Socio-Economic, Demographic Risk Indicators of Dental Caries Amongst Adults

Objectives: To identify the socio-economic, demographic and behavioural risk factors associated with high-risk caries prevalence, in the Republic of Ireland. Rationale: The National Survey of Adult Oral Health (NSAOH) 2000/02 conducted by the Oral Health Services Research Centre, National University of Ireland, Cork, found evidence of declining caries levels and increased tooth retention, in line with other developed economies. With this trend it may be more appropriate to identify, target, and divert resources toward groups at high-risk to caries rather than the more resource intensive population based approach. Methods: Factors such as age, gender, fluoridation, eligibility status, health board differences, employment status, educational attainment, anxiety about dental visits, frequency of brushing, attendance patterns were regressed on a dichotomous and trichotomous version of prevalence Decayed Missing Filled Surfaces (DMFS) and visual-DMFS scores, as the dependent variable, using Logistic and Ordered Logistic regression models on epidemiological data from NSAOH (2000/02). The predictor variables explaining differences in caries prevalence were elucidated from questionnaire responses in the national survey. Goodness of fit of the models was evaluated by estimating its sensitivity, specificity, positive/negative predictive values, and accuracy. Receiver Operating Characteristic (ROC) curve based analysis was also used to as assess fit. Results: Age, females, regular usage of dental services, anxiety about visiting the dentist, and those with primary education only, were more likely to be of high-risk to dental caries. Exposure to fluoridated water reduced the likelihood of high DMFS prevalence, but was only statistically significant for 35-44 year olds. Regular brushing was significant for all age groups in reducing the likelihood of high DMFS prevalence. Anxiety was significant only for the 16-24's. Conclusions: In the presence of scarce resources and in the interest of economic efficiency those identified as high-risk should be selectively targeted for preventive programmes rather than using the population approach.