Detroit Center for Research on Oral Health Disparities

This project is a community-focused multi-level research project that aimed to understand why some children and their caregivers develop dental caries and others do not even when they live in the same communities and experience the same social environments. The research project focused on evaluating the determinants of progression of caries. A representative sample of 1021 low-income children (0-5 years) and their caregivers was selected from low-income census tracts in Detroit and followed up for 4 years. Analysis of the longitudinal data identified several important risk factors associated with dental caries experience. Positive psychosocial determinants, such as maternal oral health self-efficacy and knowledge, mother's brushing frequency, social support, family income, and dental insurance coverage were associated with greater brushing frequency and better oral health in the children. Negative factors such as fatalistic oral health beliefs and feelings of parental stress were related to poorer oral health in these children. These mothers unfortunately experience high rates of depressive symptoms. Household food insufficiency, deteriorated housing, and frequent experiences of discrimination increase the likelihood of reporting depressive symptoms whereas social support was protective. In an accompanying project, we found that the current Medicaid dental policy promote practice patterns that do not promote oral health. These findings illustrate the complex factors that contribute to the intra-community variation in dental caries experience. The reduction in dental disparities will not be simple and requires multi-level and multi-determinant interventions. Simple preventive procedures may assist in preventing caries but not in promoting oral health in the long-term.