Oral Disease in Immigrant Children Attending a University Dental Clinic

Abstract

Background: One-quarter of American children are born into immigrant families facing high risks of dental disease and barriers to care. The aims of this study are to describe immigrant children’s oral health seeking care at a university pediatric dental clinic, to compare their level of dental disease with equivalent national levels utilizing the National Health and Nutrition Examination Survey (NHANES) and to assess preferences for behavior guidance techniques by region of origin. Methods: This retrospective longitudinal study utilized interpreter use as a proxy for recent immigrant status. Eligible participants were healthy new patients requesting examinations between 09/2010-09/2016. Patient data on demographics, visits characteristics, dental caries variables, and time elapsed between initial and last visit was collected at baseline and at last examinations. Two-sample t-tests and Fisher’s exact tests were utilized to evaluate differences within the sample and with NHANES data. Logistic regression with adjusted odds ratios (OR) and 95% confidence intervals (CI) was utilized to evaluate associations between region of origin and preferred behavior guidance techniques (p<0.05). Results: In our study population (N=285), the mean age of children was 5.8 years (SD: 2.6). Females represented 47.7% of the study population. Overall 97.5 % had public insurance. The majority were from Asia (40%) and Latin America (34.7%). Dental caries was present in 90.1% of children. At baseline visit, all age groups demonstrated over a 9-fold increase in the mean number of decayed teeth (dt, DT) compared to NHANES data (all p<0.001). At last visit, the mean dt and DT of children aged 12-19 years was not significantly different than NHANES data (p=0.09). After adjusting for confounding variables, preferences for restorative treatment under general anesthesia were significantly higher among Middle Easterners (OR=5.45;95%CI=1.36,21.91), Asians (OR=2.56;95%CI=1.22,5.37) and Latin Americans (OR=1.98;95%CI=1.02,3.82) compared to Europeans. Conclusion: Immigrant children receiving care at our university pediatric dental clinic start with a significantly high level of dental caries that declines over time when compared with national averages. Preferences for behavior guidance techniques, in particular general anesthesia, may vary by region and should be taken into consideration when discussing behavioral management techniques.