The Effects of Socioeconomic Status, Parental Education Level, Oral and Dental Health Practices, Dietary Habits and Anthropometric Measurements on Dental Health in 12-Year-Old School Children


 Background

Dental caries is the most common progressive chronic disease in school-age children with an increasing prevalence as children grow up. This study aims to examine the effects of socioeconomic status, parental education level, oral and dental health practices, dietary habits and anthropometric measurements on dental health in 12-year-old schoolchildren.
Methods

The sample of the study consisted of 254 children (44.1% boys and 55.9% girls) in three schools, which were identified as low, moderate and high socioeconomic status.
Results

It was found that 70.9% of the children have dental caries on their permanent teeth. The frequency of seeing a dentist, the status of receiving oral and dental health education and the frequency of changing toothbrush vary according to the socioeconomic status. Oral and dental health indicators were determined to be affected by the frequency and duration of tooth brushing. It was found that dmft values of the children consuming molasses and table sugar are higher. There is a negative correlation between oral and dental health indicators and anthropometric measurements and parental education level.
Conclusions

Dietary habits, anthropometric measurements, oral and dental health practices, gender, and parental socioeconomic status and education level were shown to be effective on caries risk.


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not included in the examination for milk teeth. The dental caries levels of the children were determined using WHO classi cation based on the means DMFT and dmft (< 1.2 "very low", 1.2-2.6 "low", 2.7-4.4 "moderate", 4.5-6.5 "high", and > 6.5 "very high") (WHO, 2013). SPSS (Statistical Package for the Social Sciences) package program was used to analyze the data. Chi-Square and Fisher's Exact Chi-Square tests were performed to determine whether there was a signi cant relationship between qualitative variables. Spearman Correlation was used to determine the relationship between the factors affecting oral and dental health indicators. Statistical signi cance was evaluated at p < 0.01 and p < 0.05. The con dence interval for all statistical tests was adopted as 95.0%.

Results
A total of 254 12-year-old children (44.1% boys and 55.9% girls) participated in the study. It was found that 70.9% of the children have dental caries on their permanent teeth and 44.1% of them have at least one caries on their milk teeth. Moreover, it was found that the number of girls who have caries on their permanent teeth and boys who have caries on their milk teeth is higher (p < 0.05). dmft and dmfs indices were found to be very low in 47.2% and 75.2% of the children, respectively. It was discovered that low DMFT rates (girls 20.5%, boys 9.8%) were higher in girls and high dmfs rates (girls 2.1%, male, 9.8%) were higher in boys (p < 0.05) ( Table 1). It was found that nearly all of the children brush their teeth (96.1%) and the number of those who do not brush their teeth (7.9%) is higher among ones the with low socioeconomic status (p < 0.05). 34.3% of the students reported that they brush their teeth once a day and 21.7% reported they sometimes brush their teeth. The number of those who brush their teeth several times a week (10.1%) is higher among the ones with moderate socioeconomic status and the number of those who brush their teeth three times a day (6.3%) is higher among the ones with high socioeconomic status (p < 0.05). Nearly half of the children (49.2%) stated that they rst saw a dentist at the age of 6-10 and 14.2% reported that they have never seen a dentist. It was found that the number of those who see a dentist 1-2 times a year (30.0%), have previously received oral and dental health education (65.6%) and change their toothbrush every three months (43.8%) is higher among the ones with high socioeconomic status (p < 0.05). It was discovered that 39.0% of children have harmful oral and dental health habits in which lip bite (62.6%) is the leading ( Table 2).   It was discovered that there is a negative relationship between waist-to-height ratio and FT; between waist circumference and FT and DMFT; between hip circumference and DMFT (p < 0.05). It was also found that there is a negative relationship between dt and Body Mass Index, hip circumference, upper middle arm circumference, biceps skinfold thickness and triceps skinfold thickness (p < 0.01); and between ft and hip circumference (p < 0.05). There is a negative relationship between dmft and Body Mass Index, waist circumference, hip circumference, upper middle arm circumference, biceps skinfold thickness and triceps skinfold thickness (p < 0.01). It was obtained that socioeconomic status is correlated with DT and DMFT negatively; and with FT positively (p < 0.01). Maternal education level was correlated with DT (p < 0.01), MT (p < 0.05) and DMFT (p < 0.05) negatively; and with FT positively (p < 0.05). It was also found that there is a negative relationship between paternal education level and DT (p < 0.01), MT (p < 0.05) and DMFT (p < 0.01). It was determined that there is a negative relationship between dt and dmft and socioeconomic status, maternal and paternal educational status (p < 0.05) ( Table 5).

