Spatial Analysis of Unrestored Early Childhood Caries in North Carolina

Objectives: The influence of social determinants of health and upstream or community factors on oral health and disease is well-established. Untreated dental disease in children is an important problem from clinical, public health and policy standpoints—however, empirical evidence on its spatial distribution and community-level determinants is scant. To address this knowledge gap, we sought to characterize the spatial distribution of unrestored early childhood caries (ECC) in a large, community-based sample of preschool-age children in North Carolina (NC).
Methods: We used tooth surface-level clinical data of caries experience from 6,404 preschool-age children (mean age=52 months; range=36-72 months) who were participants of the ZOE 2.0 study in NC. Clinical examinations were done by trained and calibrated examiners in community locations using ICDAS criteria. We defined ECC at the ‘moderate’ clinical presentation threshold (ICDAS>2). We used a geographic information systems (GIS) analysis approach to determine the spatial distribution and clustering of unrestored ECC across the state of NC. We used Getis-Ord Gi* statistic to conduct ‘hot spot’ analyses and the Anselin local Moran’s I measure to identify within-cluster positive and negative outliers. Analyses were done using ArcGIS Pro 2.2 software.
Results: The prevalence of untreated decay in the study population was 36% (n=2,302), two-thirds of all ECC cases. We found evidence of spatial heterogeneity and identified 4 clusters of high and 1 cluster of low density of unrestored disease at the 99% confidence level, whereas these figures were 6 and 1, respectively, at the 95% confidence level. Local Moran’s I analysis revealed several positive (i.e., good/poor oral health in a high/low disease density area) and negative outliers within these clusters.
Conclusions: Understanding of the spatial distribution of oral disease experience and specifically unmet restorative treatment needs can provide valuable insights and directions for the development of state-wide programs for oral health promotion and disease treatment.