RESUMO
OBJECTIVES: The present study assessed whether living in a conflict zone and in internally displaced person (IDP) camps were associated with the number of untreated caries in primary, permanent and all teeth in Libyan children and whether these associations differed by parents' educational attainment. METHODS: Cross-sectional studies were conducted in Benghazi, Libya, in 2016/2017 during the war and in 2022 after the war including children in schools and in IDP camps in the same setting. Self-administered questionnaires and clinical examinations were used for data collection from primary schoolchildren. The questionnaire collected information on children's date of birth, sex, level of parental education and school type. The children were also asked to report on how often they consumed sugary drinks and whether they brushed their teeth regularly. In addition, untreated caries in primary, permanent and all teeth were assessed according to World Health Organization criteria at the dentine level. Multilevel negative binomial regression models were used to assess the relation between dependent variables (untreated caries in primary, permanent and all teeth) and living environment (during and after the war and living in IDP camps) and parental educational attainment adjusted for oral health behaviours and demographic factors. The modifying effect of parental educational attainment (no, one and both parents university educated) on the association between living environment and the number of decayed teeth was also assessed. RESULTS: Data were available from 2406 Libyan children, 8-12 years old (mean = 10.8, SD = 1.8). The mean (SD) number of untreated decayed primary teeth was 1.20 (2.34), permanent teeth = 0.68 (1.32) and all teeth = 1.88 (2.50). Compared to children living in Benghazi during the war, children living in the city after the war had significantly greater number of decayed primary (adjusted prevalence ratio [APR] = 4.25, p = .01) and permanent teeth (APR = 3.77, p = .03) and children in IDP camps had significantly greater number of primary teeth (APR = 16.23, p = .03). Compared to children whose both parents were university-educated, those with no university-educated parents had a significantly greater number of decayed primary teeth (APR = 1.65, p = .02) and significantly less number of decayed permanent (APR = 0.40, p < .001) and all teeth (APR = 0.47, p < .001). There was a significant interaction between parental education and living environment in the number of all decayed teeth in children who lived in Benghazi during the war: children whose both parents were non-university-educated had significantly less number of all decayed teeth (p = .03) with no interaction effect in those living in Benghazi after the war or in IDP camps (p > .05). CONCLUSION: Children living in Benghazi after the war had more untreated decay in primary and permanent teeth than children during the war. Having parents with no university education was associated with greater or less untreated decay depending on the dentition. These variations were most pronounced among children during the war in all teeth with no significant differences in after-war and IDP camps groups. Further research is required to understand how living in war environment influenced oral health. In addition, children affected by wars and children living in IDP camps should be identified as target groups for oral health promotion programs.
