Determinants of the incidence of clinical consequences of untreated dental caries among underprivileged schoolchildren: a two-year prospective cohort study.

OBJECTIVES

To investigate the influence of structural and intermediary determinants on the incidence of clinical consequences of untreated dental caries in schoolchildren.

METHODS

A two-year prospective cohort study was conducted with 329 twelve-year-old students from public schools in [Text blinded for peer review]. Socioeconomic status (family income, parents' schooling, number of goods, and number of rooms), psychosocial factors (oral health beliefs, sense of coherence [SOC-13], social support [SSA]) and number of decayed teeth were assessed at baseline. Use of dental services in the last 12 months and frequency of toothbrushing were registered at two-year follow-up. The incidence of clinical consequences of untreated dental caries was measured by the number of teeth with PUFA index (Pulpal involvement, Ulceration, Fistula, and Abscess) between baseline and the two-year follow-up. Structural equation modeling were used to test the model adapted from WHO (World Health Organization) conceptual framework on social determinants of health.

RESULTS

The incidence of clinical consequences of untreated dental caries was directly predicted by dental caries at baseline (β = 0.338). Lower socioeconomic status (β = -0.019) indirectly predicted the incidence of clinical consequences of untreated dental caries via parents' sense of coherence, use of dental services and dental caries. Lower social support (β = -0.038) indirectly predicted the incidence of clinical consequences of untreated dental caries via use of dental services and dental caries.

CONCLUSION

Strategies tackling structural determinants and intermediary factors should be considered in addressing the clinical consequences of untreated dental caries.

CLINICAL SIGNIFICANCE: This study highlights that the clinical consequences of untreated dental caries in schoolchildren are primarily driven by baseline caries experience. Socioeconomic inequalities and psychosocial factors show modest associations with the outcome through indirect pathways mediated by behavioural and clinical pathways. Preventive strategies should prioritise early caries management alongside addressing social inequalities in oral heatlh.