Mean DMFT/S Among School Attending 12-year-olds Residing in Puerto Rico: Academic Years and K. Ramirez 1, S. Rivas-Tumanyan 2, W.J. Psoter 3, E. Santiago 2, A. Elias 2 ( 1 ) University of Costa Rica, San Jose, CR ( 2 ) University of Puerto Rico School of Dental Medicine, San Juan, PR ( 3 ) New York University College of Dentistry, New York, USA

Specific Aims  Assess mean DMFT/S among school attending 12-year-olds residing in Puerto Rico during academic year  Compare the mean DMFT/S among school attending 12-year-olds residing in Puerto Rico during academic year with mean DMFT/S reported in the academic year

Timetable of Health Reform Implementation and Data Collection Health Reform Implemented Health Reform Implemented School Survey Data Collection Health Reform Completed Health Reform Completed School Survey Data Collection

Puerto Rico Health Reform*  Contracted private insurance companies  Increased provider’s service network  Access to medical and dental services to medically indigent population (approximately 40% of PR**)  Establishes basic minimal coverage for dental services *Law #72 of September 7, 1993, Government of Puerto Rico **Puerto Rico Community Surveys, 2009

Health Reform Dental Coverage: Levels of Prevention PrimarySecondaryTertiary Health Disease (miSalud, 2012; Harris et al., 2009)

Study Design Cross-sectional Diagnostic criteria Oral Health Surveys of the National Institute of Dental Research Diagnostic Criteria and Procedures Sample - Probabilistic - Stratified by clusters  11 regions  types of schools  grade profile  socioeconomic status (school poverty levels and tuition cost)  urban or rural - n=74 schools - 12-year-old-school attendants (n=1,435); (N=71,358) - Probabilistic - Stratified by clusters  11 regions  types of schools  gender  socioeconomic status (school poverty levels and tuition cost) - n=133 schools - 12-year-old-school attendants (n=1,550); (N=53,198) Selection of schools Probability: proportional to size Selection of participants  Approximately 25 children in each school  Quota sample balance by gender  Approximately 20 children in each school (10 boys and 10 girls)  Randomized selection from student lists Comparison of Methodologies

ExaminerIntraInterExaminerIntraInter Intra and Inter Weighted Kappa Statistic for DMFS and

Schools Selected by Health Reform Regions

Results

Mean DMFT Index Among School Attending 12-year-olds Residing in Puerto Rico

Mean DMFT Index and 95% Confidence Interval by School Type* and Puerto Rico *Proxy for SES

Mean DMFS Index Among School Attending 12-year-olds Residing in Puerto Rico

Comparison: DMFS Puerto Rico ( ) Filled % 50% (48%-52%) D M F DMFS 42% (41%-43%) 8% (7.96%-8.04%) 3% 32% Δ%Δ% CI 95% 35% 24% 63% 28% CI 95% (29%-35%) ( ) (1.1%-2.2%) (61%-67%) Missing Decayed Missing Filled

Mean DMFS Index and 95% Confidence Interval by School Type* and Puerto Rico *Proxy for SES Public Private PR Public Private PR PublicPrivatePRPublicPrivatePR Upper Mean Lower

DISCUSSION: PR-USA Mean DMFT/S PopulationAgeYearDMFT/S Fluoride Program PR 12 years old (1) / /4.2 None USA 12 to 15 years old (2) (2) 2.1/ /2.8 Water (64.3%) (3) ( 1) Elias 2003; (2) CDC 2005, (3) CDC 2008

Conclusions  Mean DMFT/S Indices decreased in Puerto Rico from 1997 to 2011  Mean DMFT/S Indices are higher in Puerto Rico than USA  A health disparity between public and private school attending children persists

Recommendation  Additional analysis are needed taking in consideration secular changes, in order to measure the impact of the health reform

Acknowledgements  Dr. Ottón Fernández, Director Graduate Programs School of Dentistry, University of Costa Rica  Dr. Estela Estapé, Post-Doctoral Master of Science in Clinical Research Program, University of Puerto Rico  Partially funded by NIH S21MD and,  Colgate-Palmolive Company

Comparison of PR and other Racial Groups in the USA PopulationAgeRace/EthnicityYearDMFS/T PR 12 years old Hispanic (1) / /2.7 USA (2) 6 to 19 years old Mexican American Black Non-Hispanic White Non-Hispanic / / /1.6 ( 1) Elias 2003; (2) CDC 2005