Immigrant background as a determinant of caries development in Swedish children

Inequalities in oral health persist, particularly in highly developed countries, where socioeconomic status is an important explanatory factor. Previous analyses identified immigrant background as a determinant of dental caries development. The present study further explored this association by investigating the influence of home language and the income classification of the country or region of origin on caries development.

This prospective longitudinal cohort study followed 3,402 children who lived in 23 socioeconomically disadvantaged areas in Stockholm, Sweden, from ages 1 to 3 years. Caries was assessed using the International Caries Detection and Assessment System (ICDAS II) criteria. Primary outcome measures were number of tooth surfaces with dental caries (ICDAS ≥ 1 and ICDAS ≥ 3). Longitudinal data were collected through annual clinical examinations that included questionnaires at ages 1, 2, and 3 years. Immigrant background was defined by the languages spoken at home, which were linked to the income classification of the country or region of origin and categorized as low-, middle-, or high-income European or non-European countries or regions. These factors, home language and income classification, served as exposure variables in the analysis.

The study identified 83 home languages. The reference group, the Swedish language group, had the lowest caries count at all time points and showed the smallest increase in caries development. The Mixed language group (Swedish and one or more foreign home languages) had a caries risk between the reference group (Swedish language) and the non-Swedish language group (no Swedish was spoken at home). Higher caries development was found among some immigrant groups, particularly those from middle-income European countries and non-European countries or regions.

Immigrant background emerged as a sociodemographic determinant, with evident variation in caries outcomes across different groups. Preventive efforts should continue, but further development to better address the specific needs of multicultural, low-socioeconomic communities. Measures such as use of interpreters, multilingual materials, and establishment of community outreach programs could be beneficial.

ISRCTN35086887. Registered 16 December 2013.