Dental caries, tooth wear and dietary sugar intake in a sample of Northland Māori.

Abstract

Background In New Zealand, there are well known disparities in oral health between different ethnicities and groups with different socioeconomic status. It has been recently shown that Māori are 1.8 times more likely to be higher daily consumers of sugar-sweetened beverages and food (SSB and SSF) in comparison to their European counterparts. Excessive intake of dietary sugar as well as carbonated drinks can have consequences on oral health, such as caries and tooth wear, but also broader implication for overall health. The aims of this study were: 1) to describe self-reported oral hygiene, caries experience, tooth wear and dietary sugar intake in a Northland Māori sample; and 2) to investigate for possible associations between dental health and consumption of SSB/SSF. As whanau ora is an important aspect of Māori health, families were investigated as a unit.

Methods A pilot study was designed as cross-sectional, family aggregation study. Forty-three Māori families (41 parents and 90 children) residing in Northland, New Zealand were recruited from three primary health care services. The study participants were firstly asked to fill in a questionnaire on self-reported oral hygiene, dental health, jaw habits, dental care service utilisation, and sweet beverages and food frequency consumption. Participants underwent a clinical dental examination, received an intraoral scan, and finally provided a hair sample for an objective measure of dietary sugar consumption (13C). Oral hygiene was measured using Greene’s simplified oral hygiene index (OHI-S). Dental caries experience was assessed using the Decayed Missing Filled Teeth Index (DMFT/dmft), while tooth wear was assessed by the Basic Erosive Wear Examination (BEWE). Data were analysed by a mixed model with DMFT/dmft and BEWE as response variables, adjusted for gender, OHI-S, and family member (parent versus child), and family cluster as random effect. Family pattern were investigated using intraclass correlation coefficients and scattergrams, as appropriate.

Results Some 95% of study participants lived in an area with high deprivation scores (NZDep=8-10), and about half of the parent sample reported an inability to see a dentist. Self-reported caries experience was high in parents, as the vast majority of them received dental restorations (90.2%) and tooth extractions (65.9%). Children reported brushing their teeth and having greater access to dental care services more often than parents. Tooth clenching/grinding were self-reported by over 30% of the parents and children samples, while almost 90% of them reported snacking between meals (i.e. grazing). Oral hygiene was fair in both parents and children (Mean OHI-S levels  1.3). The mean DMFT/dmft ( SD) for parents and children were 9.8 ( 5.6) and 2.3 ( 2.1), respectively. Tooth wear levels were mostly confined to enamel in both parents (BEWE=6.3  2.3) and children (4.3  2.7). Oral hygiene, as represented by OHI-S, was significantly associated with both DMFT/dmft (IRR=1.39; P=0.006) and BEWE scores (P=0.028). Sugar intake, as represented by SSB, SSF, and 13C hair content, was not significantly associated with DMFT/dmft and BEWE scores. Weak family patterns were identified for both caries experience and erosion (ICC  0.23).

Conclusion The small investigated sample had high deprivation scores and modest-to-low oral health. Caries experience and tooth wear were significantly associated with oral hygiene, but not with dietary sugar intake. A larger sample is needed to confirm this result. It is evident that oral health disparities still exist in New Zealand, and also affect Māori.