Gains in children's dental health differ by socioeconomic position: evidence of widening inequalities in southern Brazil

Abstract

Oral health inequalities are the measures by which equity in oral health is tracked. Despite widespread improvement in children's dental health globally, substantial socio-economic disparities persist and may be worsening.

Objectives: Quantify 10-year changes in child caries occurrence by socio-economic position in a Southern Brazilian city and compare oral health inequalities over time.

Methods: Representative surveys of dental caries in children (age <6 years) in Canoas, Brazil, were conducted in 2000 and 2010 following standardized methods. For each survey year, we calculated disparities by socio-economic position (maternal education and family income) in age- and sex-standardized caries occurrence (prevalence: dmft > 0; severity: mean dmft) using absolute measures (difference and Slope Index of Inequality) and relative measures (ratio and Relative Index of Inequality).

Results: Comparing 2010 to 2000, caries occurrence was lower in all socio-economic strata. However, reductions were more pronounced among socio-economically advantaged groups, yielding no improvement in children's oral health disparities. Some disparity indicators were consistent with increasing inequality.

Conclusions: Overall, dental caries levels among children in Canoas improved, but inequalities in disease distribution endured. Concerted public health efforts targeting socio-economically disadvantaged groups are needed to achieve greater equity in children's oral health.

Figure 1. Significant Caries Index (SiC) by deciles of caries experience in 2000 and 2010 (Canoas, Brazil)

The Significant Caries Index (i.e. the mean decayed, missing, filled tooth index in the upper 33% of population by dmft) within each decile of caries experience is shown for the years 2000 (circles) and 2010 (triangles) in the Oral Health Canoas surveys. Despite overall improvements in caries status from 2000 to 2010, the SiC score was no lower in 2010 than in 2000 among those children belonging to the worse-off decile of the population by caries experience.