Inequities in Caries-burden Challenges ‘High-risk’ Prevention Approach in South Africa

Objectives: To determine the socio-economic inequities in dental caries experience, evaluate the spatial relationship between mean DMFT and caries prevalence and its implication for the high-risk approach to caries prevention in South Africa. Methods: Secondary analysis of caries data of 12-year-olds, available from 37 regions in 7 of the 9 provinces, was carried out. The data set used was obtained from the 1999-2002 national children oral health survey. Logistic regression analysis was used to determine risks for caries experience in each province, using the broad categories of occupation reported for breadwinners in the household of children examined and their population group as independent variables. Those in professional/administrative/service occupations, and the White population served as reference categories. Regression curve-estimation was used to examine the relationship between mean DMFT and caries prevalence. Results: The mean DMFT (+/-SD) for the study population was 1.18 (+/-2.12) and caries prevalence was 38.7%. The highest mean DMFT was in the Coloured population (2.14+/-2.50). The relative risk for children of the unemployed to experience caries was lowest in the Northwest province (Odds ratio [OR]=0.49; p<0.01), but relatively high in both Kwazulu Natal and Northern Cape provinces with OR of 1.27 and 1.37 respectively. This is despite the fact that the mean DMFT in these provinces was <1.5. Caries prevalence could be mathematically predicted from the mean DMFT. The regression curve derived demonstrated that a unit increase in caries experience in low-level caries areas would generate more cases than similar increase in high-level caries areas. Conclusions: DMFT alone provided an incomplete picture of the impact of caries in South Africa and there is a need for monitoring inequities. The pattern of caries distribution suggests that 'high-risk' approach may inadvertently reinforce present inequities in caries-burden, and supports the use of a population approach, such as water fluoridation.