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Social Inequalities in Health Mark the Differences in the Extent and Severity of Dental Caries Among 12 year-old Students
Probably because of inequalities in health, tooth decay is present in areas of endemic fluorosis, despite the known and expected role of fluoride in strengthening the tooth against acid produced by bacteria.
By Daouda Cisse
Jan. 27, 2016

In a recent article, Dr. Daouda Cisse, showed that tooth decay is present in areas of endemic fluorosis in Senegal. This presence of caries is due to the fact that the only fluorine can not guarantee a good caries prevention. It has been proven that for a good prevention of tooth decay, it is necessary, to control his eating sweets consumption, to have good dental hygiene by properly cleaning the mouth after food intake, to meet the dentist systematically and regularly during the year, and finally to properly use fluorine. These preventive practices depend largely on the socio-educational, economical and cultural environment of the children and children's parents. The children whose parents have little means to regularly buy their toothbrushes will (all things being equal) be most affected by caries than children whose affluent parents. Differences in children about socio-educational, economical and cultural environment, could be reconciled with the types of schools that children attended.

In this paper, Dr Cisse said : « All the students in the 3 types of schools were not differently affected by fluorosis »

But « the prevalence of dental caries was significantly higher in Franco-Arab schools than in confessional and public schools. This is due, in part, to the integration of oral hygiene teaching in public and confessional schools programs ».He added :« the prevalence would be associated with eating habits of school children who consume more sweets without adequate oral hygiene measures ». He showed that the prevalence of caries found in this study was relatively low because of the presence of fluoride in the waters of Kaolack city. Indeed, when fluorides stick to the enamel, they replace hydroxyl groupings and produce fluorapatite which is more resistant to dissolution by acid than hydroxyapatite and this, in some way, prevents dental caries.

The results showed that the mean DMF index consisted of more than 98% of decayed teeth and only 0.4% of filled teeth, reflecting low visits to dental practices by students. Therefore, Dr Cisse suggested that the use of modern treatments is not systematic during dental pain and self-medication are probably done. He noticed : « DMFt index was higher in Franco-Arab schools where students were almost twice as severely affected as those in public schools ». The analysis that can be made of these results may be economical or cultural because students who attended private schools were generally from rich families who tended to receive from their parents enough money to buy cariogenic foods and snacks; children who studied in public schools had cheaper meals generally low in fermentable sugar; the gap between the severity of caries between Franco-Arab school students, on the one hand, and confessional religious and public school students, can be explained by cultural reasons. So the assumption that Franco-Arab school students are more severely affected by tooth decay because they are less sensitised to oral hygiene measures than confessional and public school students seems plausible.

Dr Cisse goes on to suggest thatbecause students are equally affected by dental fluorosis, the differences are probably in oral health that stem from economic, social and cultural inequalities that authorities must face through community programs of prevention and promotion of oral health.

Lead Author:

Dr D. Cisse, PhD, , Public Health Service, Department of Odontology, Faculty of Medecine, Pharmacy and Dentistry, University Cheikh Anta Diop, Dakar, Senegal

A paper about the study appeared recently in

Science Journal of Public Health

ISSN: 2328-7942 (Print); ISSN: 2328-7950 (Online)

Paper link:

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