A model for oral health gradients in children: using structural equation modeling.

Detecting the underlying socioeconomic and behavioral determinants is essential for reducing oral health disparities in children. OBJECTIVE To test a conceptual model in children to explore the interaction amongst social, environmental, behavioral factors and oral health outcomes. METHODS This analytic cross-sectional study was performed in 2014-2015 in Shiraz, Iran. The sampling was conducted using a multistage stratified design to represent the whole 6-year-olds in Shiraz County. Participants were 830, 6-year-old first grade primary schoolchildren and their parents. Children were examined to register decayed, missing and filled teeth (dmft) and simplified oral hygiene index (OHI-S). Parents were asked for data on socio-cultural risk factors, oral health behaviors and children's oral health related quality of life (C-OHRQoL). Data on environmental risk factors were collected from several sources. The proposed model, a development of Peterson's, was tested using structural equation modeling (SEM). RESULTS The tested model could empirically demonstrate the wide range of social and behavioral factors affecting C-OHRQoL. Socioeconomic status (SES) affected the OHRQoL of children through several pathways. Tooth brushing frequency, use of oral health services and consuming cariogenic foods were the mediators, through which SES affected dmft and subsequently C-OHRQoL. CONCLUSIONS Using the modified Petersen's model and SEM, the paths in which different distal and proximal factors affect oral health outcomes in children could be clearly identified. It showed that addressing the underlying social, economic and behavioral determinants is essential for reducing oral health disparities among Iranian children.