Impacts of the COVID-19 Pandemic Exposure on Child Dental Caries: Difference-in-Differences Analysis

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Abstract

The impact of the coronavirus disease 2019 (COVID-19) pandemic on dental caries is unknown. We investigated the effect of the pandemic on child dental caries in Japan by comparing the increase in dental caries from fourth to sixth grade between two cohorts, COVID-19 exposed cohort and COVID-19 unexposed cohort, using difference-in-differences analysis. Longitudinal data that followed elementary school children in Adachi City, Tokyo, were analyzed. The analysis consisted of two cohorts: those who were in fourth grade in 2016 and sixth grade in 2018 (COVID-19 unexposed cohort, N = 399) and those who were in fourth grade in 2018 and sixth grade in 2020 (COVID-19 exposed cohort, N = 3,082). Children's dental caries were examined by school dentists. A difference-in-differences analysis, adjusting for time-variant variables, i.e., household socioeconomic status, children's oral health behavior, and caregivers' psychological distress, was performed. In fourth grade, the number of Decayed, Missing, and Filled permanent Teeth (DMFT) was not different between the COVID-19 unexposed and exposed cohorts (mean = 0.241 and 0.242, respectively). In sixth grade, DMFT increased by 0.067 in the COVID-19 unexposed cohort and 0.180 in the COVID-19 exposed cohort. The interaction term of grade and cohorts for caries by difference-in-differences analysis showed that dental caries among the COVID-19 exposed cohort showed a significant increase in the number of dental caries by 0.116 (95% confidence interval 0.015, 0.216) compared to the COVID-19 unexposed cohort. Child dental caries slightly increased after the pandemic. Studies with longer follow-ups are needed to evaluate the impact of the pandemic on child dental caries.

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Oral diseases: a global public health challenge

Marco A. Peres, Lorna M D Macpherson, Robert J. Weyant … (2019)

Oral diseases are among the most prevalent diseases globally and have serious health and economic burdens, greatly reducing quality of life for those affected. The most prevalent and consequential oral diseases globally are dental caries (tooth decay), periodontal disease, tooth loss, and cancers of the lips and oral cavity. In this first of two papers in a Series on oral health, we describe the scope of the global oral disease epidemic, its origins in terms of social and commercial determinants, and its costs in terms of population wellbeing and societal impact. Although oral diseases are largely preventable, they persist with high prevalence, reflecting widespread social and economic inequalities and inadequate funding for prevention and treatment, particularly in low-income and middle-income countries (LMICs). As with most non-communicable diseases (NCDs), oral conditions are chronic and strongly socially patterned. Children living in poverty, socially marginalised groups, and older people are the most affected by oral diseases, and have poor access to dental care. In many LMICs, oral diseases remain largely untreated because the treatment costs exceed available resources. The personal consequences of chronic untreated oral diseases are often severe and can include unremitting pain, sepsis, reduced quality of life, lost school days, disruption to family life, and decreased work productivity. The costs of treating oral diseases impose large economic burdens to families and health-care systems. Oral diseases are undoubtedly a global public health problem, with particular concern over their rising prevalence in many LMICs linked to wider social, economic, and commercial changes. By describing the extent and consequences of oral diseases, their social and commercial determinants, and their ongoing neglect in global health policy, we aim to highlight the urgent need to address oral diseases among other NCDs as a global health priority.

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COVID-19, school closures, and child poverty: a social crisis in the making

Wim Van Lancker, Zachary Parolin (2020)

While coronavirus disease 2019 (COVID-19) continues to spread across the globe, many countries have decided to close schools as part of a physical distancing policy to slow transmission and ease the burden on health systems. The UN Educational, Scientific and Cultural Organization estimates that 138 countries have closed schools nationwide, and several other countries have implemented regional or local closures. These school closures are affecting the education of 80% of children worldwide. Although scientific debate is ongoing with regard to the effectiveness of school closures on virus transmission, 1 the fact that schools are closed for a long period of time could have detrimental social and health consequences for children living in poverty, and are likely to exacerbate existing inequalities. We discuss two mechanisms through which school closures will affect poor children in the USA and Europe. First, school closures will exacerbate food insecurity. For many students living in poverty, schools are not only a place for learning but also for eating healthily. Research shows that school lunch is associated with improvements in academic performance, whereas food insecurity (including irregular or unhealthy diets) is associated with low educational attainment and substantial risks to the physical health and mental wellbeing of children.2, 3 The number of children facing food insecurity is substantial. According to Eurostat, 6·6% of households with children in the European Union—5·5% in the UK—cannot afford a meal with meat, fish, or a vegetarian equivalent every second day. Comparable estimates in the USA suggest that 14% of households with children had food insecurity in 2018. 4 Second, research suggests that non-school factors are a primary source of inequalities in educational outcomes. The gap in mathematical and literacy skills between children from lower and higher socioeconomic backgrounds often widens during school holiday periods. 5 The summer holiday in most American schools is estimated to contribute to a loss in academic achievement equivalent to one month of education for children with low socioeconomic status; however, this effect is not observed for children with higher socioeconomic status. 6 Summer holidays are also associated with a setback in mental health and wellbeing for children and adolescents. 7 Although the current school closures differ from summer holidays in that learning is expected to continue digitally, the closures are likely to widen the learning gap between children from lower-income and higher-income families. Children from low-income households live in conditions that make home schooling difficult. Online learning environments usually require computers and a reliable internet connection. In Europe, a substantial number of children live in homes in which they have no suitable place to do homework (5%) or have no access to the internet (6·9%). Furthermore, 10·2% of children live in homes that cannot be heated adequately, 7·2% have no access to outdoor leisure facilities, and 5% do not have access to books at the appropriate reading level. 8 In the USA, an estimated 2·5% of students in public schools do not live in a stable residence. In New York city, where a large proportion of COVID-19 cases in the USA have been observed, one in ten students were homeless or experienced severe housing instability during the previous school year. 9 While learning might continue unimpeded for children from higher income households, children from lower income households are likely to struggle to complete homework and online courses because of their precarious housing situations. Beyond the educational challenges, however, low-income families face an additional threat: the ongoing pandemic is expected to lead to a severe economic recession. Previous recessions have exacerbated levels of child poverty with long-lasting consequences for children's health, wellbeing, and learning outcomes. 10 Policy makers, school administrators, and other local officials thus face two challenges. First, the immediate nutrition and learning needs of poor students must continue to be addressed. The continuation of school-provided meals is essential in preventing widespread food insecurity. Teachers should also consider how to adapt their learning materials for students without access to wireless internet, a computer, or a place to study. Second, local and national legislators must prepare for the considerable challenges that await when the pandemic subsides. At the local level, an adequate response must include targeted education and material support for children from low-income households to begin to close the learning gap that is likely to have occurred. From a policy perspective, legislators should consider providing regular income support for households with children during the impending economic crisis to prevent a deepening and broadening of child poverty. Without such action, the current health crisis could become a social crisis that will have long-lasting consequences for children in low-income families.

