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      Socioeconomic Determinants, Maternal Health, and Caries in Young Children

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          Abstract

          Introduction:

          Maternal health during pregnancy plays a part in child health, and several conditions have been associated with adverse child outcomes.

          Objectives:

          To determine the socioeconomic determinants and maternal health factors associated with dental caries in young children.

          Methods:

          This cross-sectional study is part of a register-based cohort study including all children who were born from 2000 to 2003 and were residing in Stockholm County, Sweden, at age 3 y ( n = 73,658). The study followed the cohort until individuals were 7 y old. The final study cohort comprised all children examined at 3 and 7 y ( n = 65,259). Data on socioeconomic conditions, maternal health, and maternal health behavior were extracted from Swedish national registries. The multivariate analyses used 2 outcomes: caries experience at age 3 and 7 y (deft > 0 [decayed, extracted, and filled teeth]).

          Results:

          The results of this study show that socioeconomic and maternal health behaviors during pregnancy are important determinants of oral health in their preschool offspring. When all significant risk factors were present, the cumulative probability of being diagnosed with dental caries at age 7 y was 75%.

          Conclusion:

          This study also showed that maternal obesity and smoking during pregnancy were predictors of dental caries in preschool children. Strategies must be developed for increasing maternal motivation and self-efficacy and providing mothers with knowledge and caries-preventive tools.

          Knowledge Transfer Statement:

          The results of this study inform clinicians about the importance of including a more detailed history regarding maternal health and maternal health behaviors during pregnancy to assess caries risk in preschool children. Education, income, and other socioeconomic factors are difficult to modify in the short term. Therefore, strategies must be developed to increase parental motivation and self-efficacy to give parents the determination, knowledge, and tools for prevention.

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          Most cited references34

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          From victim blaming to upstream action: tackling the social determinants of oral health inequalities.

          The persistent and universal nature of oral health inequalities presents a significant challenge to oral health policy makers. Inequalities in oral health mirror those in general health. The universal social gradient in both general and oral health highlights the underlying influence of psychosocial, economic, environmental and political determinants. The dominant preventive approach in dentistry, i.e. narrowly focusing on changing the behaviours of high-risk individuals, has failed to effectively reduce oral health inequalities, and may indeed have increased the oral health equity gap. A conceptual shift is needed away from this biomedical/behavioural 'downstream' approach, to one addressing the 'upstream' underlying social determinants of population oral health. Failure to change our preventive approach is a dereliction of ethical and scientific integrity. A range of complementary public health actions may be implemented at local, national and international levels to promote sustainable oral health improvements and reduce inequalities. The aim of this article is to stimulate discussion and debate on the future development of oral health improvement strategies.
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            Integrating the common risk factor approach into a social determinants framework.

            The common risk factor approach (CRFA) has been highly influential in integrating oral health into general health improvement strategies. However, dental policy makers and oral health promoters have interpreted the CRFA too narrowly. They have focussed too heavily on the common behavioural risks, rather than on the broader shared social determinants of chronic diseases. A behavioural preventive approach alone will have minimal impact in tackling oral health inequalities and indeed may widen inequalities across the population. Based on recent WHO policy recommendations, this study presents the case for updating the CRFA in accordance with the social determinants agenda. The theoretical basis for a social determinants framework for oral health inequalities is presented, and implications for oral health improvement strategies are highlighted. Future action to address oral health inequalities in middle- and high-income countries requires a radical policy reorientation towards tackling the structural and environmental determinants of chronic diseases. In more equal and fairer societies, all sections of the social hierarchy experience better health and social well-being. © 2012 John Wiley & Sons A/S.
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              Trends in oral health status: United States, 1988-1994 and 1999-2004.

              This report presents national estimates and trends for a variety of oral health status measures for persons aged 2 years and older by sociodemographic and smoking status since the late 1980s in the United States. Data from the third National Health and Nutrition Examination Survey (NHANES III), 1988-1994 and from the NHANES 1999-2004 were used. These data sources were designed to provide information on the health and nutritional status of the civilian noninstitutionalized population in the United States. Information from oral health examination methods common to both survey periods were used to present prevalence estimates and for trend analyses. Statistical significance of differences between common estimates from each survey period was evaluated using two-sided t-tests. This report provides mean, percentile values, and standard errors for dental caries, dental sealants, incisal trauma, periodontal health, dental visits, perception of oral health status, tooth retention, and edentulism. Additional estimates for monitoring progress toward the Healthy People 2010 oral health objectives using NHANES source data are presented as well. For most Americans, oral health status has improved between 1988-1994 and 1999-2004. For seniors, edentulism and periodontitis has declined; for adults, improvements were seen in dental caries prevalence, tooth retention, and periodontal health; for adolescents and youths, dental sealant prevalence has increased and dental caries have decreased; however, for youths aged 2-5 years, dental caries in primary teeth has increased.
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                Author and article information

                Journal
                JDR Clin Trans Res
                JDR Clin Trans Res
                JCT
                spjct
                JDR Clinical and Translational Research
                SAGE Publications (Sage CA: Los Angeles, CA )
                2380-0844
                2380-0852
                13 July 2018
                October 2018
                : 3
                : 4
                : 395-404
                Affiliations
                [1 ]Division of Orthodontics and Pediatric Dentistry, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
                [2 ]Specialist Dental Care, Public Dental Health Service, Region Västra Götaland, Sweden
                [3 ]Clinical Epidemiology, Department of Medicine, Karolinska Institutet and Centre for Health Equity Studies, Stockholm, Sweden
                [4 ]Center for Pediatric Oral Health Research, Stockholm, Sweden
                Author notes
                [*]F.C. Soares, Division of Orthodontics and Pediatric Dentistry, Department of Dental Medicine, Karolinska Institutet, Alfred Nobels Allé 8, 141 04 Huddinge Stockholm, Sweden. Email: fercsoares@ 123456gmail.com
                Author information
                https://orcid.org/0000-0001-6465-3164
                Article
                10.1177_2380084418788066
                10.1177/2380084418788066
                6139990
                30263967
                c2f53e1f-84a8-433d-aab4-be706af205c3
                © International & American Associations for Dental Research 2018

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                Categories
                Original Reports
                Epidemiologic Research

                dental health survey,lifestyle,pediatrics,health services research,risk factor,epidemiology

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