Social Class Differentials in Dental Caries Experience
Introduction
Dental caries, which is also known as tooth cavities, caries and decay is the breaking down of teeth as a result of activities of bacteria. This ailment brings about formation of abscess, tooth loss and tissue inflammation around the tooth. Dental caries is listed among the chronic diseases affecting people worldwide[1]. This paper is concerned with the effects of the social class of a person and the predisposition to getting dental caries. The country that will be considered is Brazil, where it has been observed that children coming from poorer households suffer more from this condition compared to those in households that are better off. There has been an exponential increase in dental issues both in adult and children. These dental diseases not only have implications on the general health of an individual and their quality of life but also increase the mortality risk. It is paramount to look into the extent with which dental caries experiences is determined by inequalities in social status. There are clear social disparities in dental caries experiences in all groups of individuals: both young and old.
Dental caries affect all individuals in one way or another throughout the course of life. The primary conditions that lead to the developing of caries are: dietary patterns that involve the level of sugar consumption, oral environment which consists of the level of exposure of fluoride and bacteria.
A study on the Inequalities in the distribution of dental caries among 12-year-old Brazilian school children
This was a cross-sectional designed study conducted on a cohort of 12 year old school going children in Brazil as a suitable representation of school children. An assessment on the social differentials in the spread of dental caries among this cohort was made. The cohort under study was from the population of Santa Maria, Brazil consisting of 792 school children.[2] Information on social status and experiences on dental caries acquired from dental examination was provided by the guardians to these children.[3] The Gini coefficient and the Significant Caries Index were used in determining the differences in the distribution of dental caries. The Poisson regression models were used to determine the association. It was noted that children from households earning low incomes experienced high levels of dental caries. In a nut shell it was discovered that the occurrence of oral disease in this particular group is strongly affected by the socioeconomic factors.[4]
Among the preschool and schoolchildren, the distribution and occurrence of dental caries is associated with the socioeconomic gradients. Even though there has been a decrease in the dental experiences in children, there exists a difference in oral health which leads to a high level of disease prevalence in a few minorities.[5] The discipline of science has shown that there are underlying effects on psychosocial, economic, environmental and political factor on general health differentials. It is now acknowledged that the knowledge on the behavioral pattern of the distribution of dental caries in different groups of people is useful in making decisions necessary for prompt measures to curb this health challenge.[6]
To determine the extent of this problem, Significant Caries Index was used to find out the occurrence of dental caries in this particular population. Another parameter used in measuring the differentials in the distribution of caries is the Gini coefficient which clearly shows that there is a high prevalence of experiences in caries limited to a small portion of the population in Brazil.[7] This study was undertaken to investigate the differentials in distribution of caries and the connection between these experiences the socioeconomic pointers in a sample comprising 12 year old school children in Brazil.
Research Methods
In the year 2008, the total inhabitants was 266,403 with 12 year old children amounting to 3,180 attending public schools, which is approximately a proportion of 85% of school children aged 12 years.[8] Multistage sampling was used which entailed randomly selecting 20 from the 39 public schools in Santa Maria as the primary survey units. For the second survey unit sampling was done randomly from the sample list containing the student attending the chosen schools. In calculating to find out the occurrence of caries, a standard percentage error of 5, 95% confidence interval and 50% anticipated prevalence was used. An estimated value of 1.4 for the design effect and a proportion of one tenth to cater for non-responses were also adopted.[9] Due to lack of adequate information on the real occurrence of the result in Santa Maria, it was decided that it would be suitable to use the 50% rate of prevalence. To attain study objectives approximately 530 children was taken as the least sample size.
Mode of collecting data in this study was through administering questionnaires by the parents and conducting dental examinations on the children where international standards set for oral health researches by the World Health Organization. From the examinations a record on the dental caries prevalence was made. The parents provided the information that was used to assess the socioeconomic characteristics. The level of education between the fathers and mothers who had successfully gone through the formal education which takes 8 years was compared with those that had less. This was corresponding to the primary education in Brazil. At the time this study was conducted, the average wage in Brazil was 280 US dollars which was used as the basis for comparison in determining the level of household income.[10]
After collecting the data that was required to enable achievement of the study objectives analysis was made using the statistical software called Stata. The following outcomes were adopted in this study: the value of expectation of caries experience, dental caries prevalence and the occurrence of children in the polarization group.[11] This group was determined through a cut-off level of experience in dental caries valued at 2.00 which was the same as the average dental caries experience of a third of the group being studied and registered a large caries score.
