Health  Vol.5 No.7 , July 2013
Effect of socio-demographic status on dental caries in pupils by using a multilevel hurdle model

Introduction: Dental caries is the most prevalent chronic disease among schoolchildren. We aimed to investigate the association between dental caries index and socio-demographic status in schoolchildren by using a multilevel hurdle model. Materials and Methods: A cross-sectional epidemiological study was carried out on 906 primary school pupils in Kerman, Iran in 2012. The subjects were selected through a stratified cluster random sampling. At first, the whole target area was stratified according to two geographic areas, the north and south area. Then each area was stratified according to gender. In the next step, several schools were considered as clusters, which were selected randomly in each geographic area and gender strata. All the schoolchildren in these schools were included in this study as samples. Twelve-year-old pupils were examined for dental caries. The dependent variable in this study was the dmft/DMFT index. Eight variables, including socio-demographic information, were collected. Multilevel negative binomial hurdle model was employed for data analysis. Results: The prevalence of caries-free pupils was 30.1% and the mean dmft/DMFT was 3.6 ± 2.2. Negative binomial part of the adjusted model showed that the dmft/DMFT adjusted rate for females was 1.36 (95% CI: 1.10-1.79) times higher than males. Also, the dmft/DMFT adjusted rate for overweight pupils was 0.86 (95% CI: 0.74-0.98) times lower than those with normal weight. Logistic part of the adjusted model showed that the posibility of caries-free state in overweight pupils was 1.95 (95% CI: 1.22-3.11) times higher than those with normal weight. In addition, pupils whose fathers and mothers were workers and housewives, respectively, and those with a high maternal age were at a greater risk for caries experience than others (p < 0.05). Conclusion: BMI, gender, parent’s job and mother’s age at delivery were factors effecting on dental caries in schoolchildren. These pupils need more attention to dental care.

Cite this paper: Jahani, Y. , R. Eshraghian, M. , Foroushani, A. , Nourijelyani, K. , Mohammad, K. , Shahravan, A. and Alam, M. (2013) Effect of socio-demographic status on dental caries in pupils by using a multilevel hurdle model. Health, 5, 1110-1116. doi: 10.4236/health.2013.57150.

[1]   Selwitz, R.H., Ismail, A.I. and Pitts, N.B. (2007) Dental caries. Lancet, 369, 51-59. doi:10.1016/S0140-6736(07)60031-2

[2]   Petersen, P.E., Bourgeois, D., Ogawa, H., Estupinan-Day, S. and Ndiaye, C. (2005) The global burden of oral diseases and risks to oral health. Bulletin of the World Health Organization, 83, 661-669.

[3]   Kopycka-Kedzierawski, D.T., Auinger, P., Billings, R.J. and Weitzman, M. (2008) Caries status and overweight in 2-to 18-year-old US children: Findings from national surveys. Community Dentistry and Oral Epidemiology, 36, 157-167. doi:10.1111/j.1600-0528.2007.00384.x

[4]   Kazerouni, K., Mohammadi, N., Ansari, G. and Kamali, Z. (2005) The effects of socio-economic status on dental caries incidence in a group of primary school children, Tehran-2000. Journal of Dental School, 22, 51-59.

[5]   Motlagh, M.G., Khanik, G.R.J. and Adiban, H. (2007) Investigation of dental caries prevalence among 6 -12 year old elementary school children in Andimeshk, Iran. Journal of Medical Sciences, 7, 116-120. doi:10.3923/jms.2007.116.120

[6]   Momeni, A., Mardi, M. and Pieper, K. (2006) Caries prevalence and treatment needs of 12-year-old children in the Islamic Republic of Iran. Medical Principles and Practice, 15, 24-28. doi:10.1159/000089381

[7]   Sadeghi, M., Lynch, C.D. and Arsalan, A. (2011) Is there a correlation between dental caries and body mass index-for-age among adolescents in Iran? Community Dental Health, 28, 174-177.

[8]   Edelstein, B.L. (2006) The dental caries pandemic and disparities problem. BMC Oral Health, 6, S2. doi:10.1186/1472-6831-6-S1-S2

[9]   Saied-Moallemi, Z., Virtanen, J.I., Tehranchi, A. and Murtomaa, H. (2006) Disparities in oral health of children in Tehran, Iran. European Archives of Paediatric Dentistry, 7, 262-264. doi:10.1007/BF03262563

[10]   Solinas, G., Campus, G., Maida, C., Sotgiu, G., Cagetti, M.G. and Lesaffre, E. (2009) What statistical method should be used to evaluate risk factors associated with dmfs index? Evidence from the national pathfinder survey of 4-year-old Italian children. Community Dentistry and Oral Epidemiology, 37, 539-546. doi:10.1111/j.1600-0528.2009.00500.x

[11]   Amanlou, M., Jafari, S., Afzalianmand, N., Omrany, Z.B., Farsam, H. and Nabati, F. (2011) Association of saliva fluoride level and socioeconomic factors with dental caries in 3 -6 years old children in Tehran-Iran. Iranian Journal of Pharmaceutical Research, 10, 159-166.

[12]   Macek, M.D. and Mitola, D.J. (2006) Exploring the association between overweight and dental caries among US children. Pediatric Dentistry, 28, 375-380.

