# Socioeconomic factors in relation to dental caries among children aged 5–14 years: a cross-national comparative study using secondary data analyses

## TL;DR

This study explores how factors like income and water fluoridation affect dental caries in children globally, finding significant links with socioeconomic indicators.

## Contribution

The study provides new global insights into the socioeconomic risk factors for dental caries in children aged 5–14 years using cross-national data.

## Key findings

- Low water fluoridation is significantly associated with higher odds of caries in permanent teeth.
- Middle-income countries show increased risk of caries in both deciduous and permanent teeth compared to high-income countries.
- Shorter parental schooling is linked to lower prevalence of caries in permanent teeth.

## Abstract

Dental caries is a preventable non-communicable disease. Untreated caries in deciduous teeth may contribute to the development of caries in permanent teeth. Nevertheless, limited research has focused specifically on the risk factors in children. The current study examined the association between dental caries and socioeconomic risk factors among children aged 5–14 years across countries worldwide.

An ecological survey was conducted using nation-based, publicly available online databases from six reputable organizations: the World Health Organization, the Food and Agriculture Organization of the United Nations, the World Bank, the British Fluoridation Society, the United Nations Development Programme, and the Global Burden of Disease Project. Data were collected from these sources between 2014 and 2017. Independent variables included density of dental personnel, parental education, family income, water fluoridation, and sugar consumption. The dependent variables were the prevalence of caries in deciduous and permanent teeth. Data were analyzed using descriptive statistics, univariate analysis, and multinomial logistic regression.

After eliminating countries without complete information, this study enrolled 120 countries with complete data for both dependent and independent variables. Univariate analysis revealed significant differences by parental education, income level, and water fluoridation. We further conducted multivariate logistic regression analysis, indicating that countries with low fluoridation (< 50%) had significantly higher odds of caries in permanent teeth (OR: 13.23; 95% CI: 1.22–143.53; p = 0.03); shorter years of parental schooling was associated with lower prevalence of caries in permanent teeth (OR: 0.12; 95% CI: 0.03–0.47; p = 0.002); and middle-income countries showed increased risk in both deciduous teeth (OR: 3.44; 95% CI: 1.26–9.43; p = 0.02) and permanent teeth (OR: 6.93; 95% CI: 1.75–27.38; p = 0.01) than high-income countries. Sugar consumption and density of dental personnel were not significantly associated.

This ecological study provides valuable insights into the global patterns of dental caries in children aged 5–14 years and their associations with selected socioeconomic indicators. Our results reveal significant correlations of dental caries with income level, water fluoridation coverage, and parental education. However, these associations should be interpreted with caution due to the ecological nature of the data and several important limitations.