Effect of social class on childhood caries. A systematic review

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Objective:

To perform a meta-analysis of the association of socio-economic measures with caries in children. 

Methods:

We searched papers containing socio-economic related risk factors on caries in children. The Pubmed database was searched using the keywords: dental caries, child, risk, disadvantage, ethnic, ethnicity toothbrushing, sugar, sucrose.  The search included all literature published from 1966 to April 2002. Two literature reviews were used to help judge paper quality: “Risk factors for dental caries in young children: a systematic review of the literature (2004)” (R1) and “Socioeconomic status and selected behavioral determinants as Risk factors for dental caries (2001)” (R2).

Results:

The Inclusion criteria resulted in 4 articles being used for this meta-analysis. The assessment of data quality from the papers from R1 and R2 can be reviewed from the literature (Harris, Nicoll, Adair, & Pine, 2004; Reisine & Psoter, 2001). The four studies were homogeneous (p=0.60). The overall odds ratio was OR=2.1 with a 95% confidence interval (1.8, 2.4) indicating a significant association of social class with childhood cavities.

Conclusion:

Children in the upper social class have a lower caries risk than children in the middle class.  Belonging to the low social class increases the caries risk in primary dentition. These effects are general regardless of the reported dental health behavior of the children. 

Method	Estim	Lower	Upper	z-value	p-value	studies
Fixed	2.06	1.75	2.4	8.7	0	4
Random	2.06	1.75	2.4	8.7	0
Test for heterogeneity: Q=  1.9 on 3 degrees of freedom (p= 0.60)
	Weighted		Study		95% conf. interval
Author	Study	Fixed	Random	Estim	Lower	Upper
(Al-Malik, Holt, & Bedi)	2001	33.54	33.54	1.74	1.24	2.44
(Grindefjord, Dahllof, Nilsson, & Modeer)	1995	30.55	30.55	2.19	1.54	3.12
(Khan & Cleaton-Jones)	1998	10.34	10.34	1.73	0.94	3.18
(Irigoyen et al.)	1999	68.73	68.73	2.24	1.77	2.84