Housing type, access to transportation, living below the poverty line, disability and living in crowded housing are significant risk factors for dental caries, or cavities, in children, according to a new study by researchers from the University of Colorado School of Dental Medicine (CU SDM). The children in the study who came from neighborhoods with these risk factors were nearly 25 percent more likely to receive a caries diagnosis than children from affluent communities.
Tamanna Tiwari BDS, MDS, MPH, associate professor in the Department of Community Dentistry and Population Health, was the faculty lead on the study. Published October 9, 2024, in the Journal of Dental Research (JDR) Clinical & Translational Research, the study highlighted the need for interventions in areas where disadvantages like lack of available transportation, poverty and high unemployment rates combine to restrict access to early childhood dental care.
Tiwari said, “There's a lot of research that shows social determinants of health are an important factor in developing dental diseases, but there are very few research projects that measure these social determinants of health in a quantifiable manner. This study does exactly that.”
Jordan Pellegrom, a pediatric dentistry resident at Children’s Hospital Colorado, was the lead author on the study. Two other co-authors were Kaci Pickett, a research instructor and biostatistician at the CU School of Medicine, and Gary Kostbade, a fourth-year dental student at the CU SDM.
Implications for Pediatric Dentistry
Tiwari said that she is glad that she could introduce Kostbade to the world of research. She said, “This was a great way to introduce him to thinking about social determinants of health as he prepares to become a pediatric dentist.”
The researchers used de-identified data from the electronic medical records of 9,201 children who visited the pediatric dental clinic at Children’s Hospital Colorado in 2020. With the help of a tool embedded in the medical records system called SlicerDicer, researchers merged the de-identified patient data with county-level and zip code-level data available from public indices maintained by the federal Centers for Disease Control and Prevention (CDC). They then used logistic regressions to test the association between the CDC’s Social Vulnerability Index (SVI) and the presence or absence of dental caries. The data was adjusted for age, sex, ethnicity and race.
The study’s findings underline those in the National Institute of Health’s (NIH) landmark 2021 report, Oral Health in America, which found that nearly one out of four children living in poverty experience tooth decay, compared to about one in eight children living in households at twice the federal poverty guideline level or higher.
Pellegrom, who is now in private practice in St. Cloud, Minnesota, said he approaches his own patients differently because of what he learned doing this research. He said, “It tells me that the more I get to know families, if I can identify some of those vulnerability factors, I'm more aware of what I can do clinically that would help them.”
For example, he said, if he knew he had a patient from a neighborhood that is at increased risk for any of the aforementioned social vulnerability indicators, he might try to see the patient more frequently than usual. Or, he said, instead of filling a cavity with a composite, and running the risk that the patient could get another cavity beneath the composite, he might offer instead a stainless-steel crown that would cover the entire tooth. He said, “For patients that I know are at higher risk for caries, I might need to talk to that family about risk, to help guide them with their decisions.”
Research, Going Forward
Pellegrom said that the study shows how factors well beyond the dentist’s office can impact dental health in children, and how critical policy changes are to ensure everyone has access to good dental care.
He said, “If you can help communities be less socially vulnerable, you probably are helping them out with not just cavities, but a lot of other health outcomes. And that puts a lot less stress on the whole system.”
Tiwari said the next step is to expand the research so it is generalizable to the state’s population, and in doing so, can be a tool for influencing policy makers to reduce disparities. She said this would involve conducting larger studies, over multiple years, with a population beyond simply that of Children’s Hospital. She said the researchers might also try to drill down into details like whether there are more caries diagnoses among walk-in patients versus those who had appointments, or how social vulnerability impacts different communities, and does it vary according to other factors?
Tiwari said, “We need to do more research in this area, so that we could take this to a legislator and say, ‘Not having transportation impacts carries development or disease development, and here’s the proof. What can we do, and what policies can we make so that there is oral health equity for all kids living in Colorado?’”