[13]   Sanchez-Perez, L., Irigoyen, M.E. and Zepeda, M. (2010) Dental caries, tooth eruption timing and obesity: A longitudinal study in a group of Mexican schoolchildren. Acta Odontologica Scandinavica, 68, 57-64. doi:10.3109/00016350903449367

[14]   Norberg, C., Stalin, U.H., Matsson, L., Thorngren-Jerneck, K. and Klingberg, G. (2012) Body mass index (BMI) and dental caries in 5-year-old children from southern Sweden. Community Dentistry and Oral Epidemiology, 40, 315-322. doi:10.1111/j.1600-0528.2012.00686.x

[15]   Moghimbeigi, A., Eshraghian, M.R., Mohammad, K. and McArdle, B. (2008) Multilevel zero-inflated negative binomial regression modeling for over-dispersed count data with extra zeros. Journal of Applied Statistics, 35, 1193-1202. doi:10.1080/02664760802273203

[16]   Sufia, S., Khan, A.A. and Chaudhry, S. (2009) Maternal factors and child’s dental health. Journal of Oral Health & Community Dentistry, 3, 45-48.

[17]   Niji, R., Arita, K., Abe, Y., Lucas, M.E., Nishino, M. and Mitome, M. (2010) Maternal age at birth and other risk factors in early childhood caries. Pediatric Dentistry, 32, 493-498.

[18]   Medina-Solis, C.E., Maupome, G., del Socorro, H.M., Perez-Nunez, R., Avila-Burgos, L. and Lamadrid-Figueroa, H. (2008) Dental health services utilization and associated factors in children 6 to 12 years old in a low-income country. Journal of Public Health Dentistry, 68, 39-45. doi:10.1111/j.1752-7325.2007.00056.x

[19]   Preisser, J.S., Stamm, J.W., Long, D.L. and Kincade, M.E. (2012) Review and recommendations for zero-inflated count regression modeling of dental caries indices in epidemiological studies. Caries Research, 46, 413-423. doi:10.1159/000338992

[20]   Lewsey, J.D., Gilthorpe, M.S., Bulman, J.S. and Bedi, R. (2000) Is modelling dental caries a “normal” thing to do? Community Dental Health, 17, 212-217.

[21]   Lewsey, J.D. and Thomson, W.M. (2004) The utility of the zero-inflated poisson and zero-inflated negative binomial models: A case study of cross-sectional and longitudinal DMF data examining the effect of socio-economic status. Community Dentistry and Oral Epidemiology, 32, 183-189. doi:10.1111/j.1600-0528.2004.00155.x

[22]   World Health Organization (1997) Oral health surveys: Basic methods. 4th Edition, WHO, Geneva.

[23]   Hosseini, M., Carpenter, R.G. and Mohammad, K. (1999) Body mass index reference curves for Iran. Annals of Human Biology, 26, 527-535. doi:10.1080/030144699282444

[24]   Sadeghi, M. and Alizadeh, F. (2007) Association between dental caries and body mass index-for-age among 6 -11-year-old children in Isfahan in 2007. JODDD, 1, 119-124.

[25]   Mohammadi, T.M., Hossienian, Z. and Bakhteyar, M. (2012) The association of body mass index with dental caries in an Iranian sample of children. Journal of Oral Health and Oral Epidemiology, 1, 29-35.

[26]   Kantovitz, K.R., Pascon, F.M., Rontani, R.M. and Gaviao, M.B. (2006) Obesity and dental caries—A systematic review. Oral Health & Preventive Dentistry, 4, 137-144.

[27]   Ur Rehman, M.M., Mahmood, N. and Ur Rehman, B. (2008) The relationship of caries with oral hygiene status and extra-oral risk factors. Journal of Ayub Medical College, Abbottabad, 20, 103-108.

[28]   Elias-Boneta, A.R., Psoter, W., Elias-Viera, A.E., Jimenez, P. and Toro, C. (2006) Relationship between dental caries experience (DMFS) and dental fluorosis in 12-year-old Puerto Ricans. Community Dental Health, 23, 244-250.

[29]   De Almeida, C.M., Petersen, P.E., Andre, S.J. and Toscano, A. (2003) Changing oral health status of 6-and 12-year-old schoolchildren in Portugal. Community Dental Health, 20, 211-216.

[30]   Okeigbemen, S.A. (2004) The prevalence of dental caries among 12 to 15-year-old school children in Nigeria: Report of a local survey and campaign. Oral Health & Preventive Dentistry, 2, 27-31.

[31]   Wedl, J.S., Danias, S., Schmelzle, R. and Friedrich, R.E. (2005) Eruption times of permanent teeth in children and young adolescents in Athens (Greece). Clinical Oral Investigations, 9, 131-134. doi:10.1007/s00784-004-0295-y

[32]   Namal, N., Vehit, H.E. and Can, G. (2005) Risk factors for dental caries in Turkish preschool children. Journal of Indian Society of Pedodontics and Preventive Dentistry, 23, 115-118. doi:10.4103/0970-4388.16881

[33]   Boitor, C.G., Fratila, A., Stanciu, L., Pitic, A. and Acu, A.M. (2011) Socio-economic factors and hygienic food-illness involved in determining dental caries of 12-year- old children in rural and urban area. Review of Research and Social Intervention, 33, 167-177.