Results
For this particular group that was considered for this study, it was discovered that there is a high level of differential in the dental caries distribution. It was also discovered that there is a high level of oral diseases occurrence among the socially challenged children. Referring to the previous conducted studies, special emphasis was made on the fact that there is a decrease in experiences in dental in many countries in the past decades, a high prevalence level of oral disease was noted in minorities.[12] It was also observed that individuals earning low incomes had poor dental health.
Results from this study show that the prevalence rate and the dental diseases experience are linked to the level of household income. The underlying fact is that was discovered is that children from poor socioeconomic environment are more likely to experience dental related problems which is triggered by factors such as emotional effects from stress and improper behaviors that bring about stress. It is widely known from many surveys that have been conducted that the quality of health can be determined by the income distribution in the society. Though the multiple effects of distribution of income was not determined in this study, the association between an individual’s health and income gives enough reason to come up with differences in health between populations.[13]
The disparities in socioeconomic status that were discovered after conducting this study confirm the results that were obtained after conducting a similar study conducted on preschool children from the same city. The study that was carried prior to this one took place in 2007 and it revealed a high prevalence of caries in their primary teeth. Just as it was discovered in this study, the study conducted before showed that there was a higher record of caries experience in children having guardians with a low or no formal education and a low household income.
Differences in levels of income, state of poverty and comparison in social status have implications on an individual’s well-being.[14] These have a direct impact on the health status of an individual and indirectly on behaviors that are related to health. It was observed that groups categorized in low socioeconomic positions had a high risk of experiencing caries. Both the Significant Caries Index and the Gini coefficient clearly showed a large gap in disparities in the distribution of dental caries; that is a small fraction of the children experienced caries. This study explained the disparities in dental health owing to the social differences which clearly shows the need for public health institutions to give primary focus on these groups of the populations that exhibit high oral health demands.
This survey was conducted on 792 schoolchildren which was arrived at after sampling and was taken to be a good representing sample of the 12 year old children that attend public schools in Santa Maria. It was not possible to collect data from one school due to the refusal of the authorities to allow the examiners to examine the students. In spite of this, close to 85% of all the 12 year old school going children attend public schools in Santa Maria were examined. It was also noted after conducting this study that children irrespective of the social divide attended public schools in Santa Maria.[15] Hence, it is sufficient to generalize our observations on all school going children aged 12 years residing in the city of Santa Maria.
Findings from this survey led to the conclusion that socioeconomic factors which bring about differentials in social positions are strongly correlated to the disparities in distribution of dental caries Brazilian school going children. This knowledge is paramount in making effective decision making in the public health sector most especially in recognition of areas of the population that need proper monitoring in the oral health sector.
Summary
Many studies have been conducted with regards to the oral health of individuals and most importantly tried to explain how the dental health is an essential part of the general health of an individual. Surveys have been carried out and actually shown that social differentials in dental caries commence in early stages of life and they change as a result of one’s social status and dental visiting behaviors. Dental problems affect individuals in all stages of life, in children, adults and the old people. Dental caries have grave implications; it hinders the normal day to day activities of life, excruciating pain, misery and economic hurdles.[16] Unfortunately, in sections of populations that earn low incomes, theses dental diseases are yet to be put under control.
It is essential for institutions in the public health sector to be fully aware of the fast declining level dental health and the occurrence of caries so that proper corrective and preventive measure are undertaken.[17] Stringent measures should be put up to counter this problem which has been evident from the high prevalence of dental caries that have been discovered in different populations in various parts of the world.
The problem of dental caries has experienced continual concern on the state of health of populations across the different geographical regions in the world. Inequalities linked to well-known issues to do with immigration, improper prevention measures, socioeconomics and changes in the diet. New and renewed initiatives should be incorporated so as to fight against the fast rising resulting from dental caries. The dental section is very well equipped in terms of resources to tackle the obstacles.
The family in the lower social classes have less information regarding dental issues, and therefore are at a loss on how to prevent dental caries from their children. The major cause of this condition on the children from the poor families is due to a poor diet that is coupled with poor dental hygiene. Furthermore, these families might not have the resources to go and see a dentist regularly, which further compounds their conditions.[18] The diet afforded by these families is often unhealthy and full of sugars that attack the teeth by encouraging the growth of the bacteria responsible for the decay of teeth. Failure to have access to the dentist condemns these children to not having control over what happens to their teeth one dental caries sets in. a dentist can help in the control of dental caries by drilling out the decay and replacing it with a filling.[19] This is a process that is costly to the lower social class families, causing them to let the condition persist. This leads to pain, tooth abscess and the eventual loss of the teeth affected.
