Low sugar nutrition policies and dental caries: A study of primary schools in South Auckland.

AIM: The study assessed whether a healthy food policy implemented in one school, Yendarra Primary, situated in a socio-economically deprived area of South Auckland, had improved student oral health by comparing dental caries levels with students of similar schools in the same region with no such policy. METHODS: Records of caries of the primary and adult teeth were obtained between 2007 and 2014 for children attending Yendarra, and were compared to those of eight other public schools in the area, with a similar demographic profile. Children were selected between the ages of 8 and 11 years. Linear regression models were used to estimate the strength of association between attending Yendarra school and dental caries. RESULTS: During the study period, 3813 records were obtained of children who attended dental examinations and the schools of interest. In a linear model, mean number of carious primary and adult teeth were 0.37 lower (95% confidence interval: 0.09-0.65) in Yendarra school children, compared to those in other schools, after adjustment for confounders. Pacific students had higher numbers of carious teeth (adjusted ß coefficient: 0.25; 95% confidence interval: 0.03-0.46) than Maori. CONCLUSION: This nutrition policy, implemented in a school in the poorest region of South Auckland, which restricted sugary food and drink availability, was associated with a marked positive effect on the oral health of students, compared to students in surrounding schools. We recommend that such policies are a useful means of improving child oral health.

How Neoliberalism Shapes Indigenous Oral Health Inequalities Globally: Examples from Five Countries.

Evidence suggests that countries with neoliberal political and economic philosophical underpinnings have greater health inequalities compared to less neoliberal countries. But few studies examine how neoliberalism specifically impacts health inequalities involving highly vulnerable populations, such as Indigenous groups. Even fewer take this perspective from an oral health viewpoint. From a lens of indigenous groups in five countries (the United States, Canada, Australia, Aotearoa/New Zealand and Norway), this commentary provides critical insights of how neoliberalism, in domains including colonialism, racism, inter-generational trauma and health service provision, shapes oral health inequalities among Indigenous societies at a global level. We posit that all socially marginalised groups are disadvantaged under neoliberalism agendas, but that this is amplified among Indigenous groups because of ongoing legacies of colonialism, institutional racism and intergenerational trauma.

Oral and dental health and health care for Maori with type 2 diabetes: A qualitative study.

OBJECTIVES: Type 2 diabetes mellitus (T2DM) and periodontal disease are two highly prevalent, directly and independently associated long-term conditions that disproportionately impact Indigenous Maori in New Zealand (NZ). Although poorly understood, a number of social and biological mechanisms connect these conditions. This qualitative study explored experiences of T2DM and oral and dental (hereafter oral/dental) health; access to oral/dental health care; whether participants' experiences supported or challenged existing evidence; and sought suggestions for improving oral/dental health in a high-deprivation rural area of Northland, NZ. METHODS: Participants (n = 33) meeting the study criteria: self-identified Maori ethnicity, aged ≥ 18-years with glycated haemoglobin (HBA1c) >65 mmol/L were recruited via the local primary care clinic in September-December 2015; two left the study prior to data collection. During face-to-face semi-structured interviews, participants (n = 31) were asked How does diabetes affect your teeth? and When did you last access dental care? Kaupapa Maori (KM) theory and methodology provided an important decolonizing lens to critically analyse the fundamental causes of Indigenous health inequities. RESULTS: Independent analysis of qualitative data by three KM researchers identified four themes: access barriers to quality care; pathways to edentulism; the 'cost' of edentulism; and, unmet need. Results contributed towards informing Mana Tu-an evidence-based KM programme for diabetes in primary care-to be introduced in this and other communities from 2018. CONCLUSIONS: Oral health is integral to diabetes management, and vice versa. Subsidized specialist referrals for oral-dental health care for Maori with T2DM could improve glycaemic control and diabetes outcomes and reduce diabetes-related complications among this population.

Associations between ethnicity and child health factors in New Zealand.

OBJECTIVES: To identify associations between material and behavioral factors in relation to health among Mäori, Pacific, and New Zealand European or other (NZEO) children in New Zealand. DESIGN: Cross-sectional using a two-stage random clustered sampling procedure. PARTICIPANTS: 3,275 children: 37.4% Mäori, 32.3% Pacific, and 30.3% NZEO. MAIN OUTCOME MEASURES: Prevalence of demographic, socioeconomic, food security, physical/lifestyle, dietary, and dental factors by ethnic group. RESULTS: Proportionally more Mäori and Pacific children, respectively, lived in large households, and approximately one quarter of each group had an annual household income < dollar 20,000. Approximately one fifth of Mäori and Pacific households respectively relied on food banks when they did not have enough money for food, and more Pacific household occupants felt stressed when food could not be provided for social occasions. A higher proportion of Pacific children were obese. Approximately 40% of Mäori and NZEO children did not play physically active games, and almost four fifths of Mäori children had watched television every night the previous week. A higher proportion of Pacific children ate breakfast on the way to school or purchased their school lunch. More than half the Mäori and Pacific children had consumed a chocolate bar or soda > or = 4 times the previous month, and a higher proportion of Pacific children added sugar to hot beverages. Proportionally more Mäori children had received a restoration or experienced dental pain at night, and a higher proportion of Pacific children had received an extraction due to dental caries. CONCLUSIONS: Marked differences were found in material and behavioral outcomes in relation to child health when ethnicity was considered.

Sugar, dental caries and the incidence of acute rheumatic fever: a cohort study of Maori and Pacific children.

