AUTHOR=Imes Emily P. , Ginnis Jeannie , Shrestha Poojan , Simancas-Pallares Miguel A. , Divaris Kimon 

TITLE=Guardian Reports of Children's Sub-optimal Oral Health Are Associated With Clinically Determined Early Childhood Caries, Unrestored Caries Lesions, and History of Toothaches

JOURNAL=Frontiers in Public Health

VOLUME=9

YEAR=2021

URL=https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2021.751733

DOI=10.3389/fpubh.2021.751733

ISSN=2296-2565

ABSTRACT=<p><bold>Background:</bold> Parents'/guardians' perceptions of their children's oral health are useful proxies of their clinically determined caries status and are known to influence dental care-seeking behavior. In this study, we sought to examine (1) the social and behavioral correlates of fair/poor child oral health reported by guardians and (2) quantify the association of these reports with the prevalence of early childhood caries (ECC), unrestored caries lesions and toothaches.</p><p><bold>Methods:</bold> We used guardian-reported child oral health information (dichotomized as fair/poor vs. excellent/very good/good) obtained <italic>via</italic> a parent questionnaire that was completed for <italic>n</italic> = 7,965 participants (mean age = 52 months; range = 36-71 months) of a community-based, cross-sectional epidemiologic study of early childhood oral health in North Carolina between 2016 and 2019. Social, demographic, oral health-related behavioral data, and reports on children's history of toothaches (excluding teething) were collected in the same questionnaire. Unrestored ECC (i.e., caries lesions) was measured <italic>via</italic> clinical examinations in a subset of <italic>n</italic> = 6,328 children and was defined as the presence of one or more tooth surfaces with an ICDAS ≥ 3 caries lesion. Analyses relied on descriptive and bivariate methods, and multivariate modeling with average marginal effect (A.M.E.) estimation accounting for the clustered nature of the data. Estimates of association [prevalence ratios (PR) and adjusted marginal effects (AME) with 95% confidence intervals (CI)] were obtained <italic>via</italic> multilevel generalized linear models using Stata's <italic>svy</italic> function and accounting for the clustered nature of the data.</p><p><bold>Results:</bold> The prevalence of fair/poor oral health in this sample was 15%–it increased monotonically with children's age, was inversely associated with parents' educational attainment, and was higher among Hispanics (21%) and African Americans (15%) compared to non-Hispanic whites (11%). Brushing less than twice a day, not having a dental home, and frequently consuming sugar-containing snacks and beverages were significantly associated with worse reports (<italic>P</italic> &lt; 0.0005). Children with fair/poor reported oral health were twice as likely to have unrestored caries lesions [prevalence ratio (PR) = 2.0; 95% confidence interval (CI) = 1.8-2.1] and 3.5 times as likely to have experienced toothaches [PR = 3.5; 95% CI = 3.1-3.9] compared to those with better reported oral health.</p><p><bold>Conclusions:</bold> Guardian reports of their children's oral health are valuable indicators of clinical and public health-important child oral health status. Those with fair/poor guardian-reported child oral health have distinguishing characteristics spanning socio-demographics, oral-health related practices, diet, and presence of a dental home.</p>