.
  
  
  METHODS
  A sample of children from 20 private and public schools (n=1,211) was selected. Socio-economic data were collected from parents, and data regarding children characteristics were collected from children using a questionnaire. Dental examinations were performed to assess the presence of dental plaque: dental caries experience (DMFT≥1) and dental caries severity (mean dmf-t/DMF-T). The social school environment was assessed by a questionnaire administered to school coordinators. Multilevel Poisson regression was used to investigate the association between school social environment and dental caries prevalence and experience.
  
  
  RESULTS
  The dental caries prevalence was 32.4% (95% confidence interval: 29.7-35.2) and the mean dmf-t/DMF-T was 1.84 (standard deviation: 2.2). Multilevel models showed that the mean dmf-t/DMF-T and DMFT≥1 were associated with lower maternal schooling and higher levels of dental plaque. For contextual variables, schools offering after-hours sports activities were associated with a lower prevalence of dental caries and a lower mean of dmf-t/DMF-T, while the occurrence of violence and theft episodes was positively associated with dental caries.
  
  
  CONCLUSIONS
  The school social environment has an influence on dental caries in children. The results suggest that strategies focused on the promotion of healthier environments should be stimulated to reduce inequalities in dental caries.
authors.affiliation: Postgraduate Programs in Dentistry, Federal University of Pelotas, Pelotas, Brazil.
authors.forename: María Raquel
authors.initials: MR
authors.lastname: Fernández
authors.forename: Marília L
authors.initials: ML
authors.lastname: Goettems
authors.forename: Thiago M
authors.initials: TM
authors.lastname: Ardenghi
authors.forename: Flávio F
authors.initials: FF
authors.lastname: Demarco
authors.forename: Marcos Britto
authors.initials: MB
authors.lastname: Correa
mesh_terms: D001938:Brazil / Q000453:epidemiology; D002648:Child; D003430:Cross-Sectional Studies; D004245:DMF Index; D003731:Dental Caries / Q000453:epidemiology*; D003773:Dental Plaque / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D055361:Multilevel Analysis; D009909:Oral Health; D015995:Prevalence; D012044:Regression Analysis; D012574:Schools; D012931:Social Environment; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires