Primary teeth trauma and socioeconomic status

Dental caries and periodontal problems are strongly associated with socioeconomic status. Studies on traumatic dental injury however have found no such association although there is less agreement on whether this is also the case in the primary dentition. The aim of this review was to assess the association between socioeconomic indicators and traumatic dental injury (TDI) in primary teeth.

Methods

Searches were conducted in the PubMed, ISI, LILACS, Cochrane Library, and Embase databases. Epidemiological studies (cross-sectional, case–control, cohort, clinical trials) addressing possible associations between socioeconomic indicators and TDI in primary teeth were considered. Two reviewers conducted study selection independently. Study quality was also assessed by two reviewers using the Newcastle-Ottawa Scale (NOS). Meta-analysis was undertaken.

Results

16 studies (15 cross-sectional studies and one cohort study) were included.
The following socioeconomic indicators were investigated:
- Parents’ schooling
- Parents’ employment status
- Home ownership
- Having changed address in the previous year
- Income
- Family structure
- Number of residents in the home
- Number of children in the family
- Type of school
- Socioeconomic status
Meta-analysis was carried out for 4 indicators

Indicator	No. of studies	Subgroup	Odds ratio (95% CI)
Socioeconomic status	5
		High vs low	0.77 (0.43–1.36)
		High vs medium	1.03 (0.72–1.48)
		Medium vs low:	0.70 (0.42–1.19)
Parents’ schooling	5	Mothers	0.89 (0.74–1.08)
		Fathers	1.01 (0.62–2.74)
Home ownership	2		1.28 (0.98–1.66)
Income	8	More than 2X average salary	0.77 (0.66–0.90)
		More than 3x average salary	0.76 (0.65–0.89)

Conclusions

The authors concluded: –

The scientific evidence indicates no association between socioeconomic indicators and TDI. The association between a low income and the occurrence of TDI in the present systematic review is weak and doubtful. Prospective observational studies are needed to address this issue further.

Comments

Searches were conducted in a broad range of databases for studies to address this question and, while 16 studies have been identified, all but two of the studies were undertaken in Brazil, so the findings may not be generalisable a point noted by the authors in their discussion. While the data for income suggest that income of more then twice or 3 times the average were slightly protective of TDI, the authors caution over interpretation owing to subjectivity in the cut off values used in various studies.