Published online August 31, 2007
PEDIATRICS Vol. 120 No. 3 September 2007, pp. e510-e520 (doi:10.1542/peds.2006-3084)
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ARTICLE

Influences on Children's Oral Health: A Conceptual Model

Susan A. Fisher-Owens, MD, MPHa, Stuart A. Gansky, DrPHb, Larry J. Platt, MDc, Jane A. Weintraub, DDS, MPHb, Mah-J Soobader, PhDd, Matthew D. Bramlett, PhDe and Paul W. Newacheck, DrPHa,c

a Department of Pediatrics
c Institute of Health Policy, School of Medicine
b Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California, San Francisco, California
d Statworks, Boston, Massachusetts
e National Center for Health Statistics, Hyattsville, Maryland

OBJECTIVES. Despite marked improvements over the past century, oral health in America is a significant problem: caries is the most common chronic disease of childhood. Much oral health research examines influences primarily in the oral cavity or focuses on a limited number of individual-level factors. The purpose of this article was to present a more encompassing conceptual model of the influences on children's oral health.

METHODS. The conceptual model presented here was derived from the population health and social epidemiology fields, which have moved toward multilevel, holistic approaches to analyze the complex and interactive causes of children's health problems. It is based on a comprehensive review of major population and oral health literatures.

RESULTS. A multilevel conceptual model is described, with the individual, family, and community levels of influence on oral health outcomes. This model incorporates the 5 key domains of determinants of health as identified in the population health literature: genetic and biological factors, the social environment, the physical environment, health behaviors, and dental and medical care. The model recognizes the presence of a complex interplay of causal factors. Last, the model incorporates the aspect of time, recognizing the evolution of oral health diseases (eg, caries) and influences on the child-host over time.

CONCLUSIONS. This conceptual model represents a starting point for thinking about children's oral health. The model incorporates many of the important breakthroughs by social epidemiologists over the past 25 years by including a broad range of genetic, social, and environmental risk factors; multiple pathways by which they operate; a time dimension; the notion of differential susceptibility and resilience; and a multilevel approach. The study of children's oral health from a global perspective remains largely in its infancy and is poised for additional development. This work can help inform how best to approach and improve children's oral health.

Key Words: oral health • population health • pediatrics

Abbreviations: DMFT—decayed, missing, or filled permanent teeth

Accepted Mar 2, 2007.


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