Persistent oral health disparity in 12-year-old Hispanics: a cross-sectional study.

BACKGROUND: Dental caries is the most prevalent chronic illness worldwide. In the US dental caries has been described as a "silent epidemic", affecting 58.2 % of 12-15 year-olds, particularly in minority and immigrant groups. Caries is associated with complex yet preventable biological and behavioral factors such as dental plaque and diet, as well as social determinants of health. In developed nations, a higher risk caries has been associated with populations of low socio-economic status (SES), especially in areas with greater income disparity. An island-wide study conducted in Puerto Rico in 1997 revealed a high prevalence of dental caries in 12-year-olds and a significant health disparity between children attending private and public schools. The purpose of the present study was twofold: 1) to estimate caries levels of 12-year-old school Puerto Ricans in 2011; and 2) compare results to data obtained in 1997 to explore any possible change in caries outcomes after a government health insurance (GHI) reform was implemented. METHODS: In this cross-sectional study, a probability sample of 133 out of 1,843 schools was selected proportional to enrollment size, and stratified by 1997 GHI regions, school type, and gender. Calibrated examiners conducted oral soft tissue and caries examinations. Dental caries prevalence was estimated. Mean Decayed Missing Filled Tooth/Surface (DMFT/S) indices and mean Significant Caries Index (SiC) were calculated and compared retrospectively to data obtained in 1997. RESULTS: The final sample included 1,587 school-enrolled children. About 53 % of participants were female and 77 % attended public schools. Between 1997 and 2011, reductions were observed in caries prevalence (81 to 69 %), mean DMFT scores (3.8 to 2.5), mean DMFS scores (6.5 to 3.9), and mean SiC index (7.3 to 5.6) in both private and public schools, with a more prominent decrease in private schools. Between 1997 and 2011, overall the filled component increased (50 to 67 %), while decayed and missing component decreased (42 to 30 %) and (8 to 3 %), respectively. CONCLUSIONS: Among 12-year-old schoolchildren in Puerto Rico between 1997 and 2011, caries prevalence, extent, and severity decreased as well as the DMFT missing component, while the filled component increased. Dental caries prevalence was high and the health disparity persists between children enrolled in public and private schools after more than a decade of the GHI implementation. The relationship between GHI implementation and other potentially relevant co-factors for caries warrants further research, as does the seemingly entrenched disparity across groups.

The prevalence of pit and fissure sealants among twelve year olds living in Puerto Rico during 1997.

OBJECTIVE: to estimate the prevalence of pit and fissure sealants on first permanent molars in twelve year olds living in Puerto Rico and to further evaluate dental sealant prevalence by (1) urban/rural and public/private school status as well as (2) gender; DESIGN: population-based, cross-sectional study. SETTING: public and private schools encompassing the 11 health regions of Puerto Rico. SUBJECTS: a probabilistic sample of 12-year old school attendees in Puerto Rico representing a population of approximately 70,000. METHOD: during April through December 1997, the first permanent molars of 1435 subjects were evaluated by visual and tactile methods for the presence of dental sealants. RESULTS: the data collected revealed that 4.3% of 12 years olds presented at least one permanent first molar sealed. A statistically significant difference (p = 0.01) between urban-public (2.5%), rural-public (3.39%) and urban-private (11.0%) schools was observed. The prevalence of sealants was higher in males (5.5%) than females (2.9%); (p = 0.02). CONCLUSIONS: the prevalence of dental sealants in the first permanent molars of 12-year olds living in Puerto Rico during 1997 (4.3%) is lower than that reported in the United States (18.5%). Sealant prevalence was higher in males and students attending (urban) private schools.

Dental caries prevalence of twelve year olds in Puerto Rico.

OBJECTIVE: To assess the prevalence of dental caries amongst twelve-year old Puerto Ricans. DESIGN: Population-based, cross-sectional study. SETTING: Public and private schools in the 11 health regions of Puerto Rico. SUBJECTS: A probabilistic sample of 12-year old school attendees in Puerto Rico. METHOD: One thousand four hundred and thirty-five subjects were evaluated following NIDCR criteria and methodology for DMFS and DMFT indicators from a population of approximately 70,000 12-year olds during April through December 1997. RESULTS: The overall mean DMFS was 6.5 (SE 0.38) and ranged from 9.2 in the Central Region to 5.3 in the Metropolitan and West Regions. The mean DMFT was 3.8 (SE 0.18). The decayed component comprised 42% of the DMFS; caries prevalence for the population was 81%. CONCLUSION: The mean DMFS for twelve year olds is higher than the mean DMFS of 4.2 to 4.7, reported for 12 to 17 years olds in the USA. Dental caries is a highly prevalent disease amongst 12-year olds in Puerto Rico.