Systems mapping of multilevel factors contributing to dental caries in adolescents

Abstract

Dental caries is a prevalent chronic disease among adolescents. Caries activity increases significantly during adolescence due to an increase in susceptible tooth surfaces, immature permanent tooth enamel, independence in pursuing self-care, and a tendency toward poor diet and oral hygiene. Dental caries in permanent teeth is more prevalent among adolescents in low-income families and racial/ethnic minority groups, and these disparities in adolescent dental caries experience have persisted for decades. Several conceptual and data-driven models have proposed unidirectional mechanisms that contribute to the extant disparities in adolescent dental caries experience. Our objective, using a literature review, is to provide an overview of risk factors contributing to adolescent dental caries. Specifically, we map the interactive relationships of multilevel factors that influence dental caries among adolescents. Such interactive multilevel relationships more closely reflect the complex nature of dental caries experience among the adolescent population. The methods that we use are two-fold: (1) a literature review using PubMed and Cochrane databases to find contributing factors; and (2) the system dynamics approach for mapping feedback mechanisms underlying adolescent dental caries through causal loop diagramming. The results of this study, based on the review of 138 articles, identified individual, family and community-level factors and their interactions contributing to dental caries experience in adolescents. Our results also provide hypotheses about the mechanisms underlying persistence of dental caries among adolescents.

Conclusions: Our findings may contribute to a deeper understanding of the multilevel and interconnected factors that shape the persistence of dental caries experience among adolescents.

Keywords: adolescents; causal loop diagram; dental caries; system dynamics; systems science.

Figure 1

Flow diagram of the literature review process.

Figure 2

Frequency of multi-level factors.

Figure 3

Frequency of individual level factors.

Figure 4

Frequency of family level factors.

Figure 5

Frequency of community level factors.

Figure 6

Causal loop diagram of feedback mechanisms affecting adolescents’ dental caries. : Reinforcing Loop. R1: Dental caries & Deterioration in Self-esteem. R2: Learning Barriers, Health Literacy & Diet. R3: Health Literacy & Self-efficacy. R4: Self-efficacy & Diet. R5: Self-efficacy & Peer Pressure. R6: Dental caries & Barriers (School Performance). R7: Fear of Pain & Dental Anxiety. R8: Overburdened Dental clinics & Treatment Delay. R9: Family Health Behavior & Regular Dental Visits. : Balancing Loop. B1: Need-Based Dental Visit. B2: Dental Visit & Fluoride Exposure. B3: Dental Visit & Family Health Behavior. B4: Family Health Behavior & Healthy Diet.