May 16th 2016

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Risk determinants of dental caries and oral hygiene
status in 3-15 year-old recent immigrant and refugee
children in Saskatchewan, Canada: A Baseline Study.
J. Hoover, H. Vatenparast*, G. Uswak
College of Dentistry
*College of Pharmacy & Nutrition

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Purpose
 identify the risk determinants of caries and record oral
hygiene status in recent immigrant and refugee
children residing in Saskatoon and Regina,
Saskatchewan, Canada

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Background
 Recent immigrants & refugees at risk for oral diseases
 Face access to care barriers
a) Language barriers
b) Lack of dental benefits
c) Difficulty in paying out-of-pocket
d) Variability in oral health KAP
 Lack of published data
 Desire to fill knowledge gaps & inform policy decisions

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Methods
 Convenience samples:
a) 3-15 year-old recent immigrant and refugee children (n=
133)
b) adult guardians (n=86)
c) All arrived in Canada within last 7 years
d) Participants part of larger study Healthy Immigrant Children
Research study
• assessed general health, nutrition, socioeconomic and food
security status

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Methods
 Clinical examination of children
 2 calibrated examiners(one in each locale)
 portable dental unit, dental mirror & explorer

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Methods
 dmft/DMFT calculated excluding second molars
 Simplified Oral Hygiene Index (debris & calculus)
 +/- gingivitis
 Treatment needs:
a) urgent treatment for pain/infection
b) Extractions
c) Restorations
d) Orthodontics
e) OHI & periodontal therapy

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Methods – Survey Instrument
 All adults accompanying children completed a
questionnaire aimed at:
a) oral health KAP
b) perceived oral health status
c) perceived barriers to oral care in Saskatchewan
 face–to-face interview with trained interpreters
 Approval from U of S Behavioral Research Ethics Board
University of Saskatchewan

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Methods - Analysis
 descriptive analysis SPSS 20.0 & SAS 9.3
 regression analysis
 Immigrant/refugee - Independent t-test & Mann-
Whitney U Tests, (continuous variables)
 Chi Square test & Fisher's Exact Tests (categorical
variables), as applicable for categorical variables
 outcome of interest for logistic regression was
presence/absence of at least one carious tooth

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Results
 Refugee children had statistically significant higher DMFT
scores than immigrant children (p<0.001)
a) Refugee mean dmft/DMFT score 5.80±4.24
b) Immigrant mean dmft/DMFT score 3.52±3.78
c) Significant difference only in f/F between populations
d) mean score of 0.48 ±1.52 (immigrant) and 1.55±2.36
(refugees) p<0.001
 Significantly higher than dmft/DMFT scores for Canadian
children

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Results – Treatment Needs
Need Immigrants Refugees p-value
Urgent (pain/infection) 3 (6.8%) 4 (4.5%) 0.68*
Extraction or surgery 3 (6.8%) 10 (11.2%) 0.54*
Restorations 24 (54.5%) 51 (57.3%) 0.76**
Plaque Control Instruction 42 (95.5%) 81 (91%) 0.50*
Scaling and root planning 20 (45.5%) 41 (46.1%) 0.95**
Orthodontic Treatment 15 (34.1%) 35 (39.3%) 0.56**
*-Fisher's Exact test **-Pearson's chi-square test

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Results
 Significant differences between adult immigrants vs.
refugees & adult immigrants had:
a) significantly higher proficiency in English language
b) More knowledge about oral health
• Brushing after meals (p<0.009)
• Causes of tooth decay (p<0.002)
• Benefits of fluoride (p<0.001)
• Knowledge of plaque (p<0.003) components like fluoride and
dental floss compared to refugee adults.

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Summary
 Refugee children > immigrant children re: disease
 Immigrants/refugee children > oral disease experience
& treatment needs than Canadians
 in line with other at-risk population groups
 Other priorities take precedent over dental care & lack
of financial resources becomes barrier when seeking
care
 Language is key barrier (p<0.0001)
 Need to link immigrants/refugees with resources

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Limitations
 Convenience sample
 Small sample size