Influence of an oral health promotion program on the evolution of dental status in New Caledonia: A focus on health inequities.

Abstract

New Caledonia is a sui generis collectivity of overseas France situated in the south Pacific Ocean. Geographical and social inequalities are superimposed on ethnic disparities with high prevalence of chronic diseases such as oral diseases. In 2012, the health agency has evaluated the children's health status. Then, an oral health promotion program was developed in 2014. Another study was conducted in 2019 in New Caledonia to appreciate the evolution of children's oral health. A sample of 488 9-years-old children was randomly selected. Dental status was clinically recorded, families and children answered questionnaires about oral health determinants. The methodology (sampling, study variables…) was similar to the one used in the 2012 study. Multivariate mixed-models were conducted to compare 2012 and 2019 dental status and to explore the determinants of caries experience in 2019. Results indicated that caries prevalence and experience decreased between 2012 and 2019, with nonetheless various trends depending on the province or type of indexes. The number of carious lesions (d3t + D3T) in 2019 was used as an outcome variable in four models. Model 1 integrated social variables; ethnicity was found to be the only significant determinant. Model 2 was related to oral health care; participation in the program & and access to oral health care was found to be significant. For oral health behaviours (model 3), tooth brushing frequency and consumption of sugary snacks were significant risk factors. In a final model with significant variables from the previous models, ethnicity, accessibility of oral health care, number of sealed molars, consumption of sugary snacks remained explanatory factors. Five years after the implementation of the oral health promotion program, positive changes in oral health have been observed. However, health equity is still an issue with varying health status depending on ethnicity, behavioural factors and accessibility to oral health care.