Racial comparison of oral health in United States school children: Validity of the outcome measures and predictors of disease

Objectives. This study investigated the relationship between race and coronal caries outcome measures in non-Hispanic schoolchildren 5 to 17 years of age who participated in a clinical examination in the 1986--1987 National Survey of Oral Health in United States School Children. The following were specific aims of this study: (1) To study racial variation in sources of measurement bias in oral disease indexes, namely dental maturation and tooth-surfaces excluded from and included in the coronal caries outcome measures; (2) To assess the effects of the use of preventive services and treatments on coronal caries in non-Hispanic Black and non-Hispanic White children by comparing different exposures to fluoride and the use of dental sealants; (3) To assess the relationship between race and the coronal caries prevalence when the joint effects of sociodemographic characteristics, disease preventions, and measurement biases are taken into account.;Methods. The source of the data for this study was the National Survey of Oral Health in United States School Children conducted by the National Institute of Dental Research during the 1986--87 school year. In this research, 13,791 non-Hispanic Black and non-Hispanic White schoolchildren who had lifetime or no exposure to community water fluoridation were studied. Bivariate statistical methods were employed to examine the association between: (1) race and various independent variables or predictors and (2) race and multiple outcome measures. Logistic and multiple regression models were used to assess the relationship between race and coronal caries outcomes when the joint effects of sociodemographic characteristics, disease prevention factors, and dental maturation were taken into account.;Results. The study provides evidence that the dental age (maturation) of Black children was older than that for White children of similar chronological age. The hypothesis that non-Hispanic Black children were significantly less likely than non-Hispanic White children to have access to oral health care was supported also. In particular, Blacks were less likely to use those disease prevention regimens that were associated with dental office visits---supplemental fluorides and dental sealants. On the other hand, Black children were more likely to have access to community-based disease preventions---public water fluoridation and school-based fluoride program, although chance variation could not be ruled out. When disease prevention regimens and dental maturation factors were taken into account, along with sociodemographic characteristics, consistently Black children had less favorable coronal caries experience than White children had.;Among children who had a coronal caries experience, there was a clearer pattern of excess coronal caries in Blacks than that observed in Whites, regardless of which outcome measure was used. Furthermore, this disparity was independent of the controls for the confounders. The DMFS score indicated an even greater racial disparity than that observed in the total population. Blacks had a significantly higher DMFS score than Whites, irrespective of any adjustments. Also in this population, racial variations in untreated decay, tooth-extractions, and tooth-surface restoration were supported. The significant disadvantage for Blacks, compared to Whites, persisted after controlling for indicators of access to care, although the disparity was diminished. (Previous studies have attributed this disparity to the lack of access to dental care). The percentages of the total DMFS score that were untreated (DS/DMFS) or restored (FS/DMFS) showed this same picture. The weighted index was consistently higher in Blacks than it was in Whites, with or without adjustments for any of the other factors. (Abstract shortened by UMI.).