OBJECTIVE: To determine whether dental caries, as an indicator of cumulative exposure to sugar, is associated with the incidence of acute rheumatic fever and chronic rheumatic heart disease, in Maori and Pacific children aged 5 and 6 years at their first dental visit. MATERIALS AND METHODS: A cohort study was undertaken which linked school dental service records of caries with national hospital discharge and mortality records. Cox models were used to investigate the strength of the association between dental caries and rheumatic fever incidence. RESULTS: A total of 20 333 children who were free of rheumatic heart disease at enrolment were available for analysis. During a mean follow-up time of 5 years, 96 children developed acute rheumatic fever or chronic rheumatic heart disease. After adjustment for potential confounders, children with five or more primary teeth affected by caries were 57% (95% CI: 20% to 106%) more likely to develop disease during follow-up, compared to children whose primary teeth were caries free. The population attributable to the risk for caries in this cohort was 22%. CONCLUSIONS: Dental caries is positively associated with the incidence of acute rheumatic fever and chronic rheumatic heart disease in Maori and Pacific children. Sugar intake, an important risk factor for dental caries, is also likely to influence the aetiology of rheumatic fever.

Exploring factors that influence child use of dental services and toothbrushing in New Zealand.

OBJECTIVES: To explore factors contributing to dental service use and toothbrushing among Mäori, Pacific and New Zealand European or Other (NZEO) children in New Zealand. METHODS: Data were obtained from the 2002 National Child Nutrition Survey. Models representing demographic, socio-economic status (SES), lifestyle, dietary, food security and oral health paradigms were tested using logistic regression. RESULTS: Mäori and Pacific children were more likely to not attend for dental care (OR: 1.99 and 2.05 respectively) than NZEO children when age, sex and time lived in New Zealand were accounted for. The addition of household (OR: 1.93 and 2.05 respectively) or lifestyle (OR: 1.95 and 1.81 respectively) factors resulted in minimal OR changes for Mäori or Pacific child dental attendance, whereas addition of dietary (OR: 1.44 and 1.23 respectively) and food security (OR: 1.43 and 1.32 respectively) items reduced the ORs of Mäori and Pacific child dental attendance so they no longer differed significantly to NZEO children. Addition of dental factors increased the ORs of Mäori and Pacific children not utilizing dental services compared with NZEO children (OR: 2.30 and 2.13 respectively). Mäori and Pacific children were more likely to not brush teeth (OR: 3.86 and 1.49 respectively) than NZEO children when age, sex and time lived in New Zealand were accounted for. Addition of dietary factors resulted in a 36% OR reduction of Mäori children not brushing (OR: 2.57), while addition of household SES (OR: 1.06), lifestyle (OR: 1.14), dietary (OR: 0.71) or food security factors (OR: 1.19) reduced the ORs of Pacific children so they were no longer significantly different to NZEO children. CONCLUSIONS: Mäori and Pacific children were more likely to have not received dental care (variance largely explained by dietary and food security factors) and Mäori children were more likely to not brush their teeth (variance largely explained by dietary items) than NZEO children.

Predictors of dental pain and general anesthetic receipt for hospital dental procedures among New Zealand children.

OBJECTIVES: To predict experience of dental pain and hospital dental general anesthetic receipt among Mäori, Pacific and New Zealand European or Other (NZEO) children in New Zealand. METHODS: Data were from the 2002 National Child Nutrition Survey. Models representing demographic, socio-economic status (SES), lifestyle, dietary, food security and oral health paradigms were tested using logistic regression. RESULTS: Some 3275 children participated; 37.4% Mäori, 32.3% Pacific and 30.3% NZEO. Mäori children had higher odds of dental pain experience than NZEO children after adjusting for age, sex and length of time lived in New Zealand and with addition of household SES or physical factors. There were no differences in Pacific and NZEO child dental pain experience when the same factors were accounted for. The prevalence of dental general anesthetic receipt was similar among Mäori, Pacific and NZEO children after adjusting for demographic, lifestyle, dietary, food security and dental factors in separate models. When such factors were investigated together, Pacific children were less likely to have received a dental general anesthetic than NZEO children. CONCLUSIONS: Mäori children were more likely to experience dental pain and Pacific children were less likely to have received a dental general anesthetic than NZEO children after accounting for various behavioral and material factors. The latter may reflect issues pertaining to access and culturally insensitive services rather than demand for care per se.

Child use of dental services and receipt of dental care in New Zealand.

AIM: To examine dental service use and dental care receipt by a range of factors among Maori, Pacific and New Zealand European or Other children in New Zealand. METHODS: Data were from the 2002 National Children's Nutrition Survey. Bivariate associations were calculated between three dental service use and dental care receipt measures, and 48 personal characteristics in five domains. Analyses took into account the complex sampling design. RESULTS: Some 3275 children participated; 37.4% Maori, 32.3% Pacific and 30.3% New Zealand European or Other. Irregular dental attendance was associated with children who were 11-14 years, Pacific, had not always lived in New Zealand, lived in rented accommodation, frequently watched television, consumed breakfast on the way to school, purchased lunch, consumed sugar-containing products or had food security issues. A higher proportion of children who were aged 11-14 years, Maori, had low household income, lived with 4+ children, regularly watched television, consumed breakfast on the way to school, frequently consumed high-sugar foods, had food security issues, experienced dental pain at night or had received dental care under a general anaesthetic had received a restoration. Extraction receipt was associated with children who were Pacific, had low household income, had a disability, purchased their lunch, regularly consumed high-sugar-containing products, had food security issues, had experienced dental pain at night or received dental care under a general anaesthetic. CONCLUSIONS: Material and behavioural factors all play a role in New Zealand child use of dental services and receipt of dental care.