On Oral Health in Young Individuals with a Focus on Sweden and Vietnam : A Cultural Perspective

Sammanfattning: AIM: The overall aim of this thesis was to study culture as an oral health determinant for dental caries and gingivitis in children living in Jönköping, Sweden, in relation to children living in Da Nang, Vietnam.MATERIALS AND METHODS: In 1993 and 2003, cross-sectional studies with clinical examinations and questionnaires were performed in Jönköping, Sweden, with a random sample of 130 children from each of four age groups; 3, 5, 10 and 15 years. The final study sample comprised 739 children, 154 (21%) with two foreign-born parents and 585 (79%) with two Swedish-born parents (Paper I). In 2000, all 15-year-olds (n=143) at one school in Jönköping, Sweden, were asked to participate in a questionnaire study connected to clinical data. The final sample comprised 117 individuals, 51 (44%) with foreign-born parents and 66 (56%) with Swedish-born parents (Paper II). In 2008, a cross-sectional study with clinical examinations and questionnaires was performed in Da Nang, Vietnam with 840 randomly selected children, 210 in each of four age groups; 3, 5, 10 and 15 years. The final sample comprised 745 individuals (Papers III and IV).RESULTS: In 2003, the mean number of decayed (initial and manifest) and filled tooth surfaces was significantly higher in all age groups in children with foreign-born parents compared with children with Swedish-born parents. The gap between children with foreign-born parents and Swedish-born parents increased over the ten-year period from 1993 to 2003. The odds ratio of dental caries development among 10- and 15-year-old children with foreign-born-parents was more than six times higher than for their counterparts with Swedish-born parents (Paper I). Fifteen-year-olds born in Sweden of foreignborn parents and those who had immigrated before one year of age had a caries prevalence similar to 15-year-olds with Swedish-born parents, whereas the caries prevalence in children who had immigrated to Sweden after 7 years of age was 2-3 times higher (Paper II). Among the 3- and 5-year-olds in Vietnam, 98% suffered from dental caries, compared with 91% of 10- and 15-year-olds (Paper IV). The distribution of the most frequent values of decayed and filled primary tooth surfaces (dfs) in 5-year-olds was 16–20, and of decayed and filled permanent tooth surfaces (DFS) in 15-year-olds was 1–5. The maximum dfs was 76–80, and significant numbers of children had dfs between 20 and 50. The percentage of tooth sites with plaque and gingivitis was higher for children in all age groups with foreign-born parents compared with children with Swedish-born parents, except among the 15-year-olds in 2003. In Vietnam, the prevalence of plaque and gingivitis was high in all age groups, especially in 10- and 15-year-olds. Fifteen-yearolds in Sweden with foreign-born parents had a higher intake of snack products between principal meals compared with 15-year-olds with Swedish-born parents (Paper II). In Sweden, most children in all age groups brushed their teeth themselves or with help from their parents twice or more than twice a day (Paper I). Among 3- and 5-year-olds in Vietnam, about half of the parents reported that their children brushed their teeth themselves or with help from parents twice or more than twice a day (Paper III). All 3-year-olds and 99% of 5-year-olds in Sweden brushed their teeth with fluoride toothpaste (Paper I). Among 15-year-olds in Sweden with foreign-born parents, 88% reported that they brushed their teeth with fluoride toothpaste at least twice a day compared with 98% of 15-year-olds with Swedish-born parents (Paper II). In Vietnam, 44–78% of the children used fluoride toothpaste for toothbrushing and 51% consumed sweets between principal meals at least once a day (Paper III). Sweetened milk was the most common source of this sugar intake for the 3- and 5-year-olds (Paper III).CONCLUSIONS: Culture is an important oral health determinant for dental caries and gingivitis in children. There is an urgent need to improve oral health care promotion and preventive programmes for children with foreign-born parents in Sweden, but also a great need for such programmes for children in Vietnam.