287 - Pre-pandemic NHANES Pediatric Teeth: Poverty Still Bites

Dental decay is the most common preventable chronic disease of childhood.  Dental health can affect physical and mental health, and pediatricians have embraced the role of advocating for preventive care to obviate the later need for restorative dental care, but health care systems are often not aligned with dental care systems, especially for systems serving children living in poverty.

Objective:

To describe prevalence of sound teeth, restorations, active caries, and missing teeth among the nation’s youth using the most recent available National Health and Nutrition Examination Survey (NHANES) data

Design/Methods:

NHANES 2017-March 2020 Pre-pandemic data were used to investigate the dental health of 5,225 youth ages 1 to 20 years who had complete oral exams, representing 73,450,902 people in the US.  Inclusion into NHANES is based on a complex, multistage, probability sampling design to allow the results to produce reliable national estimates.  Dental exams were performed in a mobile examination center by licensed dentist.  For each study subject, there was a tooth count; each tooth was examined for dental caries and presence of prior fillings.  Erupted wisdom teeth were counted but not assessed for caries or fillings.  Demographic data were collected for each study participant and income categories were created using the variable INDFMPIR that is the ratio of family income to the federal poverty index based on family size. Statistical analyses were performed using SAS v9.4 which accounted for the complex sample design of NHANES. 

Results:

Overall, 53.5% of children had teeth without untreated cavities or fillings, 11.5% had untreated cavities, 39.9% had fillings, and 1.7% had missing teeth due to cavities.  The proportion of children without cavities or fillings decrease with increasing age (Table 1) and increased with increasing family incomes (Table 2).  16.7% of children living at or below the federal poverty index had untreated dental caries compared to 7.2% of children whose family’s income is more than 3 times the federal poverty index.   Differences were less pronounced by race and ethnicity; however, Mexican Americans were more likely to have teeth with fillings (51.5%) and less likely to have teeth without active dental caries or fillings (41.8%).

Conclusion(s):

Untreated dental caries are common in children, more so in those living in poverty.  Less than half of children enter adulthood without fillings or untreated cavities.  There remains much to do to help families preventing dental decay in their children.