Dental caries is one of the most preventable diseases and yet continues to affect many persons of all ages, with a particular concentration on school going children. Among the different methods devised to deal with this condition, the addition of fluoride in minute quantities to the drinking water has been found to be very effective at the prevention of this disease. It is considered to be one of the great achievements of the 20th century in the process of improving the dental health of the population. The effectiveness of fluoride at the prevention of dental caries has been rated at 18-40%.[20] There is a possibility that the water consumed by the families in the lower social class might not be adequately treated with fluoride. Toothpastes also incorporate fluoride, but the poor dental hygiene that is common among these families contributes in undoing any benefits that might be gotten from that (Holtzman, 2009, pp. 227). The health systems in most countries tend to consider dental health differently from the other medical issues. As a result, more attention is given to the communicable and lifestyle diseases during policy making with little attention being accorded to the dental wellbeing of the population. The apparent apathy of the governments towards dental caries causes this condition to be treated casually as opposed to being viewed as a disease that it really is.
Conclusion and Recommendations
There are many ways in which opportunities can be manipulated for the good of all. First of all, hardly any infants are taken for dental visits. With this regard, non-dental health practitioners such as paediatricians ought to actively indulge themselves in improving the oral health of children. This important initiative will increase accessing of dental services and primarily prevent the occurrences of dental caries that will trigger the repeat of such diseases in later stages of life. Paediatricians and other health officers that are charged with the responsibilities of taking care of children can also be trained in dental health. This is made possible by incorporating oral health in their training course. This is significant in ensuring that detection and supportive strategies are put in place specifically in populations that have a high prevalence rate.
For ease of access to oral health services, obstacles in terms of geography, finance and culture should be put into consideration.[21] In marginalized areas, focus should be put primarily on making sure that the health agencies are strategically placed for easy access. Many individuals especially in low and middle income earning populations may not be able to access oral health services due to high costs.[22] Governing authorities could take action by funding health institutions partially or fully so that services are offered at a subsidized price to all and sundry. Cultural rigidity can also greatly affect the ease with which an individual accesses these particular services. The government should put up programs that will educate individuals in the society on the importance of abandoning some practices that are detrimental to the good health of an individual.
To deal with the crisis involved in the oral public health, an internationally recognized global gathering should be organized. This will bring together researchers in diverse parts of the world to critically look into the evidence available and arrange the most suitable measures that will change the rate of occurrences of dental caries.[23] In addition, new global surveys that put special focus on epidemiology should be properly planned and conducted. This is instrumental in gathering the necessary information on caries that will assist in channeling resources and manage the grave decline that is associated with dental caries.
Worldwide dental profession should be taken as a primary commitment so that basic prevention measures are undertaken and offered to a variety of the populations that are not receiving the same.[24] Particular efforts should be channeled towards use of fluorides, oral cleanliness, dental pastes, counseling services on diets and other well-known corrective ways. Research has been a discipline that is important in solving problems in the society. Committing research resources will assist in coming up with advanced anti caries inputs and products that will avail the much needed know-how that will take care of the dental caries problems.
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[1] Zini, Sgan-Cohen and Marcenes, 2012, p. 47
[2] Piovesan et al., 2011, pp. 69-75
[3] Voogd, 2014, pp. 276-81
[4] Oliveira, Sheiham and Bönecker, 2008, pp. 37-43
[5] Oliveira, Sheiham and Bönecker, 2008, pp. 37-43
[6] Oliveira, Sheiham and Bönecker, 2008, pp. 37-43
[7] Oliveira, Sheiham and Bönecker, 2008, pp. 37-43
[8] Oliveira, Sheiham and Bönecker, 2008, pp. 37-43
[9] Piovesan et al., 2011, pp. 69-75
[10] Piovesan et al., 2011, pp. 69-75
[11] Piovesan et al., 2011, pp. 69-75
[12] Piovesan et al., 2011, pp. 69-75
[13] Piovesan et al., 2011, pp. 69-75
[14] Piovesan et al., 2011, pp. 69-75
[15] Piovesan et al., 2011, pp. 69-75
[16] Mellor, 2000, p. 372
[17] Perera and Ekanayake, 2008, pp. 105-111
[18] Al-Mendalawi and Karam, 2014, p. 5
[19] Smith, 2002, pp. 223-232
[20] Jones and Worthington, 2000, p. 390
[21] Mehta et al., 2012, p. 26
[22] Maltz and Beighton, 2012, p. 134
[23] Geist and Geist, 2012
[24] Jones, 2011, p. 102