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Effects of COVID‐19 Lockdown on Lifestyle Behaviors in Children with Obesity Living in Verona, Italy: A Longitudinal Study

Angelo Pietrobelli, Luca Pecoraro, Alessandro Ferruzzi … (2020)

Abstract Objective To test the hypothesis that youths with obesity, when removed from structured school activities and confined to their homes during the COVID‐19 pandemic, will display unfavorable trends in lifestyle behaviors. Methods The sample included 41 children and adolescents with obesity participating in a longitudinal observational study located in Verona, Italy. Lifestyle information including diet, activity, and sleep behaviors were collected at baseline and three weeks into the national lockdown during which home confinement was mandatory. Changes in outcomes over the two study time points were evaluated for significance using paired t‐tests. Results There were no changes in reported vegetable intake; fruit intake increased (p=0.055) during the lockdown. By contrast, potato chip, red meat, and sugary drink intakes increased significantly during the lockdown (p‐value range, 0.005 to <0.001). Time spent in sports activities decreased (X±SD) by 2.30±4.60 hours/week (p=0.003) and sleep time increased by 0.65±1.29 hours/day (p=0.003). Screen time increased by 4.85±2.40 hours/day (p<0.001). Conclusions Recognizing these adverse collateral effects of the COVID‐19 pandemic lockdown is critical in avoiding depreciation of weight control efforts among youths afflicted with excess adiposity. Depending on duration, these untoward lockdown effects may have a lasting impact on a child’s or adolescent’s adult adiposity level.

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Author and article information

Journal

Journal ID (nlm-ta): Caries Res

Journal ID (iso-abbrev): Caries Res

Journal ID (publisher-id): CRE

Title: Caries Research

Publisher: S. Karger AG (Allschwilerstrasse 10, P.O. Box · Postfach · Case postale, CH–4009, Basel, Switzerland · Schweiz · Suisse, Phone: +41 61 306 11 11, Fax: +41 61 306 12 34, karger@karger.com )

ISSN (Print): 0008-6568

ISSN (Electronic): 1421-976X

Publication date (Electronic): 28 November 2022

Publication date PMC-release: 28 November 2022

Pages: 1-9

Affiliations

[1] ^aDepartment of Global Health Promotion, Tokyo Medical and Dental University, Tokyo, Japan

[2] ^bJapan Society for Promotion of Science, Tokyo, Japan

Author notes

*Takeo Fujiwara, fujiwara.hlth@ 123456tmd.ac.jp

Article

Publisher ID: cre-0001

DOI: 10.1159/000528006

PMC ID: 9843733

PubMed ID: 36442466

SO-VID: 637a7533-1ece-4ba4-94ab-8b1a717145b1

License:

This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.

History

Date received : 27 May 2022

Date accepted : 4 November 2022

Page count

Figures: 3, Tables: 2, References: 42, Pages: 9

Funding

This study was supported by a Health Labour Sciences Research Grant; Comprehensive Research on Lifestyle Disease from the Japanese Ministry of Health, Labour and Welfare (H27-Jyunkankito-ippan-002); Research of Policy Planning and Evaluation from the Japanese Ministry of Health, Labour and Welfare (H29-Seisaku-Shitei-004); Innovative Research Program on Suicide Countermeasures (IRPSC); Grants-in-Aid for Scientific Research from the Japan Society for the Promotion of Science (JSPS KAKENHI Grant No. 16H03276, 16K21669, 17J05974, 17K13245, 19K19310, 19K14029, 19K19309, 19K20109, 19K14172, 19J01614, 19H04879, 20K13945, 21H04848, and 21K18294); St. Luke's Life Science Institute Grants; the Japan Health Foundation Grants; and Research-Aid (Designated Theme), Meiji Yasuda Life Foundation of Health and Welfare.

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