Discussion
The present study was conducted with a total of 254 12-year-old children (112 boys, 142 girls) enrolled in three different middle schools (high, moderate and low socioeconomic status) to examine the effects of socioeconomic status, parental education level, oral and dental health practices of children, dietary habits and anthropometric measurements on oral and dental health.
Oral and dental health in school-age children totally depends on oral hygiene behavior of children and their parents, dietary habits, parental education level, socioeconomic status, regular dental examination, adequate uoride supplementation, oral micro ora, age and other demographic and cultural characteristics (Koposova et al., 2010;Koksal et al., 2011;Bafti et al., 2015). It is stated that families with high socioeconomic status behave more conscious about their children's dental health (Akinci, 2008). In this study, it was shown that factors affecting oral and dental health, such as tooth brushing practices, age and frequency of seeing a dentist and oral and dental health education vary by the one's socioeconomic status. Oral and dental health practices were found to be better in the children of families with high socioeconomic status (Table 2). Similarly, in other studies, children with high socioeconomic status are more likely to see a dentist (Edelstein, 2002;Adeniyi et al., 2016) and to have higher rates of regular brushing (Adekoya-Sofowora et al., 2006). The fact that children from higher-income households have more chances to access to dental care, including a more speci c diagnostic assessment and have one or more lled teeth explains the difference in oral and dental health by the ones' socioeconomic status. Higher prevalence of caries in lower socioeconomic status may be due to lack of prevention and treatment services most of the time.
Oral and dental diseases are seen different rates in every society and ages. The World Health   Adeniyi et al., 2016). It is stated that the prevalence of caries may be higher due to the earlier ages for dentition in girls and the emergence of periodontal problems due to hormonal changes in puberty period (Akinci, 2008).
Since dental caries has a multifaceted etiology including general health, nutrition, plaque, saliva secretion, type and amount of microorganism, sensitivity of host, oral hygiene habits, use of uoride, social and behavioral factors, any relationship between oral and dental hygiene practices and caries is di cult to be detected (Karadas et al., 2007). In this study, it was found that the indicators for milk teeth of those who have higher tooth brushing time and frequency are better (p < 0.05) ( Table 3). Proper oral and dental hygiene is also effective in preventing many diseases that are not associated with caries. The most common diseases such as caries and periodontal diseases are caused by poor oral hygiene practices as well as other factors (Ljaljević et al., 2012), children are imported to be educated in subjects such as brushing style, duration, frequency etc.
Dietary habits play an important role in general health status and oral health. In one study, the predominant factor in caries risk pro le was shown to be diet (Amila et al., 2007). In this study, the mean DMFT\dmft values of the children consuming foods with high cariogenic potential were determined likely to be high (Table 4). In a study conducted to examine the effect of backward dietary habits of children on dental health, those who consumed foods increasing the risk of dental caries more than three times a day at the age of one and those who consumed candy more than once a week at the age of three were found to have higher number of decayed and lled teeth at the age of fteen (Alm et al., 2008). The negative relationship between nutritional status and caries is explained by main meals and snacks. Main meals are stated to contain higher protein and fat and lower sugar than snacks so that snacks are associated with caries. While being exposed to sugary and starchy foods during meals reduces the risk of caries, it was revealed that high sugar consumption with snacks increase such risk (Narksawat et al., 2009). have an unbalanced diet with low nutritional value and high sugar and energy content are often affected by both malnutrition and caries. In addition, it is stated that there is a positive relationship between obesity and dental caries with increasing food and re ned food consumption and consumption frequency. Therefore, it was investigated whether there is a causal relationship between dental diseases and anthropometric measurements or whether they share the same risk factors (Hafez, 2017). In this study, a negative relationship was found between anthropometric measurements and oral and dental health indicators (Table 5) body weight. The di culty in studying the relationship between dental caries and obesity is due to the fact that many factors need to be measured at the same time in a standard way (Almerich-Torres et al.,

2016).
Socioeconomic factors have become increasingly scrutinized in studies as they affect the prevalence of dental caries, oral health practices, and parental knowledge on oral and dental health (Popoola et al., 2013;Kato et al., 2017). In this study, it was determined that socioeconomic status and parental education level are related to oral health indicators (Table 5) Consequently, it was revealed in this study that dietary habits, anthropometric measurements, oral and dental health practices, gender, parental socioeconomic and education levels are effective on caries risk. It is recommended that children and parents with low socioeconomic status should be given education on oral and dental health practices and guidance to dental care services should be increased. Regulation of dietary habits of children is considerable both for anthropometric measurements and prevention of dental caries. In assessing the effect of dietary habits on dental health, the amount and frequency of consumed foods should be examined in more detail.