Persistent poverty and child dental caries: time-varying exposure analysis

Area of Science:

• Public Health
• Pediatric Dentistry
• Socioeconomic Determinants of Health

Background:

• Dental caries is a significant public health issue affecting children globally.
• Socioeconomic factors, particularly poverty, are known to influence oral health outcomes.
• Understanding the long-term impact of poverty on child dental health is crucial for targeted interventions.

Purpose of the Study:

• To investigate the cumulative effect of persistent poverty on the incidence of dental caries in Japanese elementary schoolchildren.
• To compare the burden of dental caries in children experiencing persistent poverty versus those never experiencing poverty.
• To assess whether persistent poverty has a greater impact on dental caries than poverty measured at a single time point.

Main Methods:

• Longitudinal study using four-wave data from 4291 elementary schoolchildren in Adachi City, Tokyo (2015-2020).
• Poverty defined by household income, material deprivation, or utility payment difficulties, assessed via caregiver questionnaires.
• Dental caries assessed by school dentists; statistical analysis using targeted maximum likelihood estimation to control for confounders.

Main Results:

• Children with persistent poverty had significantly more dental caries (mean 3.81) compared to children never experiencing poverty (mean 2.39).
• Persistent poverty was associated with 1.54 more decayed teeth than never experiencing poverty, after controlling for confounders.
• The association between persistent poverty and dental caries was stronger than poverty assessed at a single time point.

Conclusions:

• The cumulative impact of persistent poverty on dental caries in children is substantial.
• Long-term poverty exposure poses a greater risk to children's dental health than short-term or intermittent poverty.
• Findings highlight the need for sustained socioeconomic support to improve child oral health outcomes.