Prevalence and socio-economic disparities in fissure sealant placement among adolescents in the Limpopo Province, South Africa.

OBJECTIVES: This study investigated socio-economic factors associated with the placement of fissure sealants in a population of South African adolescents. METHOD: The study participants were high school students aged 12 to layers who provided baseline data during 2005 in a tobacco-use prevention trial, and consented to oral examination (n=1103). Information was obtained using a self-administered survey questionnaire, including demographic data, data on oral health behaviour, the employment status of parents/guardians, and the family structure of the household and on health insurance enrolment. The main outcome measure was the presence of a fissure sealant on any tooth, recorded using the WHO oral examination protocol. Data were analysed using chi-square statistics and multiple logistic regression analysis (p<0.05). RESULTS: Overall, only 3.5% (n=37) of the study participants had a fissure sealant, and only 31.3% (n=345) had ever made a dental visit. Those who had attended seeking mostly preventive care were significantly more likely to have a fissure sealant than those who had visited mostly when they were in pain (14.2% vs. 2.9%; p<0.001). In the multi-variable adjusted analysis, those reporting to have parents who are both employed (OR = 2.76; 2.26 - 3.38), and reporting regular preventive dental visits (OR = 3.55; 2.28 -5.58) were positively associated with receiving fissure sealant, while those who self-identified as black (OR = 0.04; 0.01 - 0.13), were significantly less likely to present with a fissure sealant as compared with other ethnicity/race groups. CONCLUSIONS: Higher socio-economic status and regular access to preventive care were significantly associated with the placement of fissure sealants in the studied population.

Socio-economic inequities in dental caries experience of 12-year-old South Africans: policy implications for prevention.

OBJECTIVES: To examine the socioeconomic inequities in dental caries experience of 12-year-olds, in order to inform policy actions for caries prevention in South Africa. METHODS: Secondary analysis of the 1999-2002 national survey data of 12-year-olds (N=5411), available from 37 regions in 7 of the 9 provinces, was carried out. Logistic regression was used to determine risks for caries experience among 12-year-olds in each province, using parental occupation and racial group as independent variables. Regression curve-estimation was used to examine the spatial relationship between mean DMFT and caries prevalence. RESULTS: The mean DMFT (+/-SD) for the study population was 1.19 (+/-2.13), significant caries index was 3.35 and caries prevalence was 40.1%. The highest mean DMFT was among the Coloured population (2.14+/-2.50). Compared to children in the highest occupational class, the risk for children of the unemployed to experience caries was lower in the North West province (Odds ratio [OR]=0.47; p<0.01), but significantly higher in the coastal provinces-- KwaZulu-Natal and Northern Cape, with OR of 1.32 and 1.52 respectively. The regression curve derived demonstrated that a unit increase in caries experience in low-level caries populations would generate more cases than similar increase in high-level caries populations. CONCLUSIONS: DMFT alone provided an incomplete picture of the impact of caries in South Africa, thus the need to monitor inequities as part of policy impact. The distribution of caries suggests that 'high-risk' approach to prevention in the presence of existing social gaps may inadvertently reinforce inequities in caries-burden and supports the concurrent implementation of population-approach, such as water fluoridation.

Fluoride concentration of bottled drinking waters.

The use of bottled water and beverages may be a significant source of systemic fluoride and can therefore be considered as a risk factor for dental fluorosis in young children. The aim of this study was to determine the fluoride content of commercially available bottled drinking waters and to report on the accuracy of the labelling of fluoride concentration. Thirty brands of bottled water, classified as either spring (N = 19) or mineral (N = 11) water were evaluated. A fluoride ions-elective and a fluoride reference electrode were used to measure the fluoride concentrations. The average reading for each brand was compared with the fluoride content printed on the label. Only 56.7% (N = 17) of brands tested mention the fluoride concentration on the label, but 73.3% (N = 22) had a tested fluoride concentration of less than 0.3 ppm. Of the 8 brands testing higher than 0.3 ppm fluoride, 1 did not have the fluoride concentration labelled, while for another the tested fluoride concentration was much higher than the concentration printed on the label. When prescribing fluoride supplements, dentists should be aware of the fluoride content of bottled waters used by child patients, especially brands with a concentration higher than 0.3 ppm.

Prevalence and pattern of snuff dipping in a rural South African population.

The contradictory results of earlier studies on the role of snuff in the aetiology of oral cancer may be due to the heterogeneous composition of snuff and to regional and cultural differences in its use. The aim of this study was to determine the prevalence and pattern of use of oral snuff in a rural South African adult population, and to report on associated oral lesions. A structured questionnaire was administered by means of face-to-face interviews with a population of 30 randomly selected households (125 adults over the age of 30 years). Of the respondents, 20.8% were active oral snuff-dippers and 80.8% of them had never visited a dentist before. There was no significant difference between the genders of the dippers (P > 0.05). The mean age of dippers was 62.7 years. None of the snuff-dippers chewed or smoked tobacco, but 38.5% used alcohol. Mean dipping period was 21.5 years, for about 2 hours per day and an average of 35 minutes per dip. Of the snuff-dippers, 84.6% place their snuff in the lower labial sulcus and 15.4% in the lower buccal sulcus, 80.8% of the dippers demonstrated keratotic lesions at the site of placement. The clinical severity of the lesions was significantly associated with the brand of snuff used (P < 0.01). The high prevalence of snuff dipping and associated lesion in many of the elderly that had never visited a dentist before highlights the importance of regular screening of this group at risk.