Residence- and parental education-related social inequalities in early childhood caries: cross-sectional national Lithuanian oral health survey

Abstract Background Early childhood caries (ECC) is a highly prevalent public health problem impacting children under the age of six. The study assessed the prevalence and experience of ECC among 3- and 5-year-olds in Lithuania and investigated residence- and parental education-related social inequalities. Methods This cross-sectional study used the National Lithuanian Oral Health Survey (2017–2019) data. Parents and their 3- and 5-year-olds attending kindergartens from the five largest Lithuania’s cities and randomly selected 10 peri-urban/rural areas were invited to participate. Children’s caries experience (decayed, missing, filled teeth [d 3 mft]; [d 3 t]; [mt]; [ft] indices) and oral hygiene status (Silness-Löe index) were recorded. The World Health Organization Oral Health Questionnaire for Adults was used to collect data about family’s residence (urban, peri-urban, rural) and parental education (secondary or lower, college, university). Information regarding fluoride concentration in community water was retrieved directly from the water suppliers. The analytical strategy was based on the WHO conceptual framework for action on the social determinants of health. Negative binomial regression analyses were used. Results In total, 445 3- and 5-year-olds (227, 51.0% girls) participated in the study. The prevalence of ECC among the 3-year-olds and 5-year-olds was 30.9% and 66.9%, respectively. Mean (SD) d 3 mft score was 2.0 (3.6) among the 3-year-olds and 3.4 (3.7) among the 5-year-olds. Compared with urban residence, rural and peri-urban residence were associated with higher mean d 3 mft (RM 1.73, 95% CI 1.22–2.45; and RM 1.60, 95% CI 1.21–2.13, respectively) and higher mean d 3 t scores (RM 2.15, 95% CI 1.50–3.08; and RM 1.63, 95% CI 1.20–2.21, respectively). Mean mt scores were approximately 2.7 times higher of children whose parents had secondary or lower (RM 2.71, CI 95% 1.32–5.58) or college (RM 2.90, CI 95% 1.47–5.74) education as compared to the ones with university education. Analyses stratified by parental education indicated that higher ECC experience was observed in 3- and 5-year-olds whose parents had secondary or lower education and resided in rural or peri-urban areas. Conclusions The prevalence and experience of ECC among 3- and 5-year-olds was high. Secondary or lower parental education and residence in rural or peri-urban areas resulted in higher rates of overall ECC experience and untreated caries. Parental education-related inequalities were observed in treatment experience. The study suggests the need for the implementation of oral health-promoting programs targeting preschoolers in Lithuania with focus on reducing inequalities.