The relationship of socioeconomic status to the prevalence of dental caries and fluorosis in the elementary schoolchildren of Genesee County, Michigan.

Abstract

Socioeconomic status (SES) in the United States is based on education, income, gender, race and ethnicity. There is evidence to suggest that SES is associated with dental caries and fluorosis, however the limited number of studies to date have used questionable study designs and have inconsistently controlled for important covariates. The purpose of this study is to assess the relationships of SES to prevalence and severity of dental caries and prevalence of fluorosis using a more appropriate study design and statistical analyses. This investigation used data from the Genesee County Oral Health Project, a cross-sectional study involving an oral screening examination and a telephone interview of a representative sample of 1st- and 4th-grade elementary schoolchildren in Genesee County, Michigan. Covariates included access to care, demographics, dental behaviors, dental knowledge, dental factors, and miscellaneous factors. Weighted bivariate and multivariate analyses were conducted using SAS and SUDAAN statistical software packages. SES was inversely related to dental caries prevalence and severity, and directly related to prevalence of fluorosis. Significant SES variables were occupation, level of education, presence of health insurance and Medicaid, crowded living conditions, and family income. One versus two parents or guardians, presence of dental insurance, and eligibility for reduced-fee meals at school were not significantly related to the outcomes. The association of each SES indicator depended upon the outcome (dental caries versus fluorosis), the component part of the outcome (DS+ds, FS+fs, and DMFS+dfs), and the representation of the outcome (prevalence, severity type I, and severity type II). Two possible indirect pathways through which the SES variables imparted an effect on dental caries and fluorosis were oral health care utilization and dental knowledge. Future studies should assess: (1) why different measures of SES were related to different components of the outcomes, (2) how SES imparted an indirect effect via utilization and dental knowledge, and what effect SES would have on the outcomes in different study settings.