Poor children suffer from more dental decay than their wealthier peers. In many cases, they may lack private insurance or live in communities where routine care or preventive dental treatments such as sealants can be hard to find. They may live in areas without fluoridated water or in places where tap water is mistrusted. Public health officials and advocates place great emphasis upon addressing such community needs.
Mary Otto, AHCJ’s topic leader on oral health is writing blog posts, editing tip sheets and articles and gathering resources to help our members cover oral health care.
If you have questions or suggestions for future resources on the topic, please send them to mary@healthjournalism.org.
In fact, at a recent Capitol Hill forum on oral health Lynn Douglas Mouden, D.D.S., the chief dental officer for the Centers for Medicare and Medicaid Services went so far as to say, “The combination of dental sealants and community water fluoridation can prevent virtually all decay in children.”
Yet even when community issues are addressed, family dynamics may play a deciding role in oral health disparities.
Newly published research suggests that even young children who have had the benefits of dental insurance, fluoride treatments and sealants can suffer dental decay by the time they are teens.
For a study just published in the Journal of Dental Research, researchers at Case Western Reserve University’s School of Dental Medicine explored what factors in the children’s past might have influenced their oral health outcomes.
They concluded that the emotional health, educational level and coping skills of their mothers could have made the difference.
Starting with the oral health of teens and working backward to age 3, lead investigator Suchitra Nelson, Ph.D., and her team examined the teeth of 224 adolescent participants in a longitudinal study that followed very low birth weight and normal birth weight children over the years.
They gathered health and medical information from the children and their mothers to assess the children’s wellbeing at age 3, 8 and now 14.
They analyzed the teens’ oral health by counting the number of decayed, filled or missing permanent teeth and assessed the level of dental plaque, a symptom for poor oral hygiene.
They asked the mothers to complete a questionnaire that explored the oral health history of their children, gleaning information about the dental visits and preventive treatments they had received, how much juice and soda they drank.
They used a statistical modeling program, Structural Equations Modeling, to assess the emotional health, education levels and knowledge of the mothers when their children were 3 and 8 years old.
“In our paper, we had moms’ emotional health together with education, verbal, and cognitive ability to capture mother’s intrinsic capacity to deal with stress and other issues,” Nelson said.
It can be difficult to understand the complex pathways through which psychosocial and behavioral factors may act as mediators for oral health, Nelson acknowledged, “Structural Equations Modeling (SEM) helps to organize causal pathways (connections) and estimate the important causal pathways. It also rules out anything that is not supported by the data.
“The tests that we used are standardized tests for stress and coping used in the literature.”
They found that the teens with more oral health problems belonged to mothers who had struggled in at least one of the areas they assessed. Meanwhile, the teens with fewer oral health problems belonged to mothers with more education past high school, healthier emotional states and more knowledge about such things as nutrition.
They concluded the oral health boost enjoyed by the healthier teens came from mothers who mustered the coping skills to handle everyday stresses and develop social networks to provide for their children’s needs.
“We can’t ignore the environments of these children,” Nelson said. “It isn’t enough to tell children to brush and floss, they need more – and particularly from their caregivers.”
Her efforts to gain a deeper understanding of the impact of family life on oral health are continuing with an ongoing longitudinal study of caregivers and infants that she and her team have followed from birth.
“Currently we are following the infants until 36 months of age, but the plans are to continue seeing this cohort of children as they grow,” Nelson said. “So, it will give us more definitive answers to the role of psychosocial and behavioral variables in the development of caries (cavities).”
