Is there an Appalachian disparity in dental caries in Pennsylvania schoolchildren?

Abstract

Objectives: To determine whether there is an Appalachian disparity in caries prevalence or extent in children living in Pennsylvania.

Methods: We conducted a cross-sectional clinical assessment of caries in a sample representing 1st, 3rd, 9th, and 11th grade students across Pennsylvania. We used logistic regression and zero-inflated negative binomial regression controlling for age to examine the association of residence in an Appalachian county with caries prevalence and extent in the primary and permanent dentitions.

Results: Compared with children living outside Appalachia, more children living in Appalachia had a dft >0 (OR = 1.37, 95% CI = 1.07-1.76) and more had a DMFT >0 (OR = 1.32, 95% CI = 1.06-1.64). In addition, compared with children living outside Appalachia, children living in Appalachia had a greater primary but not permanent caries extent (IRR = 1.10, 95% CI = 1.01-1.19).

Conclusions: We found Appalachian disparities in caries prevalence in both the primary and permanent dentitions and an Appalachian disparity in caries extent in the primary dentition. None of the disparities was moderated by age. This suggests that the search for the mechanism or mechanisms for the Appalachian disparities should focus on differential exposures to risk factors occurring prior to and at the start of elementary school.

Keywords: Appalachia region; adolescent; child; dental caries.