title: Oral-health-related background factors and dental service utilisation among Sudanese children with and without a congenital heart defects.
abstract: BACKGROUND
  Sudanese children with congenital heart defects (CHDs) were found to have poorer oral health than those without CHDs. The aims of this study were to: describe the patterns of oral-health-related background factors in children with and without CHD and explore any differences, and to evaluate the effects of background factors on caries and gingivitis prevalence and dental services utilisation.
  
  
  METHODS
  In this analytical cross-sectional study, caregivers of children aged 3-12 years with (CHD cases n = 111) and without CHDs (Controls n = 182), underwent face-to-face interviews using a structured questionnaire. The questionnaire items covered several oral health background factors (independent variables) including: child's health status, oral hygiene practices, dental services utilization, mother's level of education, and caregiver's perception and awareness of their child's oral health. The relationship between these factors and occurrence of 'caries' and 'gingivitis' as well as 'child's dental services utilisation' (dependent variables) were explored using multiple adjusted and hierarchal logistic regression analyses.
  
  
  RESULTS
  Compared with controls, CHD cases had lower frequencies of brushing and use of fluoridated toothpaste, and their caregivers were less knowledgeable about caries. Among CHD cases, the variables (brushing and fluoridated toothpaste use) had significant impacts on caries prevalence (odd ratio (OR) =5.6, 95% confidence interval (CI): 1.4-22.8 and OR = 0.3, 95% CI: 0.1-0.8 for infrequent compared to frequent ones, respectively) as well as the mother's level of education (OR = 2.6, 95% CI: 1.0-6.4). When differences in background factors were controlled for, the adjusted ORs for caries and gingivitis prevalence in CHD cases compared with controls were 1.8, (95% CI: 1.1-3.2) and 5.3 (95% CI: 2.9-9.4), respectively. Among CHD cases, the child's age (8-12 years: OR = 11.9, 95% CI: 1.9-71.6), and the mother's level of education (lower education: OR = 0.2, 95% CI: 0.03-0.9) were significantly associated with the child's dental services utilisation.
  
  
  CONCLUSIONS
  Lower frequencies of brushing and use of fluoride tooth paste were reported among CHD cases, and brushing had the predominant significant impact on caries prevalence. The child's age and the mother's level of education were the main factors affecting the child's (CHD cases) dental services utilisation.
authors.affiliation: Department of Clinical Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway. Hiba.Mohammedali@student.uib.no.
authors.forename: H M
authors.initials: HM
authors.lastname: Ali
authors.affiliation: Oral Health Centre of Expertise in Western Norway, Hordaland, Bergen, Norway.
authors.forename: M
authors.initials: M
authors.lastname: Mustafa
authors.affiliation: Oral Health Centre of Expertise in Western Norway, Hordaland, Bergen, Norway.|Department of Community Dentistry, University of Science and Technology, Khartoum, Sudan.
authors.forename: E F
authors.initials: EF
authors.lastname: Nasir
authors.affiliation: Department of Clinical Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
authors.forename: S A
authors.initials: SA
authors.lastname: Lie
authors.affiliation: Ahmed Gasim hospital, Khartoum Teaching Hospital, Khartoum, Sudan.
authors.forename: S
authors.initials: S
authors.lastname: Hasabalrasol
authors.affiliation: Ahmed Gasim hospital, Faculty of Medicine University of Khartoum, Khartoum, Sudan.
authors.forename: O H
authors.initials: OH
authors.lastname: Elshazali
authors.affiliation: Department of Periodontics, University of Science and Technology, Khartoum, Sudan.
authors.forename: R W
authors.initials: RW
authors.lastname: Ali
authors.affiliation: Department of Clinical Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
authors.forename: M S
authors.initials: MS
authors.lastname: Skeie
mesh_terms: D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003729:Dental Care; D003731:Dental Caries / Q000150:complications*; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications*; D006801:Humans; D008297:Male; D009909:Oral Health; D015995:Prevalence
keywords: Caries; Children; Congenital heart defects; Dental health services; Gingivitis; Oral health background factors