Socioeconomic indicators and traumatic dental injury.

DATA SOURCES: PubMed, ISI, LILACS, Cochrane Library and Embase databases were searched.

STUDY SELECTION: Epidemiological studies (cross-sectional, case-control, cohort clinical trials) addressing possible associations between socioeconomic indicators (eg mother's schooling, household income, number of children, type of school) and traumatic dental injury in the primary dentition were considered.

DATA EXTRACTION AND SYNTHESIS: Two reviewers independently selected studies. with study quality being assessed using the Newcastle-Ottawa Scale (NOS). Data were extracted for categorical variables considered risk factors for TDI and recorded based on the distribution and frequency of TDI among children exposed to risk factors vs the frequency among children not exposed to risk factors. Meta-analysis was undertaken.

RESULTS: Sixteen studies (15 cross-sectional studies and one cohort study) were included. A wide range of socioeconomic indicators were investigated including; parents' schooling, parents' employment status, home ownership, having changed address in the previous year, income, family structure, number of residents in the home, number of children in the family, type of school and socioeconomic status. Children from families with household income less than two times average salary (US$ 592) (OR: 0.77; 95% CI: 0.66-0.90) or more than three times the average salary (US$ 888) (OR: 0.76; 95% CI: 0.65-0.89) had a significantly lower chance of having TDI in the primary dentition. TDI was not associated with socioeconomic status (high vs low - OR: 0.77; 95% CI: 0.43-1.36; high vs medium - OR: 1.03; 95% CI: 0.72-1.48; medium vs low - OR: 0.70; 95% CI: 0.42-1.19), house ownership (owned vs rented - OR: 1.28; 95% CI: 0.98-1.66), mother's schooling (OR: 0.89; 95% CI: 0.74-1.08), or father's schooling (OR: 1.01; 95% CI: 0.62-2.74).

CONCLUSIONS: The scientific evidence demonstrates that socioeconomic indicators are not associated with TDI in the primary dentition. The evidence of an association between a low income and TDI is weak. In general, studies had low risk of bias. Further prospective cohort studies are needed to confirm this association.