Addressing children's oral health inequalities: caries experience before and after the implementation of an oral health promotion program

Abstract

Objective. (1) To evaluate the dental status of 5-year-old children in Clermont-Ferrand (France) in 2009; (2) To measure changes in children's dental status between 2003 and 2009; and (3) To estimate the impact of an Oral Health Promotion (OHP) program implemented in nine schools since 2005. Materials and methods. All 5-year-olds attending public schools in deprived areas (n = 15) and six randomly selected other schools in Clermont-Ferrand were invited to participate. Dental status was recorded using d₃mft, as in 2003. Parents responded to questions about their child's oral hygiene and provided socio-demographic information. Results. Of children invited, 478 (77%) were examined. Mean dmft was 1.18 (SD 2.61); 27.6% had at least one tooth affected. Caries experience varied significantly with deprivation status, oral hygiene and household SES indicators. The only difference observed between 2003 and 2009 was an increase in the ‘f’ component (p < 0.001). Dental status had slightly deteriorated in areas characterized in 2003 by low caries levels (p=0.07). In deprived areas, mean dmft increased in schools without the OHP program (p = 0.04). Changes between 2003 and 2009 were studied at school level using Multiple Factorial Analysis; it tended to improve in four schools, which had the OHP program. Household indicators of SES changed little. Oral hygiene levels varied differently from one school to another. Conclusions. Caries experience was high, with large inequalities between children. No major differences were observed between 2003 and 2009. The OHP program has done little to reduce disparities in oral health, even if dental status improved in four schools.

Key Words::

• child–pre-school
• dental caries
• program evaluation
• socioeconomic factors

Acknowledgments

The authors wish to express appreciation for assistance provided to the Municipal School Nurse service in Clermont-Ferrand, to the Groupement Régional de Santé Publique (Auvergne) which financed the program, to the teachers of the schools involved in the program or which participated in the study and to Dr B. Decroix (Aide Odontologique Internationale, Paris) for administrative support. Assistance with the clinical parts of the study and with the conduct of the program was given by Drs M.-M. Lescuyer, B. Paul, M. Perriat, S. Vautey-Blanc, P. Riordan, M. Lagarde, C. Enjary, whom the authors thank.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.