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Risk determinants of dental caries and oral hygiene status in 3-15 year-old recent immigrant and refugee children in Saskatchewan, Canada: A Baseline Study.

J. Hoover, H. Vatenparast*, G. Uswak

College of Dentistry

*College of Pharmacy & Nutrition

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Purpose

identify the risk determinants of caries and record oral hygiene status in recent immigrant and refugee children residing in Saskatoon and Regina, Saskatchewan, Canada

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Background Recent immigrants & refugees at risk for oral diseases

Face access to care barriers

a) Language barriers

b) Lack of dental benefits

c) Difficulty in paying out-of-pocket

d) Variability in oral health KAP

Lack of published data

Desire to fill knowledge gaps & inform policy decisions

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Methods

Convenience samples:

a) 3-15 year-old recent immigrant and refugee children (n= 133)

b) adult guardians (n=86)

c) All arrived in Canada within last 7 years

d) Participants part of larger study Healthy Immigrant Children Research study • assessed general health, nutrition, socioeconomic and food

security status

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Methods

Clinical examination of children

2 calibrated examiners(one in each locale)

portable dental unit, dental mirror & explorer

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Methods dmft/DMFT calculated excluding second molars

Simplified Oral Hygiene Index (debris & calculus)

+/- gingivitis

Treatment needs:

a) urgent treatment for pain/infection

b) Extractions

c) Restorations

d) Orthodontics

e) OHI & periodontal therapy

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Methods – Survey Instrument All adults accompanying children completed a

questionnaire aimed at:

a) oral health KAP

b) perceived oral health status

c) perceived barriers to oral care in Saskatchewan

face–to-face interview with trained interpreters

Approval from U of S Behavioral Research Ethics Board University of Saskatchewan

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Methods - Analysis descriptive analysis SPSS 20.0 & SAS 9.3

regression analysis

Immigrant/refugee - Independent t-test & Mann-Whitney U Tests, (continuous variables)

Chi Square test & Fisher's Exact Tests (categorical variables), as applicable for categorical variables

outcome of interest for logistic regression was presence/absence of at least one carious tooth

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Results Refugee children had statistically significant higher DMFT

scores than immigrant children (p<0.001)

a) Refugee mean dmft/DMFT score 5.80±4.24

b) Immigrant mean dmft/DMFT score 3.52±3.78

c) Significant difference only in f/F between populations

d) mean score of 0.48 ±1.52 (immigrant) and 1.55±2.36 (refugees) p<0.001

Significantly higher than dmft/DMFT scores for Canadian children

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Results – Treatment Needs Need Immigrants Refugees p-value

Urgent (pain/infection) 3 (6.8%) 4 (4.5%) 0.68*

Extraction or surgery 3 (6.8%) 10 (11.2%) 0.54*

Restorations 24 (54.5%) 51 (57.3%) 0.76**

Plaque Control Instruction 42 (95.5%) 81 (91%) 0.50*

Scaling and root planning 20 (45.5%) 41 (46.1%) 0.95**

Orthodontic Treatment 15 (34.1%) 35 (39.3%) 0.56**

*-Fisher's Exact test **-Pearson's chi-square test

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Results

Significant differences between adult immigrants vs. refugees & adult immigrants had:

a) significantly higher proficiency in English language

b) More knowledge about oral health

• Brushing after meals (p<0.009)

• Causes of tooth decay (p<0.002)

• Benefits of fluoride (p<0.001)

• Knowledge of plaque (p<0.003) components like fluoride and dental floss compared to refugee adults.

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Summary Refugee children > immigrant children re: disease

Immigrants/refugee children > oral disease experience & treatment needs than Canadians

in line with other at-risk population groups

Other priorities take precedent over dental care & lack of financial resources becomes barrier when seeking care

Language is key barrier (p<0.0001)

Need to link immigrants/refugees with resources

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Limitations Convenience sample

Small sample size