Dental Caries of Refugee Children Compared with US Children

Meghan Sullivan Walsh June 1, 2011

Literature Review - St. Joseph/LMC Pediatric Dentistry

Dental Caries of Refugee Children Compared with US Children

Resident: Meghan Sullivan Walsh

Program: Luterhan Medical Center - Providence

Article Title: Dental Caries of Refugee Children Compared with US Children

Authors: Susan Cote, RDH, MS; Paul Geltman, MD, MPH; Martha Nunn, DDS, PhD; Kathy Lituri, RdH, MPH; Michelle Henshaw, DDS, MPH; and Raul I. Garcia, DMD

Journal: Pediatrics

Volume, Number, Year, Pages; Vol. 114, No.6, December 2004, pgs 733-740

Major Topic: To describe the prevalence of caries experience and untreated decay among newly arrived refugee children classified by their region of origin and compared with US children.

Overview of Method of Research: Within 90 days of arrival to Massachusetts, US, screenings were completed of some 224 refugees starting January 2001 and ending in September 2002. A dental hygienist performed the screening and the parent and/or child was interviewed about their dental history and history of pain. Demographic information was recorded (age, gender, race/ethnicity, and country of origin.) Caries experience was recorded as well as ‘ECC’. Treatment urgency was estimated with their own scale. In comparison to these numbers, the NHANES III database was used including a total of 11,296 US children between the ages of 2 to 16.9. Information gathered was used to construct comparisons to the refugee database. Logistical regression models were constructed to test the differences in prevalence of untreated cares and the prevalence of caries experience between US and refugee children.

Findings:

REFUGEE ANALYSIS

*Refugee children from Africa were the least likely ever to have been to a dentist

*For treatment urgency:

1) 5% of children from Africa were classified as needing urgent care as compared to 32.2% of Eastern Europeans and 13.6% from other areas.

2)Highest proportion of children with NO obvious dental problems were from Africa 40.5%

*Caries experience in total refugee population was 51.3% ; 38% - African, 79.9% -Eastern European and 50% - Other

*Refugee children from Africa had the fewest dental needs while Eastern Europeans had the greatest.

US NHANES analysis

*77.7% of US children exhibited “no obvious problem”

*77.2% of US children has no untreated caries

Comparison

*White/other refugee children were 9.4 times as likely to have untreated caries compared to white US children, 5.4 times as likely compared to African American children and 4.4 times as likely compared with other US children.

*African refugee children were only twice as likely to have untreated caries compared with white US children and not significantly different from African American children or other US children.

*White/other refugee children were 4.6 times as likely to exhibit caries compared with African refugee children.

*African refugee children were only half as likely to have caries experience compared with white US children and African American children.

Key Points/Summary:

African refugee children had significantly lower dental caries experience as well as fewer untreated caries as compared to Eastern European refugee children. African refugees were also less likely to have seen a dentist. In addition, African refugee children were also half as likely to have had a caries experience were compared with African American children. Eastern European refugees in contrast were three times as likely to have caries experience than US children and 9.4 times as likely to have untreated caries as white US children. Many factors can be attributed to these numbers. It’s been found that many Eastern African countries have naturally occurring optimal levels of fluoride in drinking water with others having very high levels of fluoride. In addition the African countries which were studied also consume far less annual per capita sugar as compared to Eastern Europeans and the US. One interesting fact in the article was that many African’s use ‘chewing sticks’ to clean their teeth which have been found to be an effective means of plaque removal.

Assessment of the Article:

I’m unsure as to why I was ‘randomly’ selected to report on this article?... In any case, this article and research was fascinating! When comparing the few families we’ve treated at St. Joseph, the numbers don’t match up, however, our families in Providence have been from Western African communities which may account for the differences. Many questions came into my head... Are Western Countries in Africa fluoridated? What kind of diets are these families consuming while in these refugee camps? Are these children now at higher risk for dental disease now that they’ve moved to the US? It would be interesting to use the data were are collecting at St. Joseph to form our own research project! The article does mention several times how important it is for us to become aquatinted with Refugee families and the children as the US does receive a huge number of these families each month. Fortunately for us we are already getting a good sense of their dental history, caries experience and the many barriers they and we face when attempting to treat their dental needs.