The aim of this study was to investigate potential differences in caries prevalence of children from ethnic minority groups compared to native Dutch children and the influence of socio-economic status (SES) and parent-reported oral health behaviour on this association. The study had a cross-sectional design, embedded in a population-based prospective multi-ethnic cohort study. 4,306 children with information on caries experience, belonging to 7 different ethnic groups, participated in this study. The decayed, missing, and filled teeth (dmft) index was assessed at the age of 6 and categorized in two ways for analysis: children without caries (dmft = 0) versus any caries experience (dmft >0) and children without caries (dmft = 0) versus children with mild caries (dmft = 1-3) or severe caries (dmft >3). Compared to native Dutch children, children with a Surinamese-Hindustani, Surinamese-Creole, Turkish, Moroccan, and Cape Verdean background had significantly higher odds for dental caries. Especially the Surinamese-Hindustani, Turkish, and Moroccan group had significantly higher odds for severe dental caries. Household income and educational level of the mother explained up to 43% of the association between ethnicity and dental caries, whereas parent-reported oral health behaviour did not mediate the association. Alarming disparities in caries prevalence between different ethnic (minority) groups exist, which cannot be fully explained by social inequalities. Public health strategies can apply this new knowledge and specifically focus on the reduction of ethnic disparities in oral health. More research is needed to explain the high caries prevalence among different ethnic minority groups.

Keywords:
Cross-sectional analysis, Dental caries, Epidemiology, Ethnicity, Paediatric dentistry, Public dental health, Socio-economic status
1.
Centraal Bureau voor de Statistiek: Jaarrapport Integratie 2014. http://www.cbs.nl/NR/rdonlyres/4735C2F5-C2C0-49C0-96CB-0010920EE4A4/0/jaarrapportintegratie2014pub.pdf.
2.
De Boer EJ, Brants HAM, Beukers M, Ocké MC, Dekker L, Nicolaou M, Snijder M: Voeding van Marokkaanse, Turkse, Surinaamse en autochtone Nederlanders in Amsterdam. RIVM Rapport 2015-0099 2015.
3.
Delgado-Angulo EK, Bernabé E, Marcenes W: Ethnic inequalities in dental caries among adults in East London. J Public Health (Oxf) 2016;38:e55-e62.
4.
Duijster D, de Jong-Lenters M, de Ruiter C, Thijssen J, van Loveren C, Verrips E: Parental and family-related influences on dental caries in children of Dutch, Moroccan and Turkish origin. Community Dent Oral Epidemiol 2015;43:152-162.
5.
Elfrink ME, Veerkamp JS, Aartman IH, Moll HA, Ten Cate JM: Validity of scoring caries and primary molar hypomineralization (DMH) on intraoral photographs. Eur Arch Paediatr Dent 2009;10:5-10.
6.
Fontana M, Santiago E, Eckert GJ, Ferreira-Zandona AG: Risk factors of caries progression in a Hispanic school-aged population. J Dent Res 2011;90:1189-1196.
7.
Gimenez T, Piovesan C, Braga MM, Raggio DP, Deery C, Ricketts DN, Ekstrand KR, Mendes FM: Visual inspection for caries detection: a systematic review and meta-analysis. J Dent Res 2015;94:895-904.
8.
Gishti O, Gaillard R, Felix JF, Bouthoorn S, Steegers E, Raat H, Hofman A, Duijts L, Franco OH, Jaddoe VW: Early origins of ethnic disparities in cardiovascular risk factors. Prev Med 2015;76:84-91.
9.
Guarnizo-Herreño CC, Wehby GL: Explaining racial/ethnic disparities in children's dental health: a decomposition analysis. Am J Public Health 2012;102:859-866.
10.
Harris R, Nicoll AD, Adair PM, Pine CM: Risk factors in young children: a systematic review of the literature. Community Dent Health 2004;21:71-85.
11.
Jaddoe VW, van Duijn CM, Franco OH, van der Heijden AJ, van Iizendoorn MH, de Jongste JC, van der Lugt A, Mackenbach JP, Moll HA, Raat H, Rivadeneira F, Steegers EA, Tiemeier H, Uitterlinden AG, Verhulst FC, Hofman A: The Generation R Study: design and cohort update 2012. Eur J Epidemiol 2012;27:739-756.
12.
Johansson I, Holgerson PL, Kressin NR, Nunn ME, Tanner AC: Snacking habits and caries in young children. Caries Res 2010;44:421-430.
13.
Khanolkar AR, Wedrén S, Essén B, Sparén P, Koupil I: Preterm and postterm birth in immigrant- and Swedish-born parents: a population register-based study. Eur J Epidemiol 2015;30:435-447.
14.
Kumar S, Tadakamadla J, Johnson NW: Effect of toothbrushing frequency on incidence and increment of dental caries: a systematic review and meta-analysis. J Dent Res 2016, Epub ahead of print.
15.
Landis JR, Koch GG: An application of hierarchical kappa-type statistics in the assessment of majority agreement among multiple observers. Biometrics 1977;33:363-374.
16.
Marmot M, Allen J, Bell R, Bloomer E, Goldblatt P; Divide Consortium for the European Review of Social Determinants of Health and the Health Divide: WHO European review of social determinants of health and the health divide. Lancet 2012;380:1011-1029.
17.
Marthaler TM: Changes in dental caries 1953-2003. Caries Res 2004;38:173-181.
18.
Martins-Júnior PA, Vieira-Andrade RG, Corrêa-Faria P, Oliveira-Ferreira F, Marques LS, Ramos-Jorge ML: Impact of early childhood caries on the oral health-related quality of life of preschool children and their parents. Caries Res 2013;47:211-218.
19.
Matsuo G, Rozier RG, Kranz AM: Dental caries: racial and ethnic disparities among North Carolina kindergarten students. Am J Public Health 2015;105:2503-2509.
20.
Mehta NK, Lee H, Ylitalo KR: Child health in the United States: recent trends in racial/ethnic disparities. Soc Sci Med 2013;95:6-15.
21.
Morrison J, Laurie CC, Marazita ML, Sanders AE, Offenbacher S, Salazar CR, Conomos MP, Thornton T, Jain D, Laurie CA, Kerr KF, Papanicolaou G, Taylor K, Kaste LM, Beck JD, Shaffer JR: Genome-wide association study of dental caries in the Hispanic Communities Health Study/Study of Latinos (HCHS/SOL). Hum Mol Genet 2016;25:807-816.
22.
Peres MA, Sheiham A, Liu P, Demarco FF, Silva AE, Assunção MC, Menezes AM, Barros FC, Peres KG: Sugar Consumption and Changes in Dental Caries from Childhood to Adolescence. J Dent Res 2016;95:388-394.
23.
Pulache J, Abanto J, Oliveira LB, Bönecker M, Porras JC: Exploring the association between oral health problems and oral health-related quality of life in Peruvian 11- to 14-year-old children. Int J Paediatr Dent 2016;26:81-90.
24.
Rugg-Gunn A: Dental caries: strategies to control this preventable disease. Acta Med Acad 2013;42:117-130.
25.
Schou L, Wight C: Does dental health education affect inequalities in dental health? Community Dent Health 1994;11:97-100.
26.
Schuller AA, van Kempen IPF, Poorterman JHG, Verrips GHW: Kies voor tanden: Een onderzoek naar mondgezondheid en preventief tandheelkundig gedrag van jeugdigen. http://www.tno.nl/media/1167/kiesvoortanden_tnols2013r10056.pdf.
27.
Schuller AA, van Dommelen P, Poorterman JH: Trends in oral health in young people in the Netherlands over the past 20 years: a study in a changing context. Community Dent Oral Epidemiol 2014;42:178-184.
28.
Schwendicke F, Dörfer CE, Schlattmann P, Foster Page L, Thomson WM, Paris S: Socioeconomic inequality and caries: a systematic review and meta-analysis. J Dent Res 2015;94:10-18.
29.
Sohn W, Burt BA, Sowers MR: Carbonated soft drinks and dental caries in the primary dentition. J Dent Res 2006;85:262-266.
30.
Stecksén-Blicks C, Hasslöf P, Kieri C, Widman K: Caries and background factors in Swedish 4-year-old children with special reference to immigrant status. Acta Odontol Scand 2014;72:852-858.
31.
Sterne JA, White IR, Carlin JB, Spratt M, Royston P, Kenward MG, Wood AM, Carpenter JR: Multiple imputation for missing data in epidemiological and clinical research: potential and pitfalls. BMJ 2009;338:b2393.
32.
Truin GJ, Frencken JE, Mulder J, Kootwijk AJ, de Jong E: Prevalentie van tandcariës en tanderosie bij Haagse schoolkinderen in de periode 1996-2005. Ned Tijdschr Tandheelkd 2007;114:335-342.
33.
Truin GJ, Schuller AA, Poorterman JHG, Mulder J: Trends in de prevalentie van cariës bij de 6- en 12-jarige jeugd in Nederland. Ned Tijdschr Tandheelkd 2010;117:143-147.
34.
Vanobbergen J, Martens L, Lesaffre E, Bogaerts K, Declerck D: Assessing risk indicators for dental caries in the primary dentition. Community Dent Oral Epidemiol 2001;29:424-434.
35.
Verrips GH, Kalsbeek H, Eijkman MA: Ethnicity and maternal education as risk indicators for dental caries, and the role of dental behavior. Community Dent Oral Epidemiol 1993;21:209-214.
36.
Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP: Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ 2007;335:806-808.
37.
Wang X, Willing MC, Marazita ML, Wendell S, Warren JJ, Broffitt B, Smith B, Busch T, Lidral AC, Levy SM: Genetic and environmental factors associated with dental caries in children: the Iowa Fluoride Study. Caries Res 2012;46:177-184.
38.
Werneck RI, Lázaro FP, Cobat A, Grant AV, Xavier MB, Abel L, Alcaïs A, Trevilatto PC, Mira MT: A major gene effect controls resistance to caries. J Dent Res 2011;90:735-739.
39.
Wigen TI, Wang NJ: Caries and background factors in Norwegian and immigrant 5-year-old children. Community Dent Oral Epidemiol 2010;38:19-28.
40.
World Health Organization: Fact sheet No 318: oral health. 2015. http://www.who.int/mediacentre/factsheets/fs318/en/.
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