Inequalities in dental caries: the role of NMES intake

Introduction: Dental caries is one of the most prevalent diseases of childhood in the UK, with a disproportionate burden experienced by the most disadvantaged groups. Non-milk extrinsic sugar (NMES) intake, poor oral hygiene and acidogenic bacteria are considered the main risk factors for caries, however, their role in explaining the observed inequalities has not been fully explored. The aim of the study is to assess the extent to which these factors explain the socio-economic (SES) inequalities in caries.

Methods: Data on treatment for decay (caries), SES (Scottish Index of Multiple Deprivation (SIMD)), NMES intake and oral hygiene was obtained from 1491 children participating in the Survey of Sugar Intake among Children in Scotland (3?17?years). Logistic regression models assessed the impact on the Caries-SES relationship of NMES intake and oral hygiene. A priori interactions tests were performed. 
Results: 54% of children had caries and there was a strong SES gradient (p<0.001). The OR [95% CI] for caries in the most deprived vs least deprived groups was 3.9 [2.8 to 5.5], and increased slightly when adjustments were made for NMES intake and oral hygiene (AOR [95% CI] =4.3 [2.9 to 6.3]). There was no evidence of an interaction between NMES intake/Oral hygiene, SES and caries (p=0.4; p=0.7).

Conclusions: The SES patterning of caries is not attenuated by NMES intake and/or oral hygiene. Further work is required to explore alternative pathways to explaining the observed inequalities in oral health and may focus on the interaction between diet and acidogenic